How to prepare for blood sampling with children of different ages

Giving blood samples with children is often a stressful but necessary situation. SYNLAB Senior Laboratory Technician Virge Jürjenson and Clinical Psychologist Marileen Olenko at Tallinn Children’s Hospital share their experiences and advice for making the procedure easier.

Marileen Olenko: "We cannot take pain or fear away from a child, but we can prepare them for it."

There is probably no child or parent who would really like giving a blood sample, but sometimes younger patients are so afraid that the tests can be delayed or, even worse, not done at all. SYNLAB Senior Laboratory Technician Virge Jürjenson and Clinical Psychologist Marileen Olenko at Tallinn Children’s Hospital share their experiences and advice on how to avoid unnecessary stress during blood sampling.

"We cannot take pain or fear away from a child, but we can prepare them for it," shares Clinical Psychologist Marileen Olenko. According to her, there are no such children who cannot give a blood sample, but it must be taken into consideration that children are different.

Some children face new situations more courageously and others less so. "The situation is similar to children playing on slides in the water centre. Some are brave, some are cautious and others are too courageous," she adds. Growing up, a person learns to deal with their anxiety and fear more and more. Apart from the child’s own nature, how often they have to do this procedure and how it has gone before also play a significant role.

Virge Jürjenson, senior laboratory technician at SYNLAB, talks about her experience that children tend to be afraid of blood sampling and need more time and adaptation. It is worth arriving early so that the child has a chance to get used to the environment or, if possible, get comfortable in the play corner.

According to Jürjenson, it is more difficult for children to go without eating or drinking, which is necessary for many tests. "We consider taking samples from children a priority so that they don’t have to wait a long time behind the door when their mind is actually ready," she notes and adds that an empty stomach makes the mood worse and sometimes fainting occurs during the blood sampling procedure as a result of not eating. For this purpose, glucose tablets and water are ready in the sampling room. "We draw parents’ attention to the fact that children should not put candy or gum in their mouths during the procedure because they may pull it into their throat when they cry."

A glass of unflavoured and non-carbonated water before giving a blood sample is allowed. In the case of blood collection with a child, it is important that the child has consumed enough water before giving blood, as this makes blood sampling easier.

Blood sampling is more difficult for a child with an anxious parent

Small patients cope with fear in different ways, but the interaction between the child and the parent plays an equally important role, the psychologist emphasises. It often turns out that blood sampling is more difficult for the child with an anxious parent.

"The smaller the child, the greater the role of the parent – how they stand this painful procedure themselves," she adds. If the parents are afraid and it is difficult for them, the child perceives this quickly.

Therefore, it would be good to first agree at home which parent is calmer and better at comforting in these situations and whose level of anxiety will not get too high if things do not immediately go as planned. Based on experience, Virge Jürjenson shares that the blood sampling of children who come to the procedure with their father often goes more smoothly and without much crying.

Often the parent becomes anxious because the child behaves as unexpectedly. In such a situation, it is easy to start arguing: "we talked about this" and "you promised", which does not make the procedure easier for either party. "Children do cry and are afraid; such behaviour is definitely not something to be ashamed of and there is no need to apologised to the staff," Jürjenson notes. "It is important to praise the child even if they cry."

According to Marileen Olenko, if the patient is a child, they need to be guided by their parent. At a certain moment, the staff communicates with the child, shows them where to sit and describes what is going to be done. However, if the situation does not go well and the parent becomes anxious, for example, starts to get angry with the child, it is more reasonable for the staff to calm down the accompanying mother or father first. The child regulates themselves with the help of the parent, so the child can be reassured and directed through the parent.

How to talk about blood sampling at home

Regardless of the child’s age, they should not be told that it does not hurt at all. "You shouldn’t negate the feeling," says the psychologist. SYNLAB’s senior laboratory technician agrees and adds that it is better to say that it is an unpleasant feeling, but it is important to justify why this procedure is necessary despite the pain.

Playing through the procedure helps younger children. "You can safely prepare for the procedure at home, and in this case not all stimuli are new in the sampling room," Marileen Olenko advises. At home, for example, you can play that the child takes a blood sample from mom and dad, dolls and cars and plays through other similar activities.

Playing through the procedure helps younger children.

Olenko also recommends the sting game. This means trying to make a sting on the skin with a pencil and trying to guess how strong the sting will be – whether it is similar to a mosquito bite or something else. "It gives the child more tools to cope with the situation," she adds.

With older children, the pain scale can be discussed in more detail and they can be taught to assess the upcoming pain. For example, they try to assess whether the pain is three or five on a ten-point scale. According to the psychologist, this helps to understand what can be expected and gives the knowledge that it is not so scary. The child feels supported if they can somehow visualise the duration of the procedure – in this case, use an exciting clock, even an hourglass, which shows that the procedure does not last long, for help.

Rewarding children with some great activities is also suitable. "This is not a buy-off, but an agreement that after the effort the child makes, a reward will follow. Most of the time, children cannot motivate themselves internally for such a procedure and they need an external motivator," explains Marileen Olenko.

In addition, it is useful to keep the child’s attention elsewhere during the blood sampling, for example by showing them a cartoon or a toy. It can also help to teach your child how to breathe calmly and deeply during the blood sampling.

After the procedure, it is good to calm down in the same room with the same people

Regardless of whether the blood sampling was completed or not, according to the psychologist, it is good to calm down for a few minutes in the same room and with the same people in order to have a safe experience. You often want to leave quickly, but in terms of a positive experience, it is safer to stay and talk, to see together which cap was put on the tube or which patch is suitable. A sticker or another such gift should be given as a reward for blood sampling when the breathing has returned to normal and the child has calmed down.

At SYNLAB, there are special vitamin bites given to brave patients after the procedure along with a diploma – which children especially like straight away. "The main thing they fear is the moment of the sting," says Virge Jürjenson and adds that after receiving the diploma, the stinging has already been wiped from their minds and they admit with a smile that it wasn’t so bad.

If the blood test was not completed, it is also good to stay in the same room with the same staff until the child has calmed down. Then it would be good to arrange the next time with the child, but not much later – according to Marileen Olenko, you should come back somewhere in three or four days and practice for it in the meantime. It is more difficult with smaller children, but with 5-6-year-olds, you can make appropriate agreements.

Once a new agreement has been reached, it is worth reminding them a few times, but refrain from raising this topic too much. The parent must know their child and understand when and how much to talk about it so that the practice increases confidence and does not create anxiety.

If you cannot postpone it

SYNLAB’s senior laboratory technician pointed out that it is not always possible to postpone blood sampling – for example, if an operation awaits or the result of the blood test is decisive in some other way. In this case, it may be necessary to call in additional personnel. This is especially important when taking a venous blood sample, where keeping your arm still is important for the quality of the sample result.

Even today, most samples are taken from venous blood because taking blood from the elbow is the safest in terms of haemolysis (breakdown of erythrocytes). "Drawing blood from other areas more often causes haemolysis, which can interfere with the determination of the corresponding blood indicator or render it not possible to issue the analysis result due to haemolysis of the sample material. Thus, whenever possible, venous blood sample is preferred, which gives more accurate results," explains Jürjenson.

"The blood collection procedure is inevitably painful, and the fact that there are strangers around also causes discomfort, but sometimes this procedure is important for further treatment," state both experts and add that most of the time the child’s hand is held by the parent when the venous blood is taken. Even in this situation, it is important that the child can calm down and talk in the same room with the same people and then get their vitamin bite, a sticker and a diploma in order to create the best and safest possible blood sampling experience for the child.