Preparing children before undergoing diagnostic tests

Dr David Howdijam MD
It is always a challenge for healthcare personnel to take samples from children for medical tests. While children usually require fewer tests than adults, there are times when children need laboratory tests. A helping hand to get them through the sample collection procedure is what is needed. It takes a caring grownup to help the child cope with any physical discomfort or pain as well as any fear, anxiety, or emotional reactions that may occur as the sample is collected. There are certain preparations needed on the part of the parents or the phlebotomists in the laboratory for collecting samples from children. Common samples include blood, urine, faeces, and throat culture samples.
The parents must explain calmly to the child how the sample would be collected and why. The child should be given time to adjust to the idea before anyone touches his or her body. In certain situations, the child could be encouraged to rehearse the procedure at home or in a setting comfortable for the child. The parents or the phlebotomist should help the child put the whole thing in perspective and relate the part of the procedure the child may find overwhelming. A reward in the form of a toffee or fun after the procedure might be told beforehand to the child to encourage cooperation.
The children’s veins are smaller and the amount of blood withdrawn needs to be carefully monitored. All paediatric patients are treated with special care during their blood flows. A more experienced technician is usually involved and helped by an assistant during the procedure.
No children wants to willingly participate in the procedure. That is why one of the basic things that could be done by the technician is to determine if the child wants to participate. Some children want to watch the procedure while some would rather look away. The phlebotomist have to calmly tell the child that it will hurt a bit but it will be over very quickly and the hurt will go away. The child should be properly acclimatised with the atmosphere and should be talked to nicely about why it is necessary.
Parents are usually encouraged to stay with the child during the blood draw. The parent can be face-to-face with the child to distract him or her from the procedure.
Some children do not like the idea of collecting their urine in a container, especially if the idea is new to them. The assistance that may be required can seem like an invasion of privacy, and the intervention with this elimination function can seem inappropriate. A child’s resistance could prolong the collection process, making it more stressful for the child and the parent. The procedure itself is not painful.
Let the child rehearse and know beforehand that a urine sample will be needed. The child could be asked if he or she can do the trick: let a bit of urine out into the toilet, then stop the flow and start again. The child needs to know how the urine sample should be collected.
The child could be encouraged to drink beforehand so that it is easier for him or her to urinate to collect the sample.
In instances where the urination is painful because of infection or a rash, the child must be explained calmly about the procedure and be assisted through it.
An often effective method is to turn on the tap as the sound of the running water can help the child to start urinating.
Older children are turned off by the suggestion that they need to provide a faeces sample for testing, even if they are told that they can do it in the privacy of their bathroom. Except for infants where the sample could be collected from a soiled diaper, the procedure for children and adults are the same.
The child will need an adult to tell them at ease about how the sample will be collected and to transfer the sample into a suitable container.
The parent or the healthcare personnel need to acknowledge the child’s reluctance and embarrassment. In certain cases, the child may need assistance from the parent during the sample collection procedure.
Throat swabs are usually intimidating to a child. The procedure causes only a moment of discomfort (a gagging reflex) as the swab makes contact. The child should be explained about the procedure giving him or her time to anticipate the procedure.
Throat swabs are challenging to the healthcare personnel because one needs 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 that can raise the stress levels and anxiety. The encounter can be more difficult if the child has had a bad experience previously.
Healthcare practitioners may devise their own unique ways to put the child at ease before collecting of samples to encourage cooperation. It takes skill and an acknowledgement of the child’s fears by the nurses or phlebotomists. Children are usually handled by more experienced nurses or technicians. It is both difficult and risky (of causing harm) when children fail to cooperate.
(The writer is Junior Consultant Pathologist, BABINA Diagnostics, Imphal)