UPDATE: My SPD kid needs a blood draw... help!

[mkat]

My highly sensitive, SPD DS, age 6, needs to have a blood draw.  His pain threshold is tiny, he becomes hysterical when he injures himself, ESPECIALLY if there could be blood, which is the first thing he checks for.  Just the mention of the word "blood" sends him into a panicked state.

I don't want to tell him too far in advance, but also don't want to surprise him with the news, like after we get to the doctor, because that will affect his trust in me.  However, if he knows ahead of time, I don't know how I will get him into the car or into the doctor's office!  

I've read about using incentives, numbing cream on the site where the blood will be drawn and other strategies, but have yet to find ideas for a highly anxious child who perceives pain and discomfort a lot more strongly than the average kid. 

How are we going to do this?  What have you found to be helpful?

Edited by mkat - 2/18/13 at 9:43am

[Emmeline II]

I know I've seen a thread on this before; hopefully it will turn up in a search.

One thing to do ahead of time is to make sure the cream will be there or better yet, try to get it ahead of time. I think it's a prescription and Dr.s don't always like to give it directly to parents. I'd also see if you can schedule the draw with someone who is known to be good with sensitive children; not everyone has the technique and patience.

[mkat]

Hi, thanks, I did find one thread from a few years ago that was helpful.  There is a cream that is over the counter that works like the prescription version, however, I have read that it can constrict the blood vessels, making the blood draw more difficult.  I'm concerned about taking that chance.  Has anyone had any experience with this?

The blood draw will take place in the doctor's office with a nurse DS knows.  She has drawn my blood before and is very good.

[blessedwithboys]

Get a rx for EMLA and buy a Tegaderm bandage.  There's only one place around me that sells actual Tegaderm occlusive bandages; they may be hard to find, but that's what you need.  You'll need at least three of them.

Practice ahead of time to show your ds how well the EMLA works.  It needs to sit for about an hour, so do this the day before the draw.  After you remove the bandage and wipe away the cream, hand your son a fork or comb or something similar and ask him to run the object gently over his skin to see the difference between numb and non-numb.

The day of the draw, about an hour before it will be done, apply the EMLA and bandages to the insides of both elbows.  He'll have to be really careful not to move his arms too fast or the thin plastic could break.  When they call you back into the lab, let the phlebotomist decide which arm has the better vein.  (That's why you numb both sides.  The first time I did this for my son, I just took a guess and ended up picking the wrong side, so we had to start all over again and it took an extra hour!)  Try to go to a place where there is someone who has had experience in the NICU/PICU.  If they can stick a teeny tiny baby, they can stick anyone.  Make sure they know to use the thinnest needle available.  If they won't have a TV available to distract your son, bring a tablet or something along to give him something to focus his eyes on away from his arm.  If you generally don't do screen-time, consider compromising for just this once.  :)

My kiddo is 10yo and still freaks the heck out if I even mention a blood test.  He knows he won't feel a thing but is scared nonetheless.  Best wishes to you and your ds!

[Virginia Mom]

Hi. Just some other tips.....have child start loading up on water a day prior....(the more fluid in system the better) your pediatrician can also give you some litocain swabs....put on about ten minutes before.......also, use a heat pack on the arms where you think they will draw...(warm/hot cloth, or a heat/heel pack provided by lab)........another tip....try to make an online appointment with the lab...and if you can call them up and explain your situation, they may suggest a specific tech....also, if they can't get a vein by the second attempt, then make them stop...SOME LABS like to use kids at guinea pigs and let the inexperienced techs work on them.....we go to our lab about every three weeks and are on a first name basis with our Tech (she's from labcorp)....she doesn't call it a blood test...it's called 'making chocolate milk'...don't laugh....she does an awesome job of distracting my kid to look at the tube filling up...and says it's chocolate milk..and then they both take turns looking for things like barbies, or legos....(i personally find teh whole thing gross and can't stand to look, but it works great for the kids)....too bad you weren't in Virginia, I'd give you our tech's name....Good Luck....feel free to PM me....we're regulars at our lab

[melissa17s]

My ds has had panic attacks during blood draws.  Over the summer, when he had a ruptured appendix, the pedi nurse in the hospital had a light for finding his veins for the iv.  She was able to find it in one poke and it was less painful, plus the light was fascinating.  I do not know how available the lights are, but it would be worth asking for.  

My ds is usually fine up to the point of being cleaned with the alcohol.  Something about the smell sets him off.  His neuro is a pia sometimes, and would not give him a prescription for the numbing cream.  We found during the numerous draws after the appendix that he did not really need it.  Instead, he has needs the clinician to listen to his requests and follow them instead of just doing what they want.  So... the more he is held or restrained by staff, the more he resists and panics.  He needs minimal touching and minimal cleaning with the alcohol swabs.  He likes to find something other than his blood to look at and then visualize something he likes, so we try not to talk him much during the process because it breaks his concentration.  Finally, he really does not like it when the clinicians say things like, that wasn't so bad or look you did not even feel the needle, etc.   We have consistently had problems with blood draws at the neuro's office.  We have better luck with the clinicians at our main clinic and the hospital (but not the ER), and they are able to take a bit of verbal abuse from a surly 11 yo that hates them for taking his blood.  When possible, I try to talk to the clinicians before ds, to let them know that he has anxiety and fear over the draw, he needs to talk to them about his needs, and that it is possible that he will panic if they try to restrain or do not follow his talking requests.  

[mkat]

Thank you, all, for the great replies.  You have given me some really helpful suggestions and things to consider. I'm still taking in everything you've all written and may be back with more questions, but just wanted to let you know how much I appreciate your responses.

[DeaGemRy]

Make sure the Elma (numbing cream) is on for at least one hour. My daughter was recently diagnosed with type 1 diabetes so had elma cream pretty much everywhere with clear bandaides where they might have needed to take blood.

It is scary & all kids are different, especially if they are highly sensitive on top of being anxious. Maybe take along a fave teddy & get the nurse to do a pretend blood draw from teddy first (we have Ruby the diabetic teddy to help my girl cope with her daily injections).

Hope it goes well, bit of an 'eeeeek oh no' situation!

[Mittsy]

Can you role play a few games of "doctor" before this happens? I would also give him some rescue remedy right before. Plan ahead with him to bring some things he finds soothing. I would have a frank discussion with him about what will happen to ease his fear, he may even like getting a few books and learning about this in depth. If it is at all possible I would go to a Children's Hospital, or ir that is not possible go to a hospital that has a ward for kids with cancer. Could you go to the hospital/lab ahead of time and ask if anyone has experience with SPD kiddo's? You may be able to coordinate to get somebody with a good deal of experience, and who is especially understanding that way.

Best of luck to you! We will have to get a bunch of blood draws soon for my dd who is a aspie and has low pain tolerance, I feel for you.

[mkat]

Thank you again for all of the replies.  It sounds like several of you have used numbing cream with success, and haven't had any issue with constriction of the blood vessels.  I also ordered a Buzzy (www.buzzy4shots.com), has anyone used one before? 

I'm also thinking that I'd like to take DS to a local children's lab to have the blood draw.  I'll definitely call ahead and make sure we get someone who is familiar with kids with major anxiety and sensory issues.  The nurse in the doc's office is lovely but I don't want to take any chances. 

Now I need to decide how far in advance to tell him about the blood draw.  I don't want him to have to worry any longer than necessary, but telling him the day of may not give him enough time to process.  He may need some time to role play as was suggested or try out the numbing cream to see how it works.  I'll have to think about that.  We wound up having a little conversation about blood tests, it came up randomly, and he couldn't even discuss it without feeling queasy and needed to change the subject.  He still remembers a traumatic blood draw he had at age 3.  This is a time when I'm not sure if more or less time to process will be better for him. 

[melissa17s]

I would be interested to hear what you think of the buzzy.  I have never seen it before and it looks promising.  

[Treasuremapper]

Great advice above. I would add to request a special blood draw appointment where your child has a private room and can lie down in comfort. Distraction works great, so talk and show electronic games or something interesting during the blood draw. Ask for a butterfly needle, which they should always use for a child.

[mkat]

Hi everyone,

Thanks again for your great replies to my question.  Believe it or not, we didn't do the blood draw last fall.  The doc decided is wasn't necessary, after all.  Now, however, some new things have come up and we are scheduled to do the blood draw first thing Monday morning.  We're going to do it at the doc's office, with a nurse DS knows.  Re-reading all of your replies is really helpful.  I just need to decide how many days in advance to tell DS what's going to happen.  I want him to have enough time to process what is going to happen, but not so much time he just works himself up, you know?  I think a week's notice is too long, maybe 3-4 days?

[mkat]

Well, we did the blood draw!  I used LMX4 lidocaine numbing cream (over-the-counter) and DS felt nothing.  He was still very nervous prior to the draw, and needed a lot of convincing to go through with it, but he ultimately did agree and handed the nurse his arm.  He felt nothing with the numbing cream.  Thanks again for all of your help and ideas.  If we every have to do this again, we have a solid plan with the numbing cream (and a few lollipops!), that made all the difference.