• Have address labels made with the child’s name, address. It can then be used for putting on blood samples sent to the clinic as well as other things. On the label I write down the date, and what test needs to be done on the sample to make sure there is no mix-up.

• We use preprinted labels (the kind you get from mail-order, usually 1000 labels for a few dollars) with the Newborn Screening lab’s address on it when we mail our finger prick form each week. It saves us lots of time.

• We keep the materials needed for the finger prick in a cosmetic box that we have decorated with stickers. It’s about the size of a small tackle box.

• We have graph paper on our fridge charting each blood test my daughter has done. She can see for herself where her phe levels are all the time and now shows more interest in them.

• Buy brightly colored Band-Aids or ones with characters on them. The child can pick out a fun Band-Aid after a blood test. We have over 11 boxes of different types of Band-Aids!

• I am constantly in search of different Band-Aids for the collection. My two-year-old picks one out before we take the sample and holds it until we’re ready for it.

• Offer a treat after a finger stick; this may be a sticker or something to eat.

• For my 6-year-old son, we first tell him that we need to do a blood test that night. I ask him what special treat he would like (within reason), such as a popsicle, bubble gum, coke or bag of Skittles. Then he gets the treat and we sit and talk about doing the blood quickly so we can do something else. This works for us.

• When it is time for a blood sample, I let my two year old choose which finger to prick and then we make a big deal about "painting the circles" (on the filter paper card).

• Before beginning to do a blood draw on our two year-old son, we try to create a quiet environment around us: no TV, no loud noises. We give him something to hold in his hand that won’t be stuck, to draw his attention away from what we’re doing with the other hand.

• My son is 2 1/2 years old. For the last six months we have had great blood drawing sessions. I am always looking for fun Band-Aids (dinosaurs, etc.) so we have a good collection. First he selects which Band-Aid he wants. Then he chooses which finger we will poke. Then we fill in the "big red polka dots" on the blood card our clinic uses. I keep the session light and tell him it is "no big deal." Now, when we're done he tells me, "See mom, no big deal!" I think the key to our success is the fact that he has control in the decision-making process (which doesn't happen a lot when you are two and have PKU!)

• Use the Soft Touch lancet. It is the best device we have found, after trying all available.

• The SoftClix is guaranteed to be the most painless lancet or your money back!

• After trying many different brands of finger sticking devices, we have found that the best one is the Ame's Glucolet. It is comparable to the "Soft Touch" device; the only difference is the location of the "trigger." It is shaped like a pen with a concealing cap. You load it by inserting a "unilet" into the end and replacing the cap. It gives a good stick but doesn’t cause a lot of pain. The best thing about this one is that after it’s loaded you can’t see the point on the unilet and therefore you aren’t anticipating the pain. And the unilet will automatically retract into the casing.

• Since we have been using the glucolet, we have had stress-free finger sticks. My two year-old son doesn’t even cry! He does not enjoy the stick but is very calm and relaxed while the blood is being applied to the filter paper. One device I strongly recommend NOT using is the Microtainer Brand Safety Flow Lancet. We used this on our son’s heel when he was an infant and he has little scars on his heels.

• I have a 2 year old daughter and I use a device that I bought at a drug store near us that is used by diabetics to do their blood work. It sounds a lot like the Tenderfoot but it looks like a pen. It is also spring loaded and all you have to do is push a small button and it pokes the finger for you. You can control how deep the lancet goes into the finger etc. The pharmacist was able to show me different kinds of tools that diabetics use. It is a lot easier on me to do it this way then to poke my daughter with a needle.

• There is a better way to do a blood test than using the poke method with a lancet. When my son was in the hospital just after birth, I noticed that his newborn screening test was done with a device called a Tenderfoot. It is a small, spring-loaded box that you hold against the baby's heel and then press a button that activates a blade that will take a swipe at the heel. This swipe makes a shallow abrasion that easily produces enough blood to fill the PKU filter card. It is much less painful than poking a child with a lancet. On some occasions, my son has even slept through his blood test when we've used this device. Also, because the spring-loaded box actually takes the swipe for you, it is much less agonizing for the parent to do. The Tenderfoot is a great solution, but there is one big catch. These devices are normally sold in big lots to hospitals. They are not normally sold directly to consumers through pharmacies. I was luckily able to obtain some samples directly from the company that makes them, but I'm not sure that they would extend this same offer to other people. As a result, I have a couple of suggestions: See if your local hospital uses these devices, and then ask if you can purchase them through the hospital. Or, call the manufacturer, to see if you can purchase directly from them. When I originally asked about this, I think they told me that prices for small quantities of these devices were about $3 each for a minimum order of 50 devices. The Tenderfoot is a prescription device, so if you are able to obtain some of them, they will probably have to be sent to you through your child's pediatrician. The company is ITC (International Technidyne Corporation) out of New Jersey. The telephone number is 1-800-631-5945.

• For older children, this company makes a device called a Tenderlet, which provides a better way to do a finger stick. That product is sold over the counter, so ask your pharmacist about it.

• Emla Cream, designed for children, releases an anesthetic into the skin that can ease the pain of blood draws. It does require a prescription. In general, it is not recommended for children under the age of one year. It needs to be put on at least sixty minutes before the draw for optimal numbing. Emla Cream may not be appropriate for some children for whom the anticipation of the draw causes more traumas and tears then the actual draw.

• When doing a finger or heel stick, make sure the room is warm and arm up the heel or finger with warm water before doing the stick to help increase blood flow.

• Wipe the punctured spot with cotton balls, alcohol pads, or a rag to encourage more bleeding.

• Do the test after a bath so the finger or toe is nice and warm and blood will flow more easily.

• Massage the leg or arm really well before hand to stimulate blood flow to the finger or toe.

• When drawing blood from any of the fingers, simply keep the hand lower than the heart for better blood flow.

• We warm our baby's heel with an electric heating pad for a few minutes to get it warm.

• Wash your hands and your child’s hand with soap and lukewarm (not hot) running water. This cleanses the hands and gets the circulation going at the same time. Another method we use for warming the fingers is a little chemical pack called the "American disposable Infant Heel Warmer", made by the American Pharmaseal Company. It is a sealed plastic package that contains a bubble containing chemicals. You squeeze the package with both hands, the bubble inside the package burst and causes a reaction in the chemicals that causes the whole thing to get very warm. Nothing spills out; it all stays enclosed in the plastic. I have found it very convenient and my son seems to get a kick out of it. You don’t have to hold the hand on the pack for a long time, but just letting the hand come into contact with it 4 or 5 times will help warm the fingers.

• Wipe the finger with an alcohol swab after cleaning it, then a clean dry cloth or dry cotton swab. Gently manipulate blood toward the end of the finger. Place whatever device you are using on the side of the finger and perform the stick. Allow the puncture to open and the first drop of blood to form, then wipe that drop off with the gauze pad.

• We’ve been told by several reliable sources that is very important because that first drop may contain tissue and will give a false reading. When the second drop forms, gently apply it to the filter paper or drop into a tube (depending on the method you use). I’ve been told that the side of the finger and side of the heel is where to stick, not the middle of the heel pad or the middle of the fingerprint because on a small child, even though their fingers and feet are chubby, you may contact a bone. The side of the heel or finger is also less likely to be callused and will bleed easier.

• Some children prefer blood draws from the big toe.

• Always do the finger stick on any finger but on the side toward the thumb. Never take it directly on the tip. That is where the nerve endings are and the "bleeders" are on the side towards the thumb. (If you turn your hand over and look at your hands, it is the area from the center of your fingertip to the right on your right hand. On the left hand, it is from the center to the left.) This area of the fingers is the "bleeder" and has always worked for me. I was so glad to have learned this. It is miserable that lab technicians don't know this secret. Also, remember warm water helps, and always hold the hand down when drawing the blood. Blood doesn't like to run uphill, no matter how hard you squeeze it.

• When my daughter was born, the health nurse drawing her blood for the initial newborn screening gave me a great suggestion when trying to do my son's blood work. She said to soak the finger/thumb/toe/heel -wherever I was drawing the blood from - in hot water. Then she said to see if it is ready press on the area and release. When the "white"went away very quickly—less that a second—and turned red, it is ready for the prick. When trying this method, the blood flows very quickly from my son's thumb or finger and in a flash his blood work is done. There is no more squeezing the heck out of his finger to get a little tiny drop.

Coping with Blood Draws

From National PKU News, Fall 1998

If you are mailing the blood from home, there are now specific postal regulations usually requiring a metal tube for the sample, as well as blood product labels. If there is the possibility of temperature extremes, the sample might need to be mailed "overnight" because the mail has no temperature controls.