Sedation for blood test for teenager?

[Thisisarubbishusername]

Has anyone’s teenager been given nasal or other sedation at an NHS hospital to allow a blood test to be administered to a severely phobic teen? Our son needs blood tests but has a severe phobia of fainting during/after the procedure, after having fainted before. I’m not sure that all the CBT, distraction, preparation and other techniques he’s trying are going to be enough. Thank you.

I can empathise op. Last time mine needed bloods done it took two attempts (appts) and they had to lay down and wait a while afterwards. They're autistic and no, tough love doesn't work. The nurse advised us to get emlea? It's a numbing cream so we tried that for the 2nd appt which seemed to help a lot.

Thanks for posts this morning .

@BertieWoostersChaps as I’ve said, I acknowledge this doesn’t compare with cancer treatment. my own goddaughter passed away after years of harsh treatment for a rare childhood cancer, so I am well aware of the immense suffering.

This post wasn’t intended to start a competition. Validating and trying to help with my own child’s difficulties does not mean I think they are worse than cancer or other illnesses. Both things can be hard.

Also to note we are all different and whilst tough love may work for some - and indeed is an approach that works for our other child - it doesn’t work for our son. Thanks all the same to those suggesting it.

What is the blood test for and is the benefit of him having the test, greater than the distress of him having the test?
Also would he tolerate a. Finger prick blood test? Some children's hospitals can get blood that way instead.

@Geneticsbunny hes having it on advice of paediatric endocrine consultant. He understands the medical necessity of the test and feels very determined to have in cold light of day when able to think logically. He has finger prick tests and equivalent for a peanut allergy and tolerates them well. I don’t think a finger prick test would enable his blood to be tested for possible endocrine issues though unfortunately.

It is worth asking as it depends on the testing needed. They do a finger pink and then squeeze the blood out in drops until they have filled a small tube. Would be enough for a dna test and for quite a lot of the clinical chemistry tests depending on which is most important. Do you have the bloods form? It will be written on there.
If you ring the secretary for endocrinology and explain the struggles your son is having and ask if a finger prick would work they will be able to tell you.

@Geneticsbunny thank you for they suggestion, I didn’t know that was possible. It might be a good solution. I’ll ask. X

The tough love thing … I’m a believer in this too but think the above suggestion is daft as while yes, in the grand scheme of things a fear of fainting isn’t the biggest if you have the fear, you know it’s irrational but once it’s there and learned behaviour/responses are ingrained it also need a little compassion and it can be over come.

OP I was once this teen and the response followed me into adulthood (thanks, tough love). Then one day when having weekly blood tests following a miscarriage I was looked after by an absolute angel of a phlebotomist who -

Made sure my bed was almost but not quite completely, vertical
windows open
encouraged me to lie down and just get my breath for a moment
had all her paraphernalia ready but where I couldn’t see it
was unbelievably quick, skilled and so good at her job. I had no idea she’d done it 😁
she barely said two words to me (sometimes the chat used to distract me has the opposite effect) but was so kind I almost cried with relief when for the first time since being a kid, I didn’t faint.

After several weeks of seeing her I’d pretty much beat it as we did the same things every time. After our last appointment DH took me out for a greasy spoon cafe breakfast to celebrate 🙂

Now when having tests done at my gp’s I keep a note in my diary of who the lovely nurses are and if possible only see them.

Hopebje gets on ok, OP

I have been known to take a towel to the dentist and physically lie down on the floor after my anaesthetic! I now have a much nicer dentist and wonderful assistant who know my anxiety around this and are proficient but gentle, don’t make me feel stupid and touch wood, all been good.

Also OP once he can have that one occasion when he’s actually ok it will help massively.

Fainting really sucks though … I find it takes me all day to recover, I feel like I’ve been hit by a bus

@tellmewhenthespaceshiplandscoz thanks for sharing and for your tips x

Might be worth writing an exposure ladder with him too as that would be the way to tackle overcoming the fear. So break the process down into small stages staring with something that he can already do but is at the top limits for him at the moment and then moving up in tiny steps with full blood test being the final step. That way he can see progress and just take it slowly until he can manage to achieve his objective. You can do the steps lots of times if needed or go back a step. So him getting used to being in the hospital and the waiting room until that is totally relaxing and normalised, then the blood room, then lying on the bed in the blood room, then the arm strap etc.

To all those posters advocating for tough love and talking about big girls' blouses, previous posters have already covered the pointlessness and cruelty of that approach, but there is also another perspective, which is a wider clinical one.

Vasovagal syncope is very much a real thing and not something that a person prone to it can control. It is also a significant consideration for the medical team, as, sometimes, the faints can be difficult to manage. Occasionally, patients will take a long time to recover their blood pressure, and it is not unheard of for the crash team to be called to help support them. This is obviously deeply unpleasant for the patient but it will also disrupt the clinic and delay appointments for other patients.

@Thisisarubbishusername is therefore very much doing the right thing here. Taking the issue seriously and figuring out a solution is in everyone's best interests.

Best of luck to you both, OP, I hope you find something that works. The finger prick method might be a sub-optimal but workable solution, definitely available for some endocrine bloods, so worth asking about.

@QuinqueremeofNiveneh thank you for using your comments and for saying you think I’m doing the right thing. It’s easy enough for parents in positions like this to second-guess ourselves even without people jumping on the tough love bandwagon. Really appreciate you taking the time to share your views and experience. X

She dd was in pre-puberty stage, she would let me bear hug her. She was panicking and fighting, but she also agreed to the process. It was one of those “fun” ASD compromises. By the time she got too big for this, she got over it and could do it independently.

he is going to be too old for that to work though.

the first time we did it without the bear hug I insisted on EMLA cream.

just brainstorming, is there anywhere that they have like recliners instead of just chairs or flat tables. If he felt nestled in and supported, even if he does pass out, it might not be as frightening.

Stupid comment. Do you not have any issues in your life?

Sore joints, parent with dementia, unexplained confusion, hormonal issues, bad period pain, child not eating well, torn meniscus, flu, boss a nightmare? Well fuck you, you don’t have cancer so you’re not allowed to feel stressed or frightened by anything ever.

See how stupid that sounds? Some children have cancer… that doesn’t mean that this child isn’t struggling because he has a phobia (that’s an overwhelming fear) and has to have a needle jabbed in his veins because he’s also having medical investigations. A child scared of a medical procedure is to be sympathised with not told to just get over it because other people have cancer.

wow - really measured response there 👏

Why would I need to be measured?

Couldn’t agree more x

I’ve been on a kid’s oncology ward, I’ve seen toddlers screaming as they are cannulated for chemo. I’ve also seen children whose veins have collapsed because of the amount of drugs they have had running through them and they are having blood taken from their ankle or neck.

So, yes, I’d be very much in the “tough love” team and doing everything I possible could to make it easier for the staff having to deal with this.

@Thisisarubbishusername I'm not sure if this helps but DD is autistic and has to have yearly bloods for a lifelong condition. She has become severely phobic of blood tests and has vasovagal syncope, so I asked the hospital to help.

DD had over ten, weekly sessions with the play therapy team. She coloured whilst they talked with her as that was less stressful. They worked through a fear ladder, and slowly made a plan for the blood test. Way before the actual test, and when she was ready, she looked in the doorway of the room. The next week she walked slightly into the room. The week after she sat on the chair for a moment.

On the day, she had a laminated plan which the staff knew to stick to, plus a double length appointment.

EMLA cream an hour and a half before, loads of it everywhere!
Drank lots of water before.
Kept warm wrapped in jumpers (being cold slows the blood flow)
The nurse filled a glove with warm water and put it on the skin first to warm it.
DD sits on my lap, she won't lie down unfortunately.
A sweet just before and during the blood test.
A very slow recovery as she often doesn't pass out until after the test.

We're going back to the play therapy team for support with vaccinations next.

Haven’t read all replies.

but where I work. We often get teens coming for blood tests and they can’t/wont do sedation. Because they have to come in as inpatient and often the beds aren’t available (because they’ve got to be Monitored for so many hours afterwards. We have a paeds ward and a paeds assessment ward but often most are too full and busy to accommodate sedation of a bigger child (the dose they need to for sedation is massive, obviously weight depending) I’ve seen them use Ketamine one to get an mri done but that was with a severely autistic teen.

things you could try to reassure him

numbing cream might be give him
time to work himself up. So try the cold spray.

lay him down but not flat and ask them to attach him to a monitor so he’s reassured if he does faint he’s being looked after

and the brutal approach is just have them hold him down. Which isn’t nice! But gets the job done.

what bloods does he need to have?

Agree with this. I’m extremely tough, can push through fear for almost anything- except planes. Not just being on them, but one flying too close overhead also sends me to jelly. There’s nothing at all rational about it, it’s all linked to a random adverse experience I had as a teenager (that I just so happened to be near a plane during) and it’s unbelievably difficult to unpick. It sounds like it’s the same for OP’s DS. He’s had the bad experience with fainting, and now the response is involuntary.

In your shoes though OP, I think I’d be worried that being sedated (if they’d even do it) could reinforce the fear if he ends up feeling very out of control due to the drugs. Perhaps the doctor he’s seeing could suggest something- maybe diazepam or something, just to take the edge off? And then some phobia-focused therapy to help him long-term. I’d make it clear to the therapist that the fear is of fainting, not of needles per se. I did a course that was focused on the safety of flying, but because it didn’t address my core fear (which is not crashing and dying), it didn’t really help much.

I’m sorry for your experiences. That sounds so heartbreaking and i have so much sympathy for you and everyone going through such horrors. I know how terrible it was for my goddaughter and her family when she was going through chemo and other treatment.

however that doesn’t mean that tough love would necessarily work or should have to work for our son. And we go out of our way to show our gratitude to the nhs staff who are helping him.

Thanks for your understanding. I am by no means set on sedation, it was just a question about whether it would eve be a possibility. I’ve taken on board lots of the comments here about how it might create similar sensations to fainting. I’ve also had a long chat with one of the endo nurses and we have a plan for how to help our son further whiter going down that route. We’ve tried phobia-focussed therapy already, including graded exposure, which has been really helpful for other scenerioz but this one is proving more difficult.