How to Coach Your Child Through an IV Start

So before I get to the nitty gritty we need to talk about scenarios for a child getting a blood draw or IV. There are typically three of them:

  1. You are in an emergency. There is no time to waste and it must be done quickly.
  2. It’s an unexpected procedure and it’s happening now but you have a bit of time to prep (at least 45 minutes).
  3. You know days or weeks ahead of time that it will have to be done.
Let’s talk about strategies for scenario one first: an emergency. It goes without saying that this is a high stress situation. You are going to be freaking out inside and it’s very easy to feel paralyzed. I want you to use that adrenaline to laser focus on your child. Get close and get engaged. These tips are usually helpful for ages 3 years old and work best if they don’t have pre-existing needle fear (more on that in later posts). You’ll need to adjust what you say for older kids. Let’s set this up:
  1. As soon as you know an emergent IV/blood draw is necessary, tell the nurse you want needle-free J-Tip anesthetic. Almost every ER & medial center has this and it will be essential. The nurse may hedge a bit but I strongly recommend you stand your ground. Say with authority “We need to have J-Tip anesthetic for this placement. Can you grab that while I tell my son what to expect?”
  2. If at all possible use a second adult that the child knows to help you (dad, grandma, etc). Have the child sit on that persons lap. You will then kneel or sit in front of the child and next to the arm the nurse won’t be working on. The person who is holding the child will slip their hands loosely around their chest and shoulders as the procedure starts. Their responsibility is to keep the child’s body & upper arm still. You will slip your hand onto the child’s wrist as the procedure starts to make sure they don’t move their lower arm or hand.
  3. Get face to face with your child and say: “We need to put a teeeeeeeensy tube in your arm to get some blood/give you medicine. We are going to do this as quick and easy as we can, okay?” *Give a smile & wait for an okay back.* “The nurse is going to use a magic mist to make your skin very sleepy so that the tube will feel like a tickle, okay?” ** “The magic mist makes a fizzy pop noise like when we open a soda can, doesn’t that sound silly?” **
  4. Hopefully the nurse now has everything prepped and ready to go. Your first challenge is sometimes going to be the arm tourniquet as kids tend not to like the feeling. Tip: have them place the tourniquet over their shirt sleeve or a piece of fabric if possible. This minimizes the pulling of hair and skin. Words to use “Before we can do the magic mist, we need to give your arm a squeeze and feel around with our fingers. You can watch if you want.”
  5. When the nurse has found the vein and is totally ready, say “Look straight into my eyes while we wait for the fizzy pop sound of the magic mist, okay? Guess what? Your only job is to hold your body still as a statue. When I have to hold my body still as a statue, I like to make my eyes wiggly. Like this…. Can you do that too? Good job!”
  6. You are in full distraction mode now. Talk, talk, talk. Continue to reinforce holding their body still as a statue and distract by doing wiggly eyes and a silly face contest. The point is to keep their eyes away from the procedure at all times.
  7. Once the J-Tip is done, they should really feel nothing else. It is extremely fast and effective anesthesia which is why in an emergency situation it’s pretty much non-negotiable for my kids.
  8. Be very, very careful with your words. Children are highly suggestible. Even saying something as simple as “It’s barely going to hurt at all.” plants the possibility of pain in their mind. Words not to use: needle, shot, poke, hurt, pain, ouch, owie. Even “be brave” can create an expectation that this is something to be afraid of.
  9. If your child asks “is it going to hurt?” choose your words with caution. The best answer you can give is: “This is the extra special teensy tube nurse and she knows all the tricks.” ~ “The way to make this quick and easy is to use the magic mist and hold reaaaaaalllllly still, okay?” Don’t repeat the word “hurt” back to your child. Quick and easy are the words you want to emphasize along with telling them how they can help make that happen. You’ll also notice that I end almost every phrase with “okay?”. I’m angling for a subconscious agreement because “okay” is a child’s natural response.
  10. When you are finished, reinforce! “Wow! You were the best still statue ever! Are you so proud of yourself?”
Now on to scenarios two and three. If you know ahead of time you are going to have this procedure your best plan of action is to prepare yourself. Read over these tips several times. It is worthwhile to make this a pleasant experience for your child because it will set the tone for future procedures. And, honestly, we have really great ways of preventing pain during draws if you know to ask for them. Do not ever let a nurse talk you out of using the numbing options. Stand your ground.
If you have a child under the age of 9, I do not usually recommend giving them advanced notice of the procedure. If you have a child over the age of 9 or 10 then you may want to give them a gentle heads up on the day of. The best reassurance for that age group is to tell them you have arranged really great numbing options so that they can relax. No matter the age, bring several distraction tools: iPad, books, iPod, etc
  1. Have the nurse check the child’s veins and tell you the place they are going to try first and second. About an hour before the procedure apply a topical numbing cream to all the areas that might be used. This cream is usually called EMLA or LMX. It is globbed on and covered with a dressing. In my experience you need at least 45 minutes for it to be completely effective. Don’t fudge on the time, longer is better.
  2. I have tested EMLA cream on myself, it is extremely effective which is why it is completely non-negotiable for my kids anytime they have any type of shot, IV or draw. Once the skin is numb it stays numb for quite some time. This even helps with post-procedure discomfort.
  3. As you are applying the cream say ”We need to put a teeeeeensy tube in your arm to get some blood/give you medicine. We are going to do this as quick and easy as we can, okay?” *Give a smile & wait for an okay back.* “I’m going to put on this magic cream to make your skin very sleepy so that the tube will feel like a tickle, okay?” ** “Doesn’t that cream feel cool and nice?” ** “This magic cream takes a little bit of time to work so we need to leave it on for a while, what kind of game do you want to play while we wait?”
  4. Bring a second adult that the child knows to help you (dad, grandma, etc). Have the child sit on that persons lap. You will then kneel or sit in front of the child and next to the arm the nurse won’t be working on. The person who is holding the child will slip their hands loosely around their chest and shoulders as the procedure starts. Their responsibility is to keep the child’s body & upper arm still. You will slip your hand onto the child’s wrist as the procedure starts to make sure they don’t move their lower arm or hand.
  5. When the cream has had to time to work and the nurse is prepped and ready, get in position face to face with your child. Your first challenge is going to be the arm tourniquet as kids tend not to like the feeling. Tip: have them place the tourniquet over their shirt sleeve or a piece of fabric if possible. This minimizes the pulling of hair and skin. Words to use “We are going to give your arm a squeeze with this rubber band and feel around with our fingers. You can watch if you want.” “Can you feel how sleepy your skin is right there?”
  6. When the nurse has found the vein and is totally ready, say “Look straight into my eyes while we let the nurse wash off your arm, okay? All you are going to feel is tickles. Guess what? Your only job is to hold your body still as a statue. When I have to hold my body still as a statue, I like to make my eyes wiggly. Like this…. Can you do that too? Good job!”
  7. You are in full distraction mode now. Talk, talk, talk. Continue to reinforce holding their body still as a statue and distract by doing wiggly eyes and a silly face contest. The point is to keep their eyes away from the procedure at all times. Alternatively you can hold up a mobile device playing their very favorite movie or show. It needs to be held so that your child’s face is turned away from the procedure.
  8. Be very, very careful with your words. Children are highly suggestible. Even saying something as simple as “It’s barely going to hurt at all.” plants the possibility of pain in their mind. Words not to use: needle, shot, poke, hurt, pain, ouch, owie. Even “be brave” can create an expectation that this is something to be afraid of.
  9. If your child asks “is it going to hurt?” choose your words with caution. The best answer you can give is: “This is the extra special teensy tube nurse and she knows all the tricks.” ~ “The way to make this quick and easy is to use the magic cream and hold reaaaaaalllllly still, okay?” Don’t repeat the word “hurt” back to your child. Quick and easy are the words you want to emphasize along with telling them how they can help make that happen. You’ll also notice that I end almost every phrase with “okay?”. I’m angling for a subconscious agreement because “okay” is a child’s natural response.
  10. When you are finished, reinforce! “Wow! You were the best still statue ever! Are you so proud of yourself?”
Well those are my basic tips and strategies for blood draws and IV starts. I’m going to follow up with a post soon on how to handle the situation when things don’t go as planned or you have a very fearful child.
About Emily

Hi, my name is Emily. I’m a wife, mother, christian, momcologist, doula, writer, nerd, entrepreneur and dreamer. I like Apple products, chocolate, books, lists, being pregnant and the color purple. I fancy myself as a quirky combination of dreamy Anne Shirley and feisty Scarlett O’Hara but in a schizophrenic sort of way. Read on...

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