Children typically require fewer tests than adults, but there are times when children need lab tests and a helping hand to get them through the procedure. A caring grownup can help the child cope with any physical pain or discomfort as well as any fear, anxiety, or emotional reactions that may occur as the sample is collected. Below are some general recommendations on helping children through these medical procedures as well as some specific tips on blood, urine and stool specimens, and throat culture sample collections.
Prepare the Child — Calmly explain how the sample will be collected and why, giving the child time to adjust to the idea before anyone touches his or her body.
Encourage Rehearsing — At home or in a setting comfortable for the child, suggest ways the child can rehearse. The child can practice some techniques at home or pretend with a doll or stuffed toy as the patient.
Help the Child Put it in Perspective — Relate the part of the procedure the child may find overwhelming to something the child has mastered or is familiar with; for example, explain that this will be over as fast as it takes for you to climb stairs at home or in less time than a certain song can be sung.
Plan a Reward — Telling the child about something fun you plan to do together after the lab test can be helpful as encouragement and distraction.
Tips for Each Type of Sample
Because children’s veins are smaller and the amount of blood withdrawn needs to be carefully monitored, pediatric patients are treated with special care during their blood draws. A more experienced technician is usually involved and 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 or singing a favorite song. You can ask, “Do you want to see how the nurse does this, or do you want to look at this book with me?”
Rehearse — Suggest a way the child can practice at home beforehand. For example, the child can rehearse sitting still and you can review 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” — Tell the 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 drawn is difficult even for grownups, but avoid coaxing the child with statements such as “be good” that can make the child feel ashamed.
Stay with Your Child — Parents are usually encouraged to stay and help their child during a blood draw. The parent can be face-to-face with the child, while the child is laying down, providing physical comfort, distraction, and assistance.
Count to 3 and Blow the Feeling Away — Blowing the feeling away is a useful technique. The slow exhale helps keep veins full and loose, which makes blood easier to draw. 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 technician, 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 technician will be less inclined to insert the needle prematurely.
Don’t Expect Just a Fingerstick — Parents often make the mistake of telling their children that their blood test will require just a fingerstick. 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 fingerstick 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 elimination 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, when you suspect a urinary tract infection or are preparing for a kindergarten physical). You may also want to know if it must be a “clean catch” (a sterile specimen) so you can prepare the child to wipe with towelettes first.
Rehearse — Let the child rehearse. If you know before your office visit that a urine sample will be needed, 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 clinic or doctor’s office.
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 office 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. 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. 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 your parent’s hand on your forehead. 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 halls, you can ask for a bag or other suitable camouflage.
Make It Interesting — When the test is for albumin, or protein in the urine, tell the child the nurse will have to dip a special paper strip into the urine for a color test. Ask the child to guess what color the strip will turn, and ask the nurse if the child can watch the strip being dipped. Or ask the child to guess what color the urine will be in the cup: golden yellow, pale yellow, clear, etc.
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, from whom a sample can be collected from a soiled diaper, 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 office or 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 grownup 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 call an adult to remove the plastic and specimen before placing urine or toilet paper in the toilet bowl. A bedpan placed under the toilet seat can work 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 swabs 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.
Throat swabs can be challenging because you have to have the child’s trust. 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 is more difficult if the child has had a bad experience previously. Perhaps the child was held down or had the tongue depressor forced into the mouth. It is 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, try showing the child a swab, giving the child a swab to hold and touch, and explaining that the swab, which will be put into the mouth to collect a sample from the throat, is similar to a big Q-tip cotton swab like they have at home.
Health practitioners may have other techniques that they have found helpful, such as having the child open his or her mouth and scream one time loudly. The scream pushes the tongue down, eliminating the need for a tongue depressor, and the swab can be quickly inserted and removed.
If you anticipate a difficult time, ask what steps can be taken to avoid a struggle and create a non-intimidating situation for your child.