Comfort Promise: Anna's Story

Meet Anna

Fourteen-year-old Anna Beach has been through a lot in her young life. Hearing loss, cochlear implants, and complex health conditions have resulted in frequent visits to Children’s Mercy Kansas City and its clinics to get the care she’s needed.

But all that became even more complicated when Anna developed an extreme fear of the needles used to give vaccinations or draw blood for important lab tests.

“Anna was probably around 5 when the needle phobia began,” said her mom, Meghan Hinojosa. “She would become so anxious she wouldn’t even look at the doctor, and she couldn’t calm herself down enough to answer their questions. She was terrified someone was going to order labs and draw blood.”

As time went on, Anna’s needle phobia became worse and worse. “We began to dread routine doctor visits,” Meghan said. “If Anna needed labs drawn, what should be a simple visit, would end up taking two to three hours.”

Then Anna was referred to one of the multidisciplinary clinics at Children's Mercy. This type of clinic helps kids who would benefit from a team approach to their care. In Anna's case, in addition to a gastroenterologist and a urology nurse practitioner, the clinic includes a pediatric psychologist.

That’s where Christina Low Kapalu, PhD, child psychologist, first met Anna.

“Anna has a pretty complex medical history, and because of her extreme needle phobia, she hadn’t had lab work done for a while,” Dr. Low Kapalu explained. “We needed the information from those labs to determine what was causing her symptoms and to be sure her medical care was appropriate.”

When Meghan expressed her concerns, Dr. Low Kapalu promised to do all she could to support Anna and help her get the blood tests she needed.

“I use the Comfort Promise with my own kids, and I want every child to have access to the same pain management strategies that my children do,” Dr. Low Kapalu said. “We applied the principles of the Comfort Promise at Anna’s visit, but customized our interventions to meet her needs.”

The Comfort Promise is a new standard of care being implemented at Children’s Mercy because kids say that health care procedures, especially when they involve a needle or a poke, can be scary for them.

By giving children ways to cope during needle procedures, it can help them:

• Have a sense of control.
• Be part of their own care.
• Cope with future health care events.
• Have a better overall experience.

In Anna’s case, Dr. Low Kapalu suggested she try a topical anesthetic to relieve the pain, but Meghan was concerned that wouldn’t do anything to relieve her anxiety.

“We used distraction strategies to help Anna,” Dr. Low Kapalu said. “We asked Child Life for an iPad Anna could interact with, I engaged in conversation with her and we performed diaphragmatic breathing.”

A Long Walk …

But Dr. Low Kapalu went above and beyond by actually walking with Anna to the lab for her blood draw. “I called ahead to the lab and requested rapid rooming. We walked all the way from the Surgery Clinic to the lab, almost a 10-minute walk. When we arrived, they took her straight back for her procedure, which relieved Anna’s anxiety.”

“It’s a long walk from the Surgery Clinic to the lab,” Meghan said. "Dr. Low Kapalu took the time to personally escort her to the lab and talked with her throughout the entire process. She really understood Anna’s concerns.”

Throughout the procedure, Anna remained calm, was able to give consent, and even chose the seat she wanted to sit in for the blood draw and how she wanted to position her arm.

Thanks to the use of those strategies, Anna was able to get her blood drawn without experiencing extreme anxiety. With a successful procedure under her belt, Anna’s confidence improved, and so did her needle phobia.

“On a scale of 1 to 10, 10 being the worst needle phobia I’ve ever seen, Anna’s was probably a 9,” Dr. Low Kapalu said. “But this first successful exposure activity, which was getting her blood drawn, really reduced her needle phobia so she could continue to work on her anxiety in outpatient therapy.”

Today, all that’s changed. Recently, Anna went to her primary care provider and received a vaccination she had previously missed because of her anxiety, and she even had her ears pierced! That’s something Meghan said would have been unthinkable before meeting Dr. Low Kapalu.

“Anna is a totally different person,” Meghan said. “She will be a freshman in the Olathe School District and is considering a career in nursing so she can help other kids overcome some of the same issues she’s faced herself.”

“Anna is an insightful, unique, one-of-a-kind person and a joy to work with,” Dr. Low Kapalu said. “Being flexible and personalizing the Comfort Promise for Anna made a huge difference in the course of her medical care for life. It’s now possible for Anna to get the vaccinations and tests she needs to be healthy.”

“Dr. Low Kapalu has a gift with children,” Meghan added. “I’m not sure she realizes the profound impact she’s had on Anna’s life, but Anna has done remarkably well thanks to the excellent care she’s received at Children’s Mercy.”

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