I won’t sugar coat this. Pediatric lab testing, especially for children under three, is no joke. Blood draws have been some of the most difficult and traumatic appointments for us. Think of vaccine appointments, then multiple them by 1,000. Our worst lab visit lasted several hours and included seven pokes. I can’t count the number of times we’ve taken our daughter for blood draws or given urine samples. Here’s what we learned along the way to make these visits less painful for all of us:
Make an appointment at a pediatric-friendly lab. Make an appointment to help avoid long wait times. Don’t just go anywhere. Find the best lab for pediatric blood draws. Often, you’ll just get a lab order form, and you’ll be responsible for choosing which lab to go to. Ask the ordering provider where they suggest going. See if you pediatricians office will do it, they tend to have great experienced nurses. Look on yelp, call the labs, see if they have pediatric-focused phlebotomists. If they tell you, "No," or there isn’t any one specializing in pediatric blood draws, go somewhere else. Phlebotomists, who don't complete pediatric blood draws regularly, won’t be able to find the vein — infants’ and toddlers’ veins are super tiny, and it takes regular practice to get it right. Your child doesn't need to be the practice patient. If you are asked whether a phlebotomist-in-training can practice on your child, and you know you child doesn't handle blood draws well, just say no.
Prepare for the Appointment. I don’t know what it is about labs, but even with appointments, they can take ages! We’ve spent several hours waiting at a various labs, even with appointments. You’re going to need to keep your child as hydrated as possible to make their veins as large as possible (easier to find) and keep that blood flowing (less pokes). Prioritize fluids and pack your child’s favorites. Pack a ton of snacks to help maintain blood sugar before and after.
And don’t forget fluids and snacks for yourself. I learned this the hard way. During an appointment where I also had to provide a blood sample, I almost passed out and my blood flow stopped. I had prioritized my daughter, while we waited for several hours, and I hadn't had anything to eat or drink the entire time. These appointments are exhausting (physically and emotionally) for both the patient and the parent. It is helpful to have two people to help the child (one to distract and comfort and one to hold the child down), so if you can bring your partner, your parent, or a friend to help, do it.
Consider purchasing a Buzzy Bee. Pop the mini ice pack it in the freezer before the appointment and bring it with you in a mini cooler with an ice pack.
Check-In. Ask the person at the check-in desk what options they have to make the blood draw more comfortable. Some places have Buzzy Bees, hot pads, or other items. Ask whether they have restraints, like special sheets to help restrain your child. You child is going to fight the blood draw, and you are going to be the only one responsible for holding them down while they’re screaming. It’s awful. Take anything they’ll offer to help. If you know your child is particularly strong, let the lab know you’re going to need help holding you child still.
During the Appointment. Don’t forget that you are in control. If the phlebotomist can’t find the vein, and your child has been shrieking for over a minute, ask them to stop. If they can’t get it the second time, ask to have someone else try. This is not the time to play nice. Advocate for your child.
Offer a Treat After. You’ll need to console your child, and it may take several minutes to calm them down after. It can be helpful to offer them a new toy or a yummy treat. Tell them how brave they are and how proud of them you are. Explain that sometimes we have to do things that are painful, like blood draws, but it’s for our health. And our health is important.
File Complaints (if necessary). If you don’t feel your child’s blood draw was handled appropriately, ask to speak with the manager. From personal experience, I suggest waiting a day or so to call so that you aren’t as riled up and can speak calmly and rationally. It’s important that managers are aware of what’s happening at the lab, so that improvements can be made as necessary. Your complaint just might help another family have a better experience.
A note on urine samples. For urine samples taken by a catheter (e.g. samples that require a “clean catch"), the above mostly applies. Ask if the urine has to be a “clean catch” (clean catches are usually required only for UTI diagnostic testing but not for biomarker or metabolic testing). If a clean catch is not necessary, ask for a pediatric bag/cup from the lab. This will be much less invasive and easier on you both. You can try the pediatric bag (it sticks on…my daughter hated them). After using pediatric bags several times, I have a much easier method to suggest.
My Pediatric Pee Collection Method. If your child is potty-trained, have them pee in their potty and collect the sample (easy peasy). If not, it’s just a little bit trickier. Buy a kid’s potty. Start in the morning. Load your child up on their favorite fluids. And keep their pants and diaper off. Keep the potty nearby and watch your child like a hawk. When they start to pee, get them to the potty and try to collect the pee in the potty. Pour the pee into the sample cup (use a funnel, if needed). You’ll probably get enough the first time — usually just 1/4 of the cup is all that’s needed, unless otherwise specified. If you don’t get enough the first time, refrigerate the urine you’ve collected (in the sample cup). And start round two — continue with lots of fluids. Continue until you have what you need. Re-diaper your kiddo and drop off the sample at the lab.
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