How to get a difficult child to take a blood test

Discussion in 'General Parenting' started by Josie, Nov 9, 2007.

  1. Josie

    Josie Active Member

    I'm reminded of the post about giving the cat a bath! LOL

    easy child/difficult child needs to get a blood test. 3 different doctors have tests they want to do and I want to do a food allergy test so we are combining it into one blood draw. There really is no option to not do it.

    difficult child has Obsessive Compulsive Disorder (OCD) and it is bothering her to even think about it. We are getting the EMLA cream and I'm offering a pretty big incentive (bribe). We can't do it before Monday for various reasons. Last night, she brought it up out of the blue and totally lost it over this. I was afraid I was going to have to give her her Seroquel over this so she didn't hurt herself.

    She says she is not going to take it. I can picture having to drag her kicking and screaming into the office. They said they have dealt with this before and can use everyone in the office to do it. I'm not sure about that, either.

    Any advice? Anyone been there done that?
     
  2. Big Bad Kitty

    Big Bad Kitty lolcat

    I am just tossing ideas out here.

    Would a sedative before the test work? Or does she have to be off all medications?

    When my daughter had to get dental work done, they were going to have to put her out. First they gave her a sedative, then when the sedative took effect, they gave her gas (in your case the EMLA cream could be taking effect) and finally they gave her an IV to put her under (in your case, they could take the blood).
     
  3. Kjs

    Kjs Guest

    difficult child was given valuim. AFter we tried holding him down, he was sweaty, hyperventalating..they wouldn't do it until he settled down. Even then they said he has to LET his body settle down or the valuim (sp?) won't work.
     
  4. Josie

    Josie Active Member

    Her psychiatrist didn't want to give her anything like Xanax for the test. I will give her the Seroquel the night before. He said I could give her the Seroquel as often as every 4 hours if needed for raging.

    We are doing another test on Saturday and I'm trying to keep her off the Seroquel until then.

    I think if I can get her into the place, she will do ok. However, she has tried to refuse to go into even the regular doctor where no shot was involved and it has gotten pretty ugly. I can only imagine what this will be like.
     
  5. Josie

    Josie Active Member

    How did he get the valium? Did someone prescribe it beforehand or was there someone there who could prescribe it?
     
  6. difficult child has had to have blood drawn more times than I can count. We have developed strategies for working with him and have noticed some things along the way.

    Feeling like he is in control of his body and what is happening to it is vital for him. We learned just how important this need for control is when he was hospitalized. He had a picture line (this is inserted directly into the chest) that had to be removed so that he could be discharged and finally come home. He was having no part of anyone removing it. His doctor came into the room and said to difficult child, "I'm going to teach you how to remove a picture line - if you would like to learn. Would you?" difficult child looked at her with an amazed look (she wasn't trying to talk him into anything), and he said "yes". He washed and gloved up and she talked him through the steps of removing the verrry long picture line.He did it on his own, he was in control, and he got to be discharged and go home. I was so knocked out by this doctor, I will NEVER forget her!! She totally got difficult child. He was 12 at the time.

    Now, when difficult child gets an IV or has blood drawn we tell him that the nurse will follow his lead - he is in control. He lets them know when he is ready and he usually chooses to not watch the procedure. If they are drawing blood only - I always bring some very good, expensive chocolate along. difficult child LOVES high end chocolate - only the best. He usually eats the chocolate during the stick. It's amazing how distracting really good chocolate can be :smile:
     
  7. 'Chelle

    'Chelle Active Member

    My difficult child is needle phobic. At the dentist's recently, she picked up a syringe which she uses to put this coating stuff on the back teeth and he saw it and was 1/2 way out of the chair before she could assure him and show him it was NOT a needle. At the one and only time we had blood taken when he was 10, we used the EMLA cream, promised him 2 ps2 games and $50 cash. He still couldn't do it and it took 5 people to hold him down. Don't know what we'll do if he ever does need dental work with freezing, or more blood taken. He's now over 6'1" and probably 190. Would have to knock him out somehow LOL.

    Sorry no advice, just can empathize with your worry. Wishing you good luck and hope you find something that works for you. {{{HUGS}}} I always read these threads, and hope there'll be something that will work for us should the need arise.
     
  8. trinityroyal

    trinityroyal Well-Known Member

    I've definitely been there done that.
    The last time difficult child had to get a needle, he ran out of the doctor's office into the pharmacy next door. He's more than a foot taller than me so I just can't pick him up anymore. So...I had to wrap my arms around his chest under his armpits, and drag him back in to the doctor's, dragging his heels on the ground the whole way. When we were in the exam room, husband had to sit on difficult child while I held his feet and a nurse held his hands.

    Needle Phobia information

    This website has some very useful information about needle phobia and coping strategies.

    Hope it helps, and best of luck
    Trinity
     
  9. Josie

    Josie Active Member

    I knew there would be people here who would understand at least. 'Chelle, I'm sorry you had to go through this too, but it does make me feel better to know I'm not the only one offering up big rewards for a simple blood test.

    If she brings it up again, I will talk to her about ways she can control the situation. Her reward is going to be a stuffed animal so maybe I can give her the stuffed animal when we get there and she can carry it in with her. Or better yet, maybe they can have the stuffed animal already and she'll actually have to go in to get it. Then maybe the stuffed animal will work like the chocolate does while she is having the stick.

    A stuffed animal may not seem like much but I have banned them since she has about 200 in her room and can't get rid of any of them.
     
  10. Marguerite

    Marguerite Active Member

    1 Day at a Time - that very much is what you need to do with a seriously anxious Obsessive Compulsive Disorder (OCD) kid. They need to understand, so THEY are making the decision and not someone else. And they are capable of being reasonable, especially when it's their own health that is a concern. Just don't let them use denial as a defence - not should you. Total honesty and explanation.

    But it's not always easy. A nephew of mine, when very young, was murder to get medicine into. He was too strong to force him, although his mother and my mother would work as a team to try to hold him to get the medicine into him (which of course only taught him even more that taking medicine was a horrible experience which robbed him of control). Then they tried hiding his medicine in food or drink - but you can't smuggle some of those flavours!

    As he grew older you could reason with him but he always hated taking medicine. And it turned out (and my sister downplayed it) that at the time he was fighting us the worst, someone where he lived had been drugging him in order to molest him... at two years of age. His refusal to take medicine was in fact his coping strategy to avoid abuse.

    difficult child 3 is needle-phobic but we explained the need for blood to be drawn and he was cooperative. But due to his extreme anxiety, his body was not. The amount of anxiety led to an over-rush of adrenalin which shut down his peripheral vascular system. (Think - in times of extreme trauma, such as when you have had a severe accident and are lying there bleeding profusely, a peripheral system shutting down also shuts off dangerous haemorrhage).

    So the sister simply couldn't get blood out of him, even after she got the needle in. She had to try several times and then move him to a bed because he was alternating between fainting and dry-retching. Eventually she timed her pull back on the needle with him breathing out; we coached him trough slow breathing.
    And this was difficult child 3 cooperating!

    Do try to get her involvement and permission, use the Emla, but also be prepared for the adrenalin reaction. Explain to her WHY this is needed, make her the doctor having to make the decision. What will happen if the blood draw is not done? Put her in the picture of all three doctors and why each one wants a blood test. Throw in the allergy blood test too, point out that you have saved these up to avoid four separate blood draws; now it can all be done in one. Explain exactly what will happen if the blood is not taken. It could mean Doctor A may not be able to work out exactly what her blood levels are of her medication, and he will then have to put her through some medication changes which could make her feel worse in various ways, and the doctor doesn't want to do that - a blood test means he will get his answers more accurately, much faster. Much better than fiddling with medications for months or longer. Also, a blood test will be looking to see if hr liver is being affected by her medication or diet - this is really important. The liver is a very important organ and we often ignore it. The liver is the organ which mops up pollution in your body, it takes out a lot of toxins and it also cleans your blood, getting rid of old and broken blood cells. These get turned into bile, which is like a special kind of detergent that helps you digest fat in your diet - it all works really well with everything else in your body. If the doctor doesn't know if a drug is making your liver sick, he could keep giving it to you and you could feel VERY sick, very tired and you would have to change your diet a lot until your liver recovered. The liver DOES recover very well, thank goodness, so even if some damage is discovered, it will get better if it's not too bad. And the liver is nowhere near that sick, she would have to be already feeling very ill and looking fairly yellow (that's caused by the bile not being removed from the bloodstream by a too-sick liver). Chances are her liver is fine - but the doctor needs to know. Some people get sick really easily on some medications, and other people are fine.

    Another reason for a blood test could be to check to see if she is really well. Blood tests can tell you so much about how your body is working. It can maintain a check to see you haven't got a hidden infection (such as chronic tonsillitis or appendicitis, or a chest infection that won't go away). It can check antibody levels to see if your body is ready to fight any one of a number of nasty diseases. It can check to see how well your blood is working to keep you well in other ways - clotting time, prothrombin time, haemoglobin levels (you need this to carry oxygen to your cells) - so many good reasons. Give her a lesson in blood physiology and see if t here's anything else she wants the doctors to check for.

    Then talk to her - what is she afraid of? Do not belittle hr fears, simply listen to them and try to help her see how likely they are.
    Pain? The emla should take care of that.
    She might bleed to death? Highly unlikely, even if she had haemophilia. How to deal with this fear? Let her know how long it would take to bleed to death assuming her body didn't automatically step in to stop the bleeding. It's a tiny hole they make, it is easy to stop the hole with a finger and anyway, she would be close enough to somewhere she could get a blood transfusion. I've never heard of this happening, but if it did she would not only make the Guinness Book of Records, she would survive and be famous.
    She might faint? That's no shame. I have seen big macho blokes keel over at a blood draw, while some tiny weedy female looking like a deer caught in the headlights is perfectly fine. Anyway, she can have the blood draw lying down and close her eyes, so nobody would know if she fainted or not.
    They might take too much blood? This can be a fear simply because there are four separate reason for this to be done. But most of these tests only need a fraction of a ml. The blood count under the microscope uses a very small drop. Haemoglobin can be measured with even less. I haven't personally done a lot of the other tests, but most pathology labs these days have machines which you feed a tiny tube of blood into (and by tiny, I mean a drop or two of blood at most) and it will spit out a lot of results. The total amount of blood they will need to take will probably only be about 10 ml, could be as much as 20 ml. She will have 5 litres of blood in her body. (An adult has 8 litres). And the blood they take will come from her veins, which will collapse back a small amount to take up any slack. The next glass of water she drinks will replace her blood volume and her bone marrow is pumping out new blood cells all the time - it has to, to replace the old ones the liver is cleaning up. Human red blood cells live longer because they have no nucleus - it is taken out before they are released from the bone marrow - but even they need to be replaced after many many times having to squeeze single file through the capillaries of the peripheral vascular system.

    Don't give her the stuffed animal first. Of course she may try to be cooperative, but what will you do if she chickens out? It's easier to continue if you still have the incentive; if you already have it (even if it's conditional) then it's harder to keep going. And be prepared to use the chocolate (or similar taste/smell bribe) as well. If it works out positively, you will get even more success if you use it again.

    When you put the emla on - put it on BOTH arms. And also be prepared to use the sedative, to try to avoid the adrenalin problem. Also, rehearse slow breathing (6 seconds in, 6 seconds out, breathing from the diaphragm). Music, massage, lavender or rose perfume - anything to help her relax.

    difficult child 3 has been actively working to overcome his fear. He went in with his father to see them do a blood draw on husband. difficult child 3 almost fainted, but he was stoic about it. Then when I was getting an antibiotic injection difficult child 3 asked permission to watch. That was a few months ago when it seemed I was getting an injection every few days; he got a lot of watching in and actually helped the nurse by holding ampoules, opening the syringe packet, putting rubbish in the bin. We were at home, which I think helped him feel safer.

    This is never easy. Every time we have to hold a kid down, we make it worse. Because they are growing and will get bigger, it's not something to be used for very long.

    And if it gets REALLY bad - hypnosis. We're almost at that stage.

    Marg
     
  11. gcvmom

    gcvmom Here we go again!

    difficult child 1 is needle-phobic in a BIG way. At first, we just had the Emla cream, but he still had major panic attacks and would often bolt or kick, fight, bite, scream, etc. Then psychiatrist gave us an rx for Ativan (similar to Valium). Helped a bit, mostly made him loopy, and he was still quite anxious, but he got through it, albeit with many tears, hyperventilation, much panic. Later, we decided to add Lexapro to his daily regimine, and it allowed me to cut the Ativan dosage in half. Now, blood draws have no tears, no hyperventilation, no panic attacks. Tiny bit of anxiety, but so much more bearable than before.

    P.S. And we freely use bribes/rewards afterwards :smile:
     
  12. Josie

    Josie Active Member

    We did the blood test today and surprisingly, there was no problem. I used the EMLA cream and showed her that she couldn't feel anything if I touched her there. She was motivated to get the bear so she went in easily enough and once we were inside she did fine.

    Thanks for all the advice and support.
     
  13. gcvmom

    gcvmom Here we go again!

    :dance:

    That's great to hear she did so well!

    I'll bet the next time will be even easier with the memory of this success filed away for future reference.
     
  14. Big Bad Kitty

    Big Bad Kitty lolcat

    I am SO glad to hear that!! Good for her! (I bet YOU feel just a bit better yourself, hmm?)
     
  15. mstddybr

    mstddybr New Member

    I went to the doctor's office today with my difficult child to get a blood test for allergies. It was a complete nightmare. He was fine until the nurse practitioner said he would get a blood test and then he began to scream that he wasn't goin to do that. The nurse came in with all the equipment she needed and he started to cry and freak out. He's a big boy for 8 years old weighing 101 lbs. so I was afraid he would get hurt worse if he fought it. I had left work early to go pick him up since I work about 45 mins. from home and he goes to school close to where we live. I rushed, got my sister to pick him up, picked him up at her house and rushed to the doctor's office where now they charge for parking in the lot. I also paid the deductible. By the time we were in the exam room going through all the drama it was almost 5 p.m. and closing time. The doctor came in and said, "just send it to the lab; they have a chair there that'll hold him." Then the nurse practitioner said to me, "Boy, he's pretty dramatic; you should send him to drama school." I got home and was upset at everyone from my husband to my 14 month old who wanted me to hold him and cried because I couldn't since my difficult child was crying and screaming loudly still because I did not give him the treat I had promised him if he was brave. Anyway, I just needed to vent a little and let it out.
    I ended up going for a walk with the baby and my difficult child once he was calm and it helped. I had been so mad at my son for making me waste my time and money but then I got really mad at the doctor and his staff. I feel like switching doctors because they seemed so insensitive. The doctor just wanted to close his office and not deal with trying to convince my son to get the test and the woman seemed very cold. I asked my husband to take my difficult child to the lab to get the test done. After we get the results I think I will switch doctors. Thanks for sharing your stories (though I know they're from a while back) and for allowing me to have a place to share mine.
    :faint:
     
  16. Christy

    Christy New Member

    Glad it went well. :)
     
  17. busywend

    busywend Well-Known Member Staff Member

    Ugh! I sooooo remember the needle incidents.

    They CAN provide a baby needle to make the draw. Ask about it before hand. You can also try a topical numbing cream before going into the office to lessen the pain.

    HUGS! I know this one all too well. Oh and throat cultures, too!:tongue:
     
  18. susiestar

    susiestar Roll With It

    I ALWAYS let the kids see me get blood drawn. We were headed down the anxiety highway with thank you in regards to needles, but then he was with me for one of my doctor appts. I needed blood - 9 tubes of it - for various tests. He watched and was amazed - it didn't hurt and certainly didn't kill me (one of his fears). Since then if the kids are with me they are welcome to come watch.

    also, for many people not seeing the needle go in is helpful. But if you feel really out of control it is more helpful to WATCH so that you KNOW what is going on. Once I insisted they let thank you watch he got a lot better. It may be counter-intuitive, but it works.

    If at all possible, have the phlebotomist use a butterfly set up to put the needle in. The unit with the needle is on a flexible tube and is much less painful most of the time. If they use that unit that they snap the test tube onto then it jars the needle in your vein. It is uncomfortable, and sometimes can even be painful. The butterfly is something they use when someone has very small veins or veins that are hard to stick. I have found less bruising and MUCH less irritation than from the unit they snap the tubes onto. Every time they put a new tube onto the snappy thingy it jars the needle. Even if it isn't uncomfortable it feels really really strange.

    I hope this is easier in the future. At least with less up-front worry for mom!
     
  19. meowbunny

    meowbunny New Member

    I have severe needle phobia. I also have to have blood drawn every 3 months. One thing that does help is I watch every move the phlebotomist makes. It was after about 3 years of almost fainting when they drew the blood for someone to suggest I watch what was happening. It made a HUGE difference. I also insist on either the butterfly if more than one tube is needed or an infant's needle (very small veins that turn here).

    I'm glad it went well. There really is something frightening about the idea of someone using a needle to get some of your body fluids. It just doesn't seem right.
     
  20. Kjs

    Kjs Guest

    they tried to get difficult child to take valium - but he refused. (that was for MRI with-contrast)

    Blood tests - up until this past year took two of us (husband and easy child) forced it.
     
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