Ways to make 12 month blood draw easier?

[1blueheron]

Hey mamas, wondering if any of you have tips on how to make the dreaded 12 month blood draw easier.  We're due for it next month.  DD does NOT like being restrained and has a long memory when it comes to stuff like this.  (I used a nosefrida on her in October and after that she didn't want anyone coming near her face for several months!)

I definitely want to get it done, since I have concerns re lead exposure, so I'm wondering if any of you have btdt and have tips/descriptions of the process.  (Oh, and she won't nurse in a novel environment - maybe after the procedure if she's upset but not before or during.)  Thanks mamas!

[crunchy_mommy]

Call a few labs and find one that has an experienced pediatric phlebotomist. I just went to our normal blood lab & I severely regret it -- the woman clearly had very little experience in drawing blood from such a young child. Also there is some kind of board, I don't remember what it's called, maybe a papoose board??? Someone recommended trying something like that if we ever had to get blood again because my DS freaked out & flailed all over the place (and not just in medical settings!)

Also tell them they have only one chance to stick her, and if they miss they need to stop immediately.

(DS's blood draw was incredibly traumatic, including multiple sticks & them digging around for a vein while I begged them to remove the needle, which they refused to do & I really should have reported it, it was that bad. He had bruising all over his arm. I didn't know about the above options & I really wish I did.)

Edited by crunchy_mommy - 1/13/11 at 6:09am

[pbjmama]

I would not use a papoose board. Only go to someone who is good, like pp said. If you get someone good you should be able to hold your child in your lap, hold down arms, tight but not crazy tight, and the draw should be over in less than a minute. 

[Courtney-Ostaff]

Why do they need to *draw* blood at all?  My pediatrician's office just used two quick heel sticks -- one for iron and one for blood.  

My 3-yr-old daughter had to have dental surgery in early December, and she is still not cool with anyone restraining her in any way.  I don't blame her -- I wouldn't want to be restrained either!  

If someone has to restrain your child, you should do it, if at all possible.  She trusts you, and so it lessens her fear by not having a stranger do it.

In terms of pain, literally a spoonful of sugar has been clinically proven to ease pain in little ones.  I guess Mary Poppins knew what she was talking about.  Maybe something sweet for her as a distraction?

Also, some Anbesol rubbed on the area would do superficial numbing. I know several moms who keep it in their purse for bee stings and the like.  

[EmmaJane]

I wish they didn't have to take so much blood for the lead testing... we live in an old house and get levels checked at every visit, and it's difficult. (Makes me realize how lucky we have to have two basically healthy children...)

Having an experienced child phlebotomist is the biggest thing, I think. They'll be better at actually hitting the vein, but also better at calming the child (and you!), and at guiding you on how to hold your daughter during the process. (And you should be holding her! We sit at a regular phlebotomy station, with her in my lap... that puts her high enough that her arm is up on the same shelf as it would be for an adult.)

One small issue: they usually use some of the stretchy rubber stuff wrapped around a pad to bandage up afterwards, that you're supposed to take off pretty soon afterwards. Once DD2 had long sleeves that covered it up, and I forgot it was there until I was changing her into pajamas that night- -- eeeeeeek! She was fine, but I felt awful...

[jtbuko]

My dd was very anemic as a toddler and had to have a lot of draws. Here's what we learned over the course of them:

hydrate well before hand (after a few rough blood draws I introduced straight juice for the first time)

use phlebotomist at/ near hospital, they are generally way better at getting vein the first time (better yet, ask folks in local moms group who they'd recommend)

don't stress yourself about it, cause baby can key off your emotion

if/ when you restrain you have to do a good job holding your child still so they can get vein

[tzs]

we also live in an old house and worry about lead....i'm so glad when i hear another parent taking it seriously and getting the test!

in any case, could you do a finger prick as sort of a prescreen? we do that first and if it comes back high then we go for a blood draw. they do the finger prick at our regular ped office. it's not so accurate but if there is any error it errs on the high side (because of residue on the skin) but at least you wouldn;t have to worry about a false negative and missing it. if it comes back as false high and then you get a normal result from a draw then you didn't go through any extra trouble than you were going to do anyway but you do have a chance of avoiding the draw if it comes back low.

for us, our first prick came back high and we went for a blood draw. we didn;t have a special pediatric phebotomist but the one we did have did a great job. i just held her on my lap and the technician showed me how to hold her arms down and it went very quickly. actually she didn't even cry (and she does for vaxes, for example.) i know people have had mixed experiences but they aren't all bad! (and the draw came back normal and did subsequent finger pricks!)

good luck!

[deditus]

I guess I have been lucky - dd has never had a problem with blood draws, but a finger stick - watch out! I nursed dd through a few and she didn't even notice. They took so many vials of blood at the ped gi to test for food allergies, CBC, celiac disease, thyroid, liver function, lead, etc, and she never made a peep.

[Addie]

 I was totally dreading getting DS's blood drawn, but it went really well. I agree with PPs suggestions of getting a good phlebotomist. We took DS to the lab at our children's hospital, and the phlebotomist was amazing. She showed DH how to hold DS so he didn't need to be in any restraints, and she found the vein in his chubby little arm immediately. He cried when the needle went in, but it went quickly and he was fine.

[cristeen]

It really depends on your kid.  I highly recommend calling and getting an appt (we walked in and waited over an hour).  Ask to be sure there's someone with experience doing ped venipuncture (how I wish I'd done this).  If your child is not the type to sit still and allow you to hold their arm, ask for an arm board.  I think a full papoose is overkill for most kids, but they should have a board that will keep the arm from bending.  And like the pp said - let them know they get one shot at it.

And make sure they have ped veni supplies on hand.  For whatever reason the phlebotomist we saw was using a straight needle instead of a butterfly, and it was not that small.  It might have been a childs size, but definitely not infant sized.  When he ripped the first needle out of his arm, they had to go searching to find another. 

And he would not have been able to rip it out of his arm if I hadn't been having to both hold him on my lap on a too-high chair (that I was sliding off of) and restrain both arms while holding one out straight.  That was just a bad set-up all around.  Make sure you're in a good position before letting them get near the kid with a needle.  If the situation is not a good fit, ask for a change (like a lower chair). 

Something good for you to know though - if your kid ever rips the needle out of their arm during a blood draw, reach up and release the cuff immediately.  The phlebotomist was more concerned with applying pressure than releasing the cuff - as long as the cuff is on he would have continued to spurt blood, pressure or no.  I had to reach up and release it before worrying about the blood getting everywhere because I knew better. 

[JBaxter]

4 kids and I've never been sent for a blood draw.  Our office does the finger stick for the iron level.  Ask why your office cant.   

[atlantafemme]

My son had to have a few blood draws and IVs in a childrens hospital when he was sick last year at 8 months. The first sticks were traumatic. I figured pediatric nurses would know what they were doing but my poor guy flailed and screamed so that 2 nurses had to hold him down as they went through both arms and both feet. My partner had to hold me down to keep me from punching the nurses... 

Anyway, on the second visit, a nurse applied a patch with numbing cream first and the stick went much easier. I guess they didn't use the numbing patch the first time b/c they felt it was an emergency and the patch takes about 20 minutes to kick in. I'd check around to see if you can find a blood draw place that will use the numbing patch, though your ped may have to prescribe it and let you apply it before the appt.

[cyanviolet]

I agree, you really don't need anything more then a heel stick to collect enough blood for the usual 12 mo tests. They were able to collect a couple of vials to do the iron and lead checks at our ped. Our little guy didn't even notice because he got to sit up/straddle on the arm rest and check out/mouth a fascinating plastic syringe while they collected the blood even though I told him what was going on. I never let him chew on plastic so he was totally fascinated with having a plastic syringe to check out. They hot packed his foot with a warm disposable diaper before hand and I made sure he was plenty hydrated. Staying calm yourself helps too!

Recap: go some place that does heel sticks, have them warm her foot up ahead of time, make sure she's hydrated and have something fascinating to play with while they collect the blood. Should be a walk in the park. If things don't go smoothly, try again a different day.

Good luck!

[IngaAnne]

Our ped did a finger prick for the 12month anemia and lead test. My son just sat there and watched the nurse squeeze his finger. We have had to get blood drawn for allergy tests at 8 and 17 months and that was a lot harder. At 8 months, we had to go see a pediatric nurse at the hospital since my son's arm and veins were so small. It's not an enjoyable experience, but there was just one stick and it was over quickly. My husband and I both go together for moral support (for each other and our son). My husband holds my son still during the procedure while I talk to, soothe, and distract him. The biggest trick to a smooth blood draw is really making sure whoever is holding the child has them pinned very well. It sounds mean, but it's safer for the child and lets them get the blood drawn more quickly. Generally, we have one person holding my son's body still (my husband), one person holding his arm still (nurse), one person taking the blood, plus me comforting him.

You first need to see if your doctor will do the prick instead of the needle draw. If you have to do the needle draw, just remain calm, bring your partner or a friend or other family member if YOU need support, and know it will be over quickly.

[1blueheron]

I'll ask about heel sticks/finger pricks, but I recall from my own childhood that a finger prick can take a while, and I think speed is going to be important for DD.  I'm going to call and have them talk me through the process before we go in, and DH will be going with me.  

I'm not a nervous person, I have no issue with needles or blood, and I know DH and I will be able to keep our cool when we're in there, but I also know DD and I have a feeling she will react poorly and (worse) remember the experience for a long time.  As I just posted in another thread, it takes two big strong adults just to get this little girl into pajamas!  People are always surprised at how strong she is.  

Thanks for all the great input.  I would not have thought about the hydration issue, but that makes so much sense when you're looking for a vein.  She never gets juice, so this may be a good time to break it out!  

[cyanviolet]

I think I can relate, I have a really squirmy, hates to be constrained little guy...it takes two of us to get him ready for bed also (that has gotten a little easier now that he's 19 mos...I call it the dawn of the age of reason). 

I think our heel stick for 2 vials was done in about 2-3 minutes. No matter what method, hydration is key, and so is warmth (which increases blood flow to the area). I am a hard stick due to a traumatic experience as a 2 year old (according to my mother) so I have to use all those tricks on myself too.

[crunchy_mommy]

Originally Posted by 1blueheron 

I'll ask about heel sticks/finger pricks, but I recall from my own childhood that a finger prick can take a while, and I think speed is going to be important for DD.  I'm going to call and have them talk me through the process before we go in, and DH will be going with me.  

I'm not a nervous person, I have no issue with needles or blood, and I know DH and I will be able to keep our cool when we're in there, but I also know DD and I have a feeling she will react poorly and (worse) remember the experience for a long time.  As I just posted in another thread, it takes two big strong adults just to get this little girl into pajamas!  People are always surprised at how strong she is.  

Yeah that sounds a lot like DS, which is why I suggested perhaps trying the papoose board (disclaimer: I've never seen or tried one on DS so I have no idea what it's actually like!) It was almost impossible for either me or DH to hold him still, he was just so strong, & I also can't imagine him being OK with the heel stick, he'd have freaked just having someone touch him that long -- I think the needle was less traumatic than a heel stick would have been for him.

Anyway... Good luck, let us know how it goes, hopefully it will be surprisingly quick & easy!! :)

[belltree]

I am so glad I found this thread. We had gone for a local lab to get the lead and iron test. And I should have just left right away, first they had know idea what the doctor ordered and were confused because he had written Pb2+ and Ferretin and thought that must be something really rare to test for, and then they insisted that these tests cannot ever be done as a heel or finger prick, although the doctor had clearly specified that this would be alright. They just seemed so clueless about what they were supposed to do, and noone seemed to listen to what I had to say. I am never going back there again.

[LCBMAX]

One more tip to add to all of the above - put a warm wet compress on the area (usually the inside of the elbow) for about 15 minutes before the draw to bring more blood to the area.

One reassurance - we had a decent, but not perfect, blood draw at 15 months I think (2 sticks), and now at nearly 3 years, he still remembers the name of the phlebotomist and she figures heavily in our fantasy play about nice doctors. He does pretend shots and blood draws all the time, is developing a very nice and reassuring bedside manner, and loves the whole story. So, a memory like an elephant and creative processing skills to go with that memory. (here's how cute: he sits on a stool in the kitchen and I have to wait in the "waiting room" til he calls out loudly "Is mama here for her appointment?" He hugs me when I show up and tells me it will hurt but only for a moment and then I can have a sticker.)

One question to the mama who said to tell the staff that they get one chance and leave if they don't hit the vein straight off - what do you do then? For my guy, the remembered pain of that one try would pretty much mean we'd need total sedation to ever try again. Do you have another trick or just an easier child?

[Super~Single~Mama]

So....we had to do the 24mo blood draw a few weeks ago and....we were bad.  I restrained him, and my ex was there and he fed chocolates to ds.  Worked like a charm.  It worked great for his shots that day too.