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
