Dear Ele,

There was a recent set of posts on this topic:

http://www.congenitaladrenalhyperplasia.org/mb/main/0529534711/

Hopefully they may help.

At this age, if it was me, I’d be trying:

- EMLA (tell her it won’t hurt - she’s so young she won’t really take it on board, but hopefully after a few blood tests she’ll realise it doesn’t hurt as much anymore) every single time, so that she can trust that it won’t hurt her. Explain to her that it’s magic cream.

- wrapping her in a sheet for the blood tests, with her lying flat on a soft bed / bench, keeping her other arm and legs firmly secured. Some people hate the idea, and it might sound extreme, but her strength is impeding the process, and she’s just getting more and more worked up. Get experienced people to help do it. After a few tests, when she’s a bit more relaxed about the whole process, it won’t be necessary anymore.

- talking to her calmly and stroking her hair the entire time the test is being done. Distract her attention as it’s done - "can you see the bird" "Can you see the fairy" etc etc - and point to things in the room.

- getting the most experienced person at the Lab to do the actual blood test. Even ring them ahead of time to explain what you’re going to need / want to do.

- play a game / introduce some concepts at home (eg. the tourniquet) - try and find this article:

2001                                            Meet Wilbur the Worm (Creative Nursing Interventions for Helping Pediatric Patients Through Starting an Intravenous Line), PENS Reporter, Volume 13, Issue 1, 2001.

 

- make sure the shoulder and elbow joint are kept completely straight and aren’t able to bend during the blood test (eg hold one hand gently under the elbow joint to keep it straight). Get someone else experienced to do this - your job is to talk and distract her at this stage.

 

- praise and treat when it’s all over.

- talk about the experience once it’s over, and continue to role play the positive experience at home before the next test.

 

Just some ideas, but it sounds to me like it’d be good to break the cycle she’s in...

 

All the best,

Louise.