Tips to help children

The Royal Children’s Hospital Melbourne has produced a series of useful videos to help prepare children for the tests they are having. Go to Be Positive’ on the hospital website. Our video on the front page, 'Abby's Tips' is from this source.

Although routine testing is less often requested for children than for adults, there are times when children need pathology tests and a helping hand through them. Here are some suggestions to help children through these procedures as well as some specific tips on blood tests, 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 comfortable setting, suggest ways to rehearse. The child can practise having the sample taken or pretend that a toy is the patient.

Help the child put it in perspective — Use something the child has mastered or is familiar with to put a time to the part of the procedure the child may find overwhelming. For example, explain that this will be over as fast as you can climb the stairs at home or before you can sing a favourite nursery rhyme.

Plan a reward — Tell the child you will have a treat ready afterwards.
 
Blood tests
Because children's veins are smaller and the amount of blood withdrawn needs to be carefully monitored, children are treated with special care when their blood is taken. An experienced pathology collector is usually involved and they may be helped by an assistant. For children older than two years of age, a vein in the crook of the elbow is the commonly-used site. 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 actively participate. Some children want to watch; others would rather look away. If the child does not want to watch, have an alternative focus in mind such as looking at a book or ipad or singing a favourite song or nursery rhyme. You can ask, "Do you want to see how the blood collector does this, or do you want to look at this book with me?"

Rehearse — Suggest ways of practising 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.
 
Prepare them for the "Ouch". Explain that it will hurt a bit but it will be over very quickly and then the hurt will go away. Before you enter the room, talk about who you will see  and what they are going to do. It is okay to tell children that having blood taken is difficult even for grown-ups.

Stay with your child — You are strongly encouraged to stay and help their child while having their blood taken.

Count to three 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 for the blood sample to be taken. It helps the child both mentally and physically. Allowing the child to count to three or to choose someone else to do the counting (the parent, nurse or phlebotomist) before the procedure 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 phlebotomist or 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 child 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 of blood, which is 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 preparation and assurance.
 
Urine specimens
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 their privacy and inappropriate. A child’s resistance can prolong the collection process, making it more stressful for both 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.

Some suggestions to minimise 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 with a towelette first. Importantly, ask if you can collect the specimen at home

Rehearse — Letting the child rehearse may be helpful. If you know before your surgery 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 doctor needs 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 — Encourage the child to drink before the surgery visit as this can help the child 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 three to four urine specimen cups in a potty seat may allow you to collect the sample more easily than catching the flow midstream in a single 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 because of 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 practise the technique. You can also suggest focusing on another body part, for example, feeling your hand on their forehead or a cool cloth on their leg. Dripping cool water over the irritated area just as urination begins can be soothing and easier for boys (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 from the toilet and into the surgery or collection area, 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.
 
Stool sample
Most older children are 'turned off' by the suggestion that they need to provide a faeces sample for testing, even if they can collect it in the privacy of their own bathroom. Fortunately, stool samples are not routinely required for children.

Except for infants in nappies, where 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.

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 that is 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 the stool. 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
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 with the throat. Explaining the procedure to the child and giving them control and coping methods helps, both in getting through the moment and for the next time.

Throat cultures can also be challenging; a child who is fearful and does not trust the nurse may refuse to open his or her mouth. This raises 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 their 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 will be put into the mouth to collect a sample from the throat and is just like a big cotton bud.

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