PKU test - Page 2

[Comtessa]

Originally Posted by *MamaJen*

You could ask your pediatrician if they do the test. They'd probably be okay with you holding or nursing the babe while they do it. And tell them to warm up the heel -- it makes it a lot easier.

This might vary by state, but my MW's told me that most pediatricians don't/can't offer this test. I don't remember why, though I'm sure they told me. However, in some states you can get a test kit for free from the state or county government - or your midwife can. They charge for it in the hospital.

I had to do some serious bullying of the nursery nurse in the hospital about this test. She first insisted that the test had to be done in the nursery because "all our equipment is there." I raised my eyebrows and said, "I believe the 'equipment' for a PKU test is a needle and a card. Are you honestly telling me that those two items are not portable?" She stormed out, came back with the needle and card, then insisted that the baby had to be in her bassinet, unswaddled, and flat on her back in order to do the heel prick. I asked nicely for an explanation of the medical necessity for this, and she said, exasperated, "because you have to put her down sometime!" So I just fixed her with a steady glare and said, "I'm sure that's true. However, 'sometime' does not have to be the first time anyone sticks my newborn with a needle. If there is no medical reason to do otherwise, I'm going to ask you to attempt to prick her heel while I'm holding her." She huffed in frustration and said, "I'll try." (She's lucky I didn't throw her out and say, "go find someone competent enough to do it without 'trying.'")

All of this is to say, just because they do hold the poor child down on a table in a separate room to get the heel prick, doesn't mean there's any particularly good reason to do so. Fight them on it, if you have to, until they give in. You have the information, and the right!

[crunchy_mama]

We took our babe to the ped afterward for the PKU. For me I certainly don't enjoy my baby getting pricked, but honestly neither one has shown much if any discomfort- plus it tests for so many things.

[ColoradoMama]

I've had five babies, and all of them have had the PKU test. With my first, it was horrible. I wish I had researched it ahead of time because 1) I would have refused the test at two days and waited until 1 or 2 weeks, and 2) I would have made them do it properly. They held her foot while they pricked her and then squeezed the heck out of her foot while she screamed and I cried. With #2 (and #3, #4, and #5), a very warm, wet washcloth was wrapped around their foot and leg for several minutes (which draws the blood to their foot and makes them bleed easier), then they were pricked. Not a tear from any of the four - #3 slept through it. #4 and #5 nursed through it, and they were fine. Like others have said, insist on holding and/or nursing your little one during the test, and don't let them do it without first warming the leg and foot with a very warm, wet wash cloth. It makes a HUGE difference.

[JenniferLS]

I can see from most of the posts on this thread, that most of you do value the PKU test...I appreciate that so much, because for my first two children, I was never really explained the seriousness of this test, and the only time i started to question was when my daughter was born, they required two PKU tests, and that made me so mad! (especially since this wasn't required for my first, so I couldn't understand the medical difference and the only explanation I got was that the state required it...not good enough for me, of course). But now I'm understanding a lot more and THANK YOU!

I'm wondering if I could somehow convince my midwife to do it...OR...if this is a stick test like for glucose or something...couldn't we draw the blood ourselves, at home? and then take it to a lab? I mean how would that be different from the midwife doing it and taking it to a lab...I guess that's my question.

Another thing, our pediatrician usually just uses the hospital lab that they are connected with. If that lab tech won't let me hold the baby, and won't warm up the foot, be as gentle as possible, etc...what should my options be? Should I just leave and say, well, I'll find someone else to do it? Or do I just suck it up and watch my baby suffer through it?

[nashvillemidwife]

It actually takes quite a bit of skill to do it right, I don't think it's something you can learn nor you would want to do it on your baby. It requires much more blood than a glucose test. I think in most places it is 5 very large drops whereas the glucometers need barely anything. Then the blood has to be applied to the card in a particular way; if you get too much, too little, put it in the wrong place, scratch the paper, touch the heel to the paper... you will ruin the sample and have to repeat it. It's also not something you would want to "convince" your midwife to do if she doesn't know how. This is the reason a lot of doctor's offices don't do them - the nursing stuff doesn't have a lot of experience doing the test (since it's usually done in the hospital), and it can take a while to get the hang of it. This is also the reason that the nurses want to do it in the nursery; if you have no experience with getting the sample with baby in mom's arms it can make it very difficult if baby starts kicking and flailing. It could be argued that it's actually easier on the baby to let them take him or her to the nursery where they can do it efficiently as they're used to rather than having them bungle it up with the baby kicking his legs in mom's arms.

[wholisticmidwife]

Take your own heal warmer and tell them you will hold the baby on your shoulder while they do the test. This will make it faster because of gravity. make sure you nurse like crazy before the poke so she is well hydrated.

[ColoradoMama]

Originally Posted by JenniferLS

Another thing, our pediatrician usually just uses the hospital lab that they are connected with. If that lab tech won't let me hold the baby, and won't warm up the foot, be as gentle as possible, etc...what should my options be? Should I just leave and say, well, I'll find someone else to do it? Or do I just suck it up and watch my baby suffer through it?

I would stay calm but keep repeating, "I will hold my child during the procedure and you can perform the test after her leg and foot are warmed." They may try to bully you, but I would be willing to bet when you don't budge, they'll give in. Probably, they won't give you a hard time - I mean, I doubt they're going to want to make it a hard procedure for your baby.

[JenniferLS]

AWESOME advice from everyone! THANK YOU SO MUCH!!!

[MidwifeErika]

Originally Posted by JenniferLS

Another thing, our pediatrician usually just uses the hospital lab that they are connected with. If that lab tech won't let me hold the baby, and won't warm up the foot, be as gentle as possible, etc...what should my options be? Should I just leave and say, well, I'll find someone else to do it? Or do I just suck it up and watch my baby suffer through it?

You can warm the foot yourself on your way in with a rice sock or one of those hand warmers that hunters use. It doesn't matter right or left foot, so just pick one and warm it up. That way you don't even have to ask them to do that. And then just ask them if you can hold your baby. Overall, it is a quick test. I wouldn't argue much with the person doing the test about how they do it because if they have a hard time doing it then it will become a LONG test. However, you could ask for someone else to do it who might be able to help you in your way. For example, I cannot poke a baby in the correct spot if they are upright... they have to lay down and then the mom can pick up the baby after I poke the foot. If I were to try doing it the other way (and I have) I will get the position of the pokes all wrong and then the poor baby won't bleed and I will have to do it again rather than just getting it right the first time.

[nashvillemidwife]

Are there really people out there trying to poke babies without warming their heels first? That's the recommended way, included in every training I've ever been to. Only difference is that the hospitals and doctor's offices use special disposable heel warmers whereas I use a bowl of warm water or a diaper.

[JenniferLS]

when my first was born, he only had to have one PKU test in the hospital...speaking of which, I just HATE the fact that they never tell you about these things ahead of time. Honestly, the first i heard about it, was after they brought him to me with a big bandage on his foot...which still bled, by the way and was very irritating...believe it or not...it was the same foot with the ID band! So the ID band had blood on it! COME ON!

When my second was born...she had one done in the hospital...and then they required a second test a week later. That is the only test I'd ever witnessed, and no, they did NOT warm the heel...they did not hold the leg veritically (so as to draw more blood out quickly). They held my baby down and squeezed the begeezes out of her tiny little heel! Maybe i should just use a different lab next time!

[snowmom5]

Originally Posted by nashvillemidwife

Are there really people out there trying to poke babies without warming their heels first? That's the recommended way, included in every training I've ever been to. Only difference is that the hospitals and doctor's offices use special disposable heel warmers whereas I use a bowl of warm water or a diaper.

My ped's office uses a diaper.

[JenniferLS]

How does a diaper warm the heel? not being sarcastic, just curious!

[Peppamint]

They have a great lancet, called the NeatNick. One poke and you'll get all the blood you need (we have to fill 5 circles, which screens for over 40 disorders). We warm the baby's heel first and do it all in mom's arms.

[nashvillemidwife]

Originally Posted by JenniferLS

How does a diaper warm the heel? not being sarcastic, just curious!

It's doesn't, unless it's full of hot water.

[Catherine12]

Our midwives did the test themselves, a week after the birth. This sort of thing may vary from state to state (we are in Vermont). I really wish I had researched this more before my first birth too - because I only realized years later that my dd1 (my only hospital birth) had never been properly screened. They did the test too early, before she had had time to digest her first feedings properly. Fortunately, she is fine. But I feel like my mws knew a lot more about what they were doing than the hospital staff did! Plus, doing it at one week is so much easier on the baby.

If you follow all the suggestions about making sure baby is hydrated, warming the foot, and nursing through it the test is really not so unpleasant for the baby - one of mine didn't even cry.

[paxye]

We don't do the PKU heel test... but we do do the Urine test on day 21...


better and more precise results without any invasive treatments.

I am not sure though if the Urine test is available everywhere though.... but it would be a good alternative.

[mwherbs]

Originally Posted by paxye

We don't do the PKU heel test... but we do do the Urine test on day 21...


better and more precise results without any invasive treatments.

I am not sure though if the Urine test is available everywhere though.... but it would be a good alternative.

what about the other metabolic diseases? are they all screened for via urine? or are they only looking for PKU? years ago the Guthrie test was done to find a small number of metabolic/genetic disorders since that time things have changed and the newer methods allow for many other metabolic disorders to be looked for-
here is a web site you can reference-
http://genes-r-us.uthscsa.edu/

[paxye]

Originally Posted by mwherbs

what about the other metabolic diseases? are they all screened for via urine? or are they only looking for PKU? years ago the Guthrie test was done to find a small number of metabolic/genetic disorders since that time things have changed and the newer methods allow for many other metabolic disorders to be looked for-
here is a web site you can reference-
http://genes-r-us.uthscsa.edu/

The test is for a whole array of metabolic diseases. The result are best if taken at 21 days so we get everything to do the test and send it ourselves.

this urinary screening test was initiated in the Province of Quebec in the early seventies; it is one of the few programs that exist in the world. It allows the early detection of organic acid disorders, or other disorders which could have been missed by the blood tests done during the first week of life if the protein intake was insufficient to reveal a metabolic block.

http://atlasgeneticsoncology.org/Edu...ID30056ES.html

[eli's mama]

If you write to your state health department you can request a test kit. I don't know how it varies state to state. I'm in CT and they send them to you for free.
My midwife has us request one as part of the birth kit so it's here when we need it. She does it at about a week after birth I think. With my second they added extra tests so I had to have him stuck again, I was mad about that. I told the nurse I would hold him and though she was kind of like "oh, no one does that" she didn't really have an issue with it.
This is one prick I won't skip.