Tuesday, May 15, 2018

Guest Post — A “Rita Visit”

For those of you who haven’t met me, my name is Rita Trujillo Hughes.  I’ve worked with the TEDDY study the past five years after “retiring” from the BDC Pediatric Diabetes Clinic where I was one of the Clinical Social Workers. I have a unique job with TEDDY.  I meet with kids who have experienced fears or lots of anxiety about getting their blood drawn.  This is a pretty common and normal fear, but one that can be really distressing to kids (and parents!).  My job is to figure out the unique worries and experiences that kids have and teach them some pretty effective coping skills or “tools” to help diminish that worry and fear.  I’ve had tons of experience working with kids and have had the pleasure of meeting lots of very smart and cute kids—teens too!
Have you noticed that your child may be more anxious about TEDDY blood draws than they were when they were younger?  That there’s more whining and resistance to the idea of getting poked?  Or that they are outright against it?  If so, this is not unusual as kids get older and their brains start to anticipate and worry about needles and pokes.
Our brains are “hard wired” to protect us from perceived threats.  It’s designed to send signals to release stress hormones (fight or flight) that help us manage an emergency. But blood draws aren’t an emergency and there are some simple things that we can do to help master the worry that can develop around blood draws.  Think of these as learning simple coping skills that can be useful in any situation that makes us anxious.

Parents:  Do blood draws make you anxious? Almost everyone has some anxiety, and most of us develop our own coping skills to manage. But if you have a lot of anxiety, kids pick up on that and it will be hard to comfort them.  Learning some skills might help you.  Or you may need to have someone who is more comfortable help out.
Prepare at home:  Ask your child about how they are feeling and what they understand about TEDDY.  Most kids worry about shots, which can be uncomfortable. TEDDY tries hard to minimize any discomfort with blood draws by using EMLA to numb the area.  To minimize worry, be matter-of-fact (“small quick little ouch and done!”).  Ask your child what they think would help keep them calm.  Sometimes an old stuffed animal has to be recommissioned for comfort duty!
Minimize other stressors:  Leave other kids at home with a sitter; avoid rush hour traffic; videos and music in the car are good distraction; a good old fashioned chat about other fun stuff works too.
 
And teach some simple coping skills.  These are designed to prevent stress from becoming overwhelming:
BREATHE:  Slow deep calming breaths (“blow out the scared feelings”) helps enormously to calm stress and fear.
Learn about how our Brain works:  I have lots of ideas to keep our “thinking” brain in charge and not let our “fear” brain take over.  We call it using our Wizard Brain to calm our Lizard Brain.
 
EYEBALL Distraction:  Don’t look at the poke.  Make your eyeballs do something else:  focus on a video or game on an iPad or phone; read out loud from a favorite book; sip water through a straw or suck on a lollipop; listen to music with headphones; talk to your mom about something funny about your friend; comes armed with some new jokes!
Avoid the stalling:  When kids get anxious, they become masters at stalling and avoiding.  Unfortunately this also increases anticipation and cranks up the anxiety. So be calm and firm that we need to get it done quickly and move on.
Special treat or reward:  Always a good incentive to look forward to.  Some kids like a food treat or a trip to spend some TEDDY money for their hard work as Jr. Scientists.
Ideally, kids should not be restrained during blood draws because that increases their sense of fear and loss of control.  Better that they have some control and are assured that using breathing and distraction really works!  Most of the time, techniques like the above help a great deal. 
If your child really gets overwhelmed with blood draws, talk with your TEDDY staff to see if we can schedule a “Rita visit”.  I love meeting new kids and figuring out what we can do to make TEDDY visits and blood draws much much easier.  Parents have told me that some of the skills their kids learn are helpful in other stressful situations too.