Tips to Help Children through Their Medical Tests

Because children's veins are smaller and the amount of blood withdrawn needs to be carefully monitored, paediatric patients are treated with special care when their blood is taken. A more experienced nurse is usually involved and may be helped by an assistant. 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, 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 (a pop-up book, for example) or singing a favorite song or nursery rhyme. 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, the child can rehearse sitting still and you can join in 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'. 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 taken is difficult even for grown-ups, 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 while having their blood taken. The parent can be face to face with the child, while the child is lying down, providing physical comfort, distraction, and assistance.

Count to 3 and Blow the Feeling Away — Blowing the feeling away can be a useful technique, because the slow exhale helps keep veins full and loose, which makes it easier to take the blood sample. 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 phlebotomist, 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 nurse will be less inclined to insert the needle prematurely.

Don’t Expect Just A Finger-Prick — Parents often make the mistake of telling their children that their blood test will require just a finger-prick. The surprise of a different approach can unnerve a child. Most diagnostic tests require a larger sample, which would be obtained from a vein, not a capillary. You can inquire if a finger-prick option is available, but know which method will be used when you talk to your child so you can provide the most assurance.

Children sometimes balk at the idea of collecting their urine in a cup, particularly if the idea is new to them. The assistance that may be required can seem like an invasion of privacy, and intervention with this excretion function can seem inappropriate. A child’s resistance can prolong the collection process, making it more stressful for the child and the parent, so you will want to prepare the child and comfortably guide him or her through the process. The procedure itself is not painful unless there is an infection or rash.

Here are some suggestions to minimize the stress of the moment.

Anticipate — Inquire at the time you make the appointment if a urine sample will be required (for example, if you suspect a urinary tract infection). You may also want to know if it must be a sterile specimen so you can prepare the child to wipe first.

Rehearse — Letting the child rehearse may be helpful. If you know before your sirgery visit that a urine sample will be needed (for example if there is a suspected urinary tract infection), spend some time the day before or that morning preparing your child. Ask the child if he or she can do this trick: let a bit of urine out into the toilet, then stop the flow and start again. Tell the child he or she will be asked to do this at the doctor's surgery.

Raise Their Comfort Level — Explain that even grown-ups collect a sample of urine this way when their doctors need them to or that even mothers need to use the towelettes when a sterile specimen is required. Assure them this is a normal procedure that is not difficult.

Drink Up — Encouraging the child to drink before the surgery visit can help the child need to urinate when it is time to collect the sample.

Simplify — Ask what supplies are on hand to make the collection as easy as possible. For a younger girl, putting 3 to 4 urine specimen cups in a potty seat may allow you to collect the sample more easily than catching the flow midstream in a cup. A receptacle placed in the toilet, such as a bedpan, can be simpler and more familiar for a child than catching urine in a cup.

Cope with Pain — If urination is painful due to infection or a rash, there are several strategies you can use. One is to suggest the child 'blow the feeling away' by blowing out a breath just as the urine starts to flow. Introducing this idea in advance gives the child time to rehearse technique. You can also suggest focusing on another body part, for example, feeling mother’s hand on your forehead or a cool cloth on your leg. Dripping cool water over the irritated area just as urination begins can be soothing (but cannot be used if a sterile specimen is required).

Turn on the Tap — The sound of running water can help the child begin to urinate.

Be Cool — For an adolescent who may be embarrassed to carry a urine specimen through the hallway, you can ask for a bag or other suitable camouflage.

Make It Interesting — When the test is for protein in the urine, tell the child the nurse will have to dip a special paper strip into the urine for a colour test.

Most older children are 'turned off' by the suggestion that they need to provide a stool sample for testing, even if they can do it in the privacy of their own bathroom. Fortunately, stool samples are not routinely required for children. 

Except for infants in nappies, from whom a sample can be collected from a soiled nappy, the procedure is the same as for an adult. The child, however, will probably need an adult to set them at ease about how the sample will be collected and to transfer the sample into a suitable container for transport to the doctor's surgery or diagnostic laboratory.

Here are some tips to make sample collection go smoothly.

Acknowledge Embarrassment — Acknowledge the child’s reluctance by saying something like "I know this may be embarrassing for you. It can be embarrassing for a grown-up who has to do it, too, but we need this because..." A statement such as this gives the child permission to express his or her feelings and become more comfortable in accepting the help required in this situation.

Simplify — Loosely fitting a sheet of plastic wrap over the toilet bowl but under the toilet seat allows the child to proceed fairly normally with a bowel movement. The child can then call an adult to remove the plastic and specimen. A bedpan placed under the toilet seat can work in the same way. A younger child can simply use a potty seat with its own collection container. In most cases, you do not need to be concerned about whether or not the sample has been contaminated by urine.

Throat cultures can be intimidating to a child, but they do not need to be traumatic. The procedure causes only a moment of discomfort (a 'gagging' reflex) as the swab makes contact. Explaining the procedure to the child and giving the child some control and coping methods helps, both in getting through the moment and for the next time, too.

Throat cultures can be challenging; a child who is fearful and does not trust the nurse may refuse to open his or her mouth, which can raise the stress levels and anxiety of everyone in the room. The encounter may be more difficult if the child has had a bad experience previously, for example having a tongue depressor forced into the mouth. It may be harder for the child to trust the medical personnel after an incident in which he or she was forced.

To put the child at ease you can show the child a swab, give the child a swab to hold and touch, and explain that the swab, which will be put into the mouth to collect a sample from the throat, is just like a big cotton bud.

If you anticipate a difficult time, ask what steps can be taken to avoid a struggle and create a non-intimidating situation for the child.