Last week I posted a request for tips that would help me make Z's first experience getting blood drawn go as smoothly as possible. We got so much good advice, I thought I should summarize some of it, and then I'll tell you what happened when we went to the clinic on Monday to get the deed done.

Six tips for making blood draws easier for young kids

Many of these tips are also helpful for vaccinations, but I find blood draws, which involve long stretches with a needle inserted into the child's arm, to be particularly challenging.

1. Get a nurse who knows how to draw blood from young children. This was the single most repeated piece of advice we received, and it makes sense. A nurse who is used to sticking little veins, who likes and can empathize with young kids, and who can take an extra moment to deal with a less-than-willing patient with consideration but confidence can make a big difference.


2. Stay calm. This is easy to accept but also easy to forget. If you are able to project and maintain a calm demeanor throughout the experience, it will help your child be as calm as possible.


3. Distract your child. Readers reported candy, special toys, videos, and more working for them.


4. Make sure your child understands what is happening to them. Explain in as much detail as they'd like what will be happening before it happens. Playact the experience in advance if your child would benefit from it. But don't tell them about it at all early enough to allow them to dwell on the upcoming event.


5. Be prepared to restrain your child in comfort. Your child will probably need to be held in your lap, even if they tolerate the event, but you should be prepared to restrain them, and to do it right: Hold the child seated in your lap, with their legs between yours. While the nurse deals with the arm that will be used to draw blood, hold the other arm against the child's chest.


6. Food and drink. Sugary stuff may suppress the pain response from getting stuck. A hydrated child's veins will be easier to stick. Keep these in mind in the hours leading up to the draw. Numbing creams are also an option - some need to be put on an hour before, others 1/2 hour before, but they can also make the veins harder to find.

What we did

These tips were really helpful, and I implemented several of them. We decided to avoid any topical anesthetic and not to lead up to the event with too much advanced warning, opting instead to tell her the morning of and explain what would happen then.

I took the pediatric specialist idea to heart, and it's something I never would have thought of doing if our readers hadn't suggested it. The lab I have gone to for blood work in the past is usually understaffed and harried in the mornings, so I found another lab in town that said they had someone on staff who was well-versed in drawing blood from young patients. (I don't know if they were actually a "pediatric phlebotomist" or not, but took what I could get.) I confirmed that they'd be in the office and available to draw Z's blood at the time I needed to bring her in.

Over the weekend, while at a Starbucks, I noticed those Horizon Organic milk drink boxes, which I never let Z have because they have added sugar, even in the Vanilla flavor. They happened to have Strawberry, which Z prefers over chocolate (apparently she and our real daughter were swapped in some hospital mix-up) so I bought one, to cover the hydration and sugar recommendations in one fell swoop.

We had also recently purchased an iTeddy on clearance at Target. If you haven't heard of iTeddy, it's a media device will go down as a weird footnote in copyright law because its software allows you to (the horror) rip DVDs into a format that can be moved across devices, including a small media player that clips into iTeddy's stomach. I couldn't get it to work properly on Monday morning when i tried to set up a video for Z to watch on it. (We'll review the iTeddy on Punnybop if and when we can get it to work.) She had never even seen iTeddy before, so I figured that paired with the right video, it'd be the perfect foil. But iTeddy would not cooperate, so I packed up our laptop instead.

My DVD choice was very strategic. There are a couple of cartoons we own because we like them but will not let Z watch yet, and she is always asking about them - The PowerPuff Girls is one, and Spongebob Squarepants is another. I'm wary of the PowerPuff videos because of the cartoon violence, whereas my avoidance of showing Z Spongebob is simply that I don't think she'll get that his obnoxious behavior is not designed to be a model for her own personal development. So I decided that that day would be a "Spongebob Day" and brought a DVD along with an episode I figured she'd find very engaging.

Unfortunately we'd left the order for blood work at her grandmother's house, where she usually spends her mornings, so I had to drive her to grandma's house to pick it up before turning around and heading to the lab. I made sure she had brought a cherished stuffed animal with her (she does this routinely anyway). I pulled out the strawberry milk as we arrived at the house and I explained to her what we had to do. She was, to use a word one commenter on our previous post offered, "horrified," but then was well distracted by the milk, which she happily drank while I ran in to get the doctor's order.

On our way to the clinic we discussed the procedure, and she offered a variety of reasons why she should not have to go through with the procedure. Today was not a good day for it, how about I just do it and she watch, etc. etc. When we got to the clinic I explained that I had brought Spongebob and that she could watch it today, and she was very excited. We watched it in the waiting room and she was friendly and calm.

Once we were called in for the actual draw, however, things deteriorated rapidly. She allowed the nurse to "do it" to her stuffed animal first while she watched, but when it was her turn she got very panicky. She wasn't interested in watching the video, so my best distraction was set aside, and after a few moments of trying to work with her as she tried to buy time ("HANG ON HANG ON HANG ON HANG ON") I held her while the nurse tied a strap around her upper arm, which seemed to make her angrier than just about anything else that happened. I ended up holding her as instructed by our readers - her legs between mine, her left arm held against her chest while the nurse handled her right arm and did the stick and draw - and was very grateful to have thought in advance about how to hold her. Unfortunately, the nurse, although she later said Z had "good veins," had to probe around a bit, and they had to get four vials of blood for all of the tests we were going to run; after one or two vials went well, the flow stopped, and they did a lot of digging to find the vein again, although they didn't have to re-stick her. Through it all Z screamed and cried and was very upset. It was sort of heartbreaking. She also kept trying to watch and although I occasionally turned her head the fact that I was constraining the rest of her body made forcing her head to one side to be unfair, and I let her move it freely, even if she chose to watch.

It was over after about ten minutes, and by then she was all cried out and grateful to be through with it. They bandaged her (and her stuffed hippo) with this slightly sticky bandaging tape I could tell would pull off easily later on. Then she and I went to Starbucks (another part of my grand plan) and got these ridiculous frosted scones and had water (her) and coffee (me). We talked a little bit about what had happened but she generally seemed interested in putting it behind her. This was also the case when we got back to her grandmother's house, where she told Karen she was "not brave" and "screamed and cried" but seemed quite content to be able to speak about the experience in the past tense.

In short, despite the fact that I ended up having to restrain her and she screamed and cried through the whole thing, I think everything I did to mitigate the situation was helpful. Most importantly, I was able to go through the experience myself in a calmer manner than I might have if I had brought fewer variables within our control. Also, since I took proactive steps to ensure the experience was as easy for her as possible, I still feel like a good Dad.

Thanks to everyone who offered advice, as well as their own memories of early needle experiences. (You can read that advice and those stories here.) I do believe that how we handle these issues can have a big impact on our children as they grow older, particularly in how they deal with medical issues and doctors, which can itself have major implications for their health.