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.).
Dorothy Bourdon - Attica, Michigan
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:
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:
Do everything you can to get your child to relax before the blood draw. It is much easier to get the stick if both the child and the lab tech are relaxed:
Make friends with the lab technicians! This one is important!!! Lab technicians dread aggressive parents. Having to deal with aggressive parents makes them tense and they miss more often.
There is also a topical anesthetic called EMLA cream that will numb the skin and make the needle stick more comfortable. It must be applied one to two hours before the procedure. Ela-Max is a similar cream that requires less time to work. However, EMLA and Ela-Max are not routinely used for blood draws and can add to a child’s anxiety, because he or she may begin to think about (and often dread) the experience during the preparation period.
Frequent blood draws can become a major emotional issue for children. If your child is already “deathly” afraid of needles or if he or she comes to that point, you may want to seek the help of professionals. Most children’s hospitals have a Child Life department with trained specialists. These departments often offer classes for patients and may be able to facilitate participation for out-patients as well. If they are not, they will be able to recommend psychologists in your area who can help your child work through his or her fears.
I know how difficult it is to watch someone you love very much go through a long illness that requires frequent needle sticks. I also know that your child is not the only one who experiences fear and pain with each stick. Dorothy, I know this whole experience is very difficult for you, too. In some ways, it would be easier for you to be sick yourself, instead of your child. What you are going through is heroic, and I’m proud of you, too.