Ask the Experts
Many parents have questions for the doctor or nurse when it comes to taking their children for a needlestick procedure such as getting an IV or blood draw. The following are some hypothetical questions that might be asked by parents such as you, with responses provided by Dr. William T. Zempsky, Associate Director of the Pain Relief Program at Connecticut Children's Medical Center, and Micke Brown, BSN, RN, Advocacy Director for the American Pain Foundation, and Ellen Hollon, CCLS, from the Child Life Council. We hope you will find these useful as you prepare for future trips to the ED or hospital.
1. Dear Nurse – I'm taking my 4-year-old son to the hospital soon for a needlestick procedure. He has been through several IV experiences before, and screamed and cried the entire time. As a mom, it was heartbreaking to watch. I tried to comfort him throughout the experiences but that seemed to make it worse. For our upcoming hospital visit, do you have any suggestions to help calm him down, and frankly, make me calmer too?
This is a common problem many parents face, but there are solutions that make a huge difference. Ask the health care professional to use a topical local anesthetic, which can be applied directly to the area where the needle will be inserted to numb the area and lessen the pain. Distraction and calming methods can also keep your son's mind at ease during a blood draw or IV. Sit him on your lap during the procedure and read him his favorite book. Distract him with a game such as Where's Waldo or sing him his favorite song. Try taking your son to a drugstore before the procedure and have him pick out a fun set of bandages and explain that he can use one after he's done with the procedure.
2. Dear Doctor – I want my son's doctor to give him a topical anesthetic prior to his upcoming blood draw procedure, but when I inquired about it I was told that my hospital doesn't keep those products in stock. What can I do?
You have the right to request topical anesthetics for your child in advance of procedural pain. According to joint recommendations from the American Academy of Pediatrics and the American Pain Society, "local anesthetics ... should be considered for even simple procedures, such as venipuncture."3 If your hospital doesn't utilize topical anesthetics, ask your doctor if he/she can prescribe one for your child that you can purchase at your local pharmacy and bring with you for needlestick procedures. You may also want to consider asking your doctor if it's possible for topical anesthetics to be put on the formulary at the hospital.
3. Dear Doctor – What are the most important questions I should ask my pediatrician before my 8-year-old daughter's hospital visit that involves needles?
It's important to ask your doctor the "what ifs" in advance. What if she cries? What if she throws a tantrum? What if she can't sit still? What if she tries to "escape"? It's important to gain an understanding of your doctor's game plan just in case any of these scenarios play out. You want to be able to feel confident that your doctor and the hospital staff can provide a comfortable environment for your daughter should she become distressed. Also, encourage your daughter to ask questions, help her write them down or draw her concerns so she can share them with her pediatrician.
4. Dear Doctor – My son has extremely sensitive skin, and I want to make sure he is given a topical local anesthetic at his next appointment involving a needlestick
procedure. Will this cause him to have an allergic reaction?
Ask your doctor about which topical anesthetic he plans to use and make sure he is aware of your son's skin sensitivity in advance.
5. Dear Nurse – I am approaching my first visit to the hospital with my 5-year-old son that involves a needlestick procedure. How can I best prepare my son for this experience and is there anything I should or should not do in advance or during the visit that will help him through it?
There is plenty you can do in advance to help him. As the "fear of the unknown" is often the scariest part of the hospital experience for children, one of the best ways to ease his anxiety is to prepare him appropriately. Work with your son to simulate the visit using dolls, cars or other toys. Let him practice not only his own role, but the part of the doctor and parent, too. (Make sure the parent and doctor are acting calm and matter-of-fact in these scenarios.) This will empower your son to understand what the visit will consist of. If possible, you could also bring your son to the hospital beforehand to meet one of the health care professionals that may be performing the procedure. Familiar faces are a strong source of comfort for children. Allow him to bring his favorite doll or toy with him to the hospital. The health care professional can mimic the procedure on the doll/toy first and make it game of "take turns" during the procedure.
6. Dear Nurse – I used to be the child who had a "needle phobia" and now I'm the parent with one. How do I reassure my 8 year old daughter when I have needle phobia?
Always remember that an anxious parent equals an anxious child. Reassurance may heighten anxiety, so avoid making comments that include pain, such as, "It'll just be a little sting" or "You'll only feel a little prick." Warning your daughter will only increase pain and anxiety, as does sympathizing with her. Instead of asking her if it hurts, ask her what she's feeling and encourage her positively. To calm your own nerves, give yourself a role that will help her. Hold her on your lap and tell her a story, which will help distract both of you! Plan for a fun event after the procedure that both of you can look forward to as a special "prize." Have a friend or loved one who is a calming influence on you come along for support. Remember to use those special "mommy or daddy" ways that you use to soothe your child. It may be the way you stroke her hair, rub her back, touch her fingers or hold them. Your special presence has a profound effect on your child that no other person has that is powerful.
7. Dear Child Life Specialist: How can I help my child cope with the hospital so that she/he doesn't have long-lasting negative effects from the experience?
First, plan to be present with your child as much as possible. You will be much better able to support your child when you are rested and well fed. Seek assistance from the child life specialist to establish a "coping plan" for you and your child to use during stressful times. If a plan is created in advance, and everyone's job is clearly understood, procedures will go much more smoothly for all involved. If your child does have difficulty coping with specific aspects of the hospitalization, he or she might benefit from engaging in "medical play" or "play with a health care theme" with the child life specialist to address those specific issues. Additionally, you can help your child cope through your openness to discuss hospital related issues; this will help your child to know it's okay to bring up concerns. Finally, after your child returns to familiar home and community, continue to discuss the hospitalization experience so that your child can frame it in as positive terms as possible.