Re: She freaked out...

[Guest guest]

Hi, -

I co-chair a support group for Oregon and SW Washington. That was once a

question which came up in our group. Here is a compilation of the results.

(n, 22, systemic)

> I wonder if they did it on mom first.

>

> I bet a big distraction like a blo-pop or some other special treAt would help.

> Been there. Almost went to a straight jacket. I had a talk w Kingsbury about

& insisted on a horse tranquilizer & if not for the child, for the mom!

Anyways, there's a drug that puts them in a happy place, it starts w an A, I

want to say Ativan? My friend who's daughter had leukemia told me about it,

they used it for every poke. Now I don't know if Kingsbury will go 4 that 4

just a blood draw, we went from blood draw to Remicade (IV arthritis drug). It

might be just one of those situations..... U do all u can to help it not be a

big deal, like numbing cream, hot towel. We told our daughter the more she

freaks out the more the veins try & hide & it takes the nurses longer.... At age

5, our daughter understood & we've been going thru distraction exercises,

breathing..... Its tough, its not fun, I dread it every time, so my heart goes

2 the mom!

so sad...where does she get her blood drawn? My daughter went through this as

well, but now we have a GREAT phlebotomist over at Meridian Park Hosp and my

daughter does VERY well. She's 8 years old.

Our labs got much better when we started having our pediatricians office do

them. We also make a trip to Target when we are done to pick out a small

" prize " . Annie says that she suggests squeezing your moms hand as hard as

you can!

My son Hunter was the same way. He totally freaked out. We found out that he

was really motivated by money and my mom started paying him $5 each time he

needed a blood draw. I would say find something that she really likes and make

that the reward for it.

> Some of the things that have worked both with my daughter and also with my own

pediatric patients (I'm an RN with Emanuel):

>

> * set up is key. I keep it honest, and I give plenty of time for discussion

of fears (unless clearly we are in an emergency situation). I let my patients

see and explore the equipment (turniquets, lap tubes, gauze, the needle <the

needle is retracted so no inadvertant injuries occur>). I have seen our child

life therapists walk the patients through the process (looking for the " right

vein " , cleaning with alcohol or chlorhexadine, applying the turniquet, the

importance of holding as still as possible for the pokey so that it is over as

quick as possible, applying gauze over the spot where the pokey was, and the

ever important bandaid). I have seen them (child life) practice on a special

doll, and also pretend with the child life therapist being the " patient " and the

patient being the " nurse " . In the outpatient setting, as is with my own

daughter, I found it best to have this discussion way in advance (days to

weeks), and make it very clear we are not doing the pokey right now, but just

learning and talking about the pokey that has to be done. We talk about things

they may be feeling (scared, etc.). I let them know that it will hurt, but it

hurts less than falling off of a bike or being being scratched by a kitty, and

even less if they hold still. Some kids shut down and don't want to talk about

it. Keep trying and keep talking to them about it until they come to a place

where they open up.

>

> * I express the importance of holding as still as possible, and I explain why

this is important, and how it is in their benefit. However if they are unable

to hold still, I explain we will have to hold them (my own daughter sits still,

for my patients if they are small enough I wrap them in a blanket with the site

exposed that I am going for-many times this is surprisingly calming to them).

If it is helpful I have parents hold their child and be present. Rarely its not

helpful for parents to be there (if their own fears and anxiety are contributing

to the problem, or sometimes they simply can't handle watching for various

reasons).

>

> * I let them know it's ok to cry, and its ok to be unhappy about having to

have a pokey.

>

> * I use bribery. I let them pick their own reward before the draw, and no

matter how the lab draw goes in the end they get their reward after the pokey is

finished. (my daughter likes lollipops, but maybe a bigger reward is in order

for this little guy that is climbing the walls during the lab draws)

>

> *during the lab draw I try to keep as peaceful of a setting as possible. We

sing calming songs (my daughter likes ABCs, and usually by the time she gets Z

the pokey is over). In the hospital we use little wands with interesting

lights, toys that have sand that slowly dumps like a timer, squishy balls that

they can squish if they have an available hand, pop-up books, or whatever else

we can think of for distraction.

>

> In the hospital using sedation is usually last on the list of things we like

to try, but sometimes its necessary.

>

> Not sure if this family could somehow gain access to a child life therapist,

but that would be helpful probably if its possible.

>

> Good luck!! =)

We had that too, and it always seemed like they needed to take a gallon

each visit. Nikki has really small, deep veins and she has endured

multiple pokes before they can get it right.

I tried dealing with my daughter first, bribes, being stern etc, but I

realized some of her fear was grounded in reality. Then I got really

uppity and insisted on the best person to do the draw. I did the Mom

stare down, so that they would tell me the truth about their abilities.

Once we got to know a really good person at each locations (office and

hospital etc) we wouldn't let anyone else near our daughter. It still

took a few times before she would trust that it was going to be ok, but

once we established that, I would remind her each visit that we would

only let the best do the draw. She is fine now most of the time but it

still creeps up and she's 14. It seemed to help calm her if I was

firmly in her camp. I have also her hypnosis works on this too. Our

pediatrician recommended that, but we didn't try that once we realized

our daughter wasn't necessarily wrong.

> We got into going to the store in the hospital after and letting Miah pick out

a treat - she also likes the stickers they give her, but really looks forward to

the treat. She was not quite that bad but used to cry through the whole thing -

now she does not even cry. Hope that helps. Sorry they are going through this.

>

> My daughter goes through the same thing every time she has blood draws. I have

to have nurses help too. it's the immunization shots that hurt the children to

make them fear blood draws. make sure they are using baby needles on the child.

Maybe the person that is doing the blood draws is not doing it correctly & is

not patient with the child. Sometimes I feel that the doctor is more sympathetic

when doing the shots & blood draws.

My daughter, , who had systemic JRA from the time she was 5 until she

turned 7 began the ordeal being terrified of the blood draws also. Her first

draw required two male nurses to hold her arm while I held her body. It was

horrendous. It did not take long until she was able to walk up to the counter

and when the nurses would come over to help hold her still she would say, " I'm

OK, I don't need you " and she would put her arm up and let them do the draw. She

needed daily blood draws for a while and was able to relax and learn not to

fight them. She never looked when they put the needle in or during the

procedure. I would hug her and position my body between her face and her arm so

she couldn't see. It took calm coaxing from me and a little reward afterwards if

she would relax. I always asked if the person doing the draw was used to drawing

blood from children and she made friends with a certain lab tech at our lab so

we would ask for him whenever we went in.

> is now 11 and has been drawing blood every two months since she was 4.

> We started by her taking her favorite stuffed animal to hold and she would

> sit on my lap as I was sitting in the " draw chair " . This worked great until

> we are too big to sit in the chair together. Now she has to sit by her

> self. We also have the same person, Grant, draw each time so it's a

> familiar face. Grant always uses a " butterfly " needle because it looks cool

> and we take our own colored co-band (the stretchy wrap) instead of a

> band-aid. We buy the colored wrap at a livestock/feed supply store. It's

> actually the same wrap veterinarian's use but comes in great fun colors.

> The stuffed animal also gets a wrap on the leg to match hers. If there is

> no drama she gets a treat of her choice (within reason of course). It works

> for us but then we live the same scenario when it comes to the Terrifying

> flue shot! Go figure!

My wife was great at distracting our little ones. Engage her in conversation

about something interesting or fun. Bring along an electronic game. Sing a

silly song to make her laugh. Bring a picture book or if your daughter is a

reader a book she can read herself. Family pictures and telling stories about

the pictures or the memory (pictures on your cell phone maybe). Anything

engaging enough that she won't focus on what's happening with the needle

I don't have much advice for the parent asking this question. I had Brett

hold in his arms when we did the bloodwork because he's stronger than

me. The nurses, like I said, did a great job of finding a vein and getting

the blood as quickly as they could. When I get my blood drawn I have to

look away.

Celia had a strong aversion to needles when she started taking Methotrexate

almost 2 years ago. She'd get really upset about the blood draws. We ended up

finding a wonderful lab tech at Legacy Good Samaritan. His name is , and

he goes by the nickname of " Harm " . (He says his buddies gave him that nickname

when he was in the military, because they told him he " wouldn't harm a fly " .

He's got phenomenal patience and compassion. The first time he drew Celia's

blood, when she was 11, she started to scream, cry, and argue - just like she'd

do with everyone else. He stayed very calm and friendly. After a few minutes,

he'd tell her he was going to go take care of his other patients but that he'd

come back soon to see if she was ready. Eventually she calmed down and let him

draw her blood. He was just as sweet with her as he'd been when we arrived. She

still gets blood drawn every 8 weeks. Even though she still doesn't like it, she

just says, " Please call and make sure is working today, because

otherwise I'd like to wait until he's there. " Sometimes the other lab techs

seems a little annoyed when I ask for him specifically, but I've never met

another one of them who's as compassionate as he is. It's got to be tough to be

a child with a chronic medical problem, to have to take medicine that makes you

feel icky, and to have to get poked with needles on a regular basis. It's

understandable why they would protest about the blood draws, but if they're

treated with patience and compassion they'll be a lot more likely to be calm and

cooperative. In case this little girl's family lives in the Portland area, the

phone number at the Legacy Good Sam lab is 503.413.1234. I wish them the best

of luck!

On Apr 5, 2011, at 8:01 PM, wrote:

> Ella has been through blood tests and being poked and prodded and never fought

it or even fussed much at all. I was always amazed at how well she did. Well,

that's apparently not the case anymore. She had an appointment today with her

pediatrician because she has a bruise-like rash and her doctors told me if he

showed up again, to bring her in so they could look at it, etc. So I did... Her

pediatrician couldn't get her rheumatologist on the phone while we were there,

but she did talk to another physician at the office and they both agreed that

they needed to do some blood work to check her platelets and make sure that was

okay. Well, as soon as the nurse walked in holding the basket thingy with the

tubes, etc in it, Ella flipped out. She started crying and saying she didn't

want to be poked because it would hurt and she hated it. They ended up having to

get another nurse to come in and help hold her. They had to stick her twice

which didn't help either. It absolutely broke my heart I think she's just had

it. She's been poked and prodded so much the past several months.

>

> So her pediatrician called back this evening and said she talked to the

rheumatologist and he wants me to circle the spots and bring her back in

tomorrow. If the spots go away but leave a discoloration then it could be a sign

of something. And they want to see if any new spots show up between then and

tomorrow. Also, he wants to do a few more tests, so they'll need to get a urine

sample (not a big deal, because apparently she seems to think peeing in a cup is

the most fun thing ever...lol) and draw more blood. I could cry. The doctor

is calling in a prescription for numbing cream and I'm going to pick that up in

the morning and use it before her appointment and hopefully it will help.

Honestly, I'm not counting on it because she started freaking out as soon as the

nurse walked in the room today. I just hate that she's having to be poked yet

again. But I'm hoping we'll figure out what's going on soon. She's still having

stiffness and limping in the mornings and pain in her ankle and knee sometimes.

There is still no or very little visible swelling though. Its just so weird.

Even when the ultrasound showed fluid on her knee, there was very little

swelling that you could see. I'm anxious to talk to her doctor tomorrow because

I'm kinda confused right now. Apparently the physician her pediatrician spoke to

first said that according to her chart Ella had not been officially diagnosed

with anything yet. But after they got the blood test and ultrasound results back

in January, the rheumatologist's nurse called me back and said that she had

fluid on her right knee and her sed rate and c-reactive protein were both high

and that along with her history and the exam, the rheumatologist felt she did

have JRA and they started her on ibuprofen 3 times a day and told me to follow

up with her pediatrician the following month (which we did...we're following up

with her ped as much as possible so we don't have to travel as much). Then this

evening when the doctor called me she said that Ella does have some type of JA

and they are leaning towards JRA since they've ruled out other things, but that

could change if they find something else. Huh?!?

>

> Another thing that has been happening recently that I'm going to mention to

the doctor tomorrow (forgot all about it today) that may or may not be

related... Ella will be walking and then just fall...its like her knee gives out

or something. Its kinda hard to explain. Its like she can't stand on that

leg...every time she does, her knee bends and she falls. After 10-15 minutes or

so she's fine and can walk on it perfectly fine. It happened once yesterday and

twice today. She said it didn't hurt but it " felt weird " and she couldn't stand

on it.

>

> I'm hoping after the appointment tomorrow I'll be a little less confused...

Any tips on handling blood draws will be greatly appreciated! Even promises of

special treats didn't help much today

>

>

> -Mom to five beautiful little girls!

>

>

[Guest guest]

wrote:

<<Ella has been through blood tests and being poked and prodded and never

fought it or even fussed much at all. I was always amazed at how well she

did. Well, that's apparently not the case anymore.>>

Mostly I wanted to extend some sympathy. Its so hard, isn't it?! My 12-year

old isn't any better with shots - one too many blood draws and a very

painful steroid injection. The EMLA cream does help quite a bit. She also

brings music to listen to, doesn't watch what is happening, and squeezes the

heck out of my arm/hand.

Oh, I also try to get her talking about something random. Distraction seems

to be helpful too.

Michele (mom to K, 12, pauci/uveitis/ANA+)

[Guest guest]

Thanks! And thanks for the suggestions !!! She's 3.5. I tried

distracting her today (and 2 of her big sisters were there and they tried

telling jokes, making silly faces, etc) and it didn't work. She knew what was

about to happen. I plan on picking up a few prizes and letting her choose one

that she can have after its over. I seriously almost started crying on the

phone tonight when the dr said they were going to have to draw blood again

tomorrow. I'm a mess anyway because there is so much other stuff going on right

now and I'm stressed out and trying to keep it together, but its one thing after

another here lately. And then just before the phone call my oldest daughter

(she's 10) handed me a stack of papers from school and one of them was a little

essay on what she wanted to be when she grows up and why. Well, she wants to be

a medical research scientist because she wants to find a cure for juvenile

arthritis so children don't have to suffer like her little sister does. It was

SO sweet, but so sad at the same time. I was bawling by the time I finished

reading it. I think it hit me how much this is affecting everyone in the

family. So yeah, I'm a basket case tonight...lol.

-Mom to five beautiful little girls!

On Apr 5, 2011, at 11:30 PM, Michele Lynch wrote:

> wrote:

>

> <<Ella has been through blood tests and being poked and prodded and never

> fought it or even fussed much at all. I was always amazed at how well she

> did. Well, that's apparently not the case anymore.>>

>

> Mostly I wanted to extend some sympathy. Its so hard, isn't it?! My 12-year

> old isn't any better with shots - one too many blood draws and a very

> painful steroid injection. The EMLA cream does help quite a bit. She also

> brings music to listen to, doesn't watch what is happening, and squeezes the

> heck out of my arm/hand.

>

> Oh, I also try to get her talking about something random. Distraction seems

> to be helpful too.

>

> Michele (mom to K, 12, pauci/uveitis/ANA+)

>

>