Because children's veins are smaller and the amount of blood withdrawn needs to be carefully monitored, pediatric patients are treated with special care during their blood draws. A more experienced technician is usually involved and helped by an assistant, says Saralynn Pruett, MT(ASCP), a phlebotomy supervisor in the department of laboratory medicine and pathology at the Mayo Foundation, Rochester, Minnesota. For children older than two years of age, a vein in the crook of the elbow is a site that is commonly used. Here are some tips that can help.
Determine if the Child Wants to Participate — One of the most basic things you can do, suggests Goldberger, is determine if the child wants to participate. Some children want to watch; others would rather look away. If the child does not want to watch, have an alternate focus in mind, such as looking at an interesting book you have brought along (an I Spy or pop-up, for example) or singing a favorite song or hymn. You can ask, "Do you want to see how the nurse does this, or do you want to look at this book with me while she works?"
Rehearse — Suggest a way the child can practice at home beforehand. For example, says Goldberger, the child can rehearse sitting still and you can review by saying "show me how you stay still, now show me how you wiggle, now show me how you stay still again." Rehearsing can help the child feel composed and in control of his or her body; the child may even be proud to demonstrate his or her ability.
Prepare Them for the "Ouch" — "We encourage parents to talk to the child ahead of time," says Pruett, "to let the child know what is going to be happening." You can tell your child that it will hurt a little bit, but it will be over very quickly and then the hurt will go away. Before you enter the room, talk about who the child will see (some people in uniforms) and what they are going to do so the child has realistic expectations. It is okay to tell children that having blood drawn is difficult even for grownups, but avoid coaxing the child with statements such as "be a good boy now" that can make the child feel ashamed.
Stay with Your Child — Parents are strongly encouraged to stay and help their child during a blood draw, says Pruett. The parent can be face to face with the child, while the child is laying down, providing physical comfort, distraction, and assistance.
Count to 3 and Blow the Feeling Away — Blowing the feeling away is one of the most useful techniques, says Goldberger, because the slow exhale helps keep veins full and loose, which makes blood easier to draw. It helps the child both mentally and physically. Allowing the child to count to 3 or to choose someone to do the counting (the parent, nurse or technician, for example) gives the child more control. The child who does the counting is able to ensure he or she is mentally prepared before saying the last number, and the technician will be less inclined to insert the needle prematurely.
Don’t Expect Just a Finger-Stick — Parents often make the mistake of telling their children that their blood test will require just a finger-stick, says Pruett. The surprise of a different approach can unnerve a child. Most diagnostic tests require a larger sample, she explains, which would be obtained from a vein, not a capillary. You can inquire if a finger-stick option is available, but know which method will be used when you talk to your child so you can provide the most assurance.