I'm the parent of a 2 year old child with biliary atresia. Kids with liver disease are subjected to frequent blood draws. Do you have any tips for parents on how to make them as bearable as possible? In the lab at my child's last appointment I heard a mother telling her 3 year old daughter "Now what did I tell you? We're not going to McDonald's if you start crying!" The lab technician was trying to comfort the child, telling her at the same time "It's okay to cry, we know this hurts." It was very sad to watch. Also, do you have advice for parents on when and how to get assertive in the lab when things aren't going well, (i.e. how many tries should we allow before we stand up and say "Get another technician" etc.).

The amount of information that can be gleaned from a small amount of blood is truly amazing. This information can literally make the difference between life and death. Unfortunately, for many children, their fear of the needle stick required to obtain that small amount of blood is greater than their fear of death itself.

The first step in making blood draws (and other needle sticks) more bearable for your child is to put yourself in your child's place. Obviously, Dorothy, you already do this, but the mother who threatened to skip McDonald's if her little girl didn't stop crying wasn't able to feel the fear and pain her daughter was experiencing.

A child's degree of needle fear changes at different developmental stages. And each individual child's fear is affected by his or her past experiences. Most children who require frequent blood draws will inevitably have a bad experience -- a technician misses the vein, digs to find it, then the child begins to cry and tries to escape from the pain, the technician tries harder, etc. Finally someone gets the needed blood and the child is no longer tormented, but the terror of the experience goes with the child. The next time someone attempts to draw blood from the child, the whole experience is revisited, bringing tension into every muscle of his or her body.

In general, it is much more difficult to draw blood from children than from adults, due to the relative size of their veins. Unlike children, most adults can reason with their fears. As adults, we can understand the need for the tests our doctors recommend. We may not be able to completely divorce ourselves from negative past experiences, but we can tell ourselves that it probably won't be as bad this time as it was last time. We know that if it is not going well we can demand a different technician, and as a last resort, we can get up and walk out. That level of control makes the experience far more manageable for adults than for children. At most developmental stages, most children don't have the ability to reason with their fears. As children, they can't demand better service, and they feel powerless to change the course of events.

As parents, we not only have power over our own medical care, but also over that of our children. As your child's guardian, there are several things you can do to make the experience better for them:

• Mirror your child's emotions back to him or her. If your child begins to act out before you even get to the lab, stop and talk about how he or she is feeling. You might begin by saying, "You are acting as if you are angry." Usually a child will respond to these kinds of statements with something like, "Yeah, I'm mad." You can keep the conversation focused by drawing out further emotions: "It really doesn't seem fair, does it?" "No. Why do I have to always get stuck?!"
• Let your child know that you accept his or her emotions. Don't say something like, "Now it's time to be a big girl." Instead say, "I understand why you are angry."

Get your child involved in a solution -- "Since we've got to get this blood test, how can we work together to make it as easy as possible?" Even very young children can brainstorm, and when they are involved in coming up with a solution, they try harder to make it work. Here are some things you might suggest during the brainstorming session:

• Your child could sit on your lap during the blood draw.
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