Preventing panic in a six year old

July 25, 2017 2:31 PM

My son is having a blood glucose study to check if he is developing CF-related diabetes. As well as a continuous glucose monitor he has to have a finger-prick test three times a day to calibrate the readings from the monitor. However, he's starting to panic each time he has to have the finger prick test. How can we teach him to stay as calm as possible?

Specifically, he starts hyperventilating, screws his hands up into tight fists and starts to protest. He knows he has to do the test and says that he's trying his best (and I believe him). He's done three finger pricks so far (out of 15).

Things we have tried to make it easier / less scary:
* Demonstrating on Mum and Dad first (without any reaction)
* Immediate post-finger-prick treat
* Putting finger on ice pack first
* Watching TV
* Sticker chart (one sticker per test, new toy when he completes the chart)
* Lots of praise when he manages it

We had enough of a breakdown this evening that we took him to his room to calm down for a few minutes before explaining again how important this test is.

Are there any techniques that we can teach him so that he can overcome his fear?

posted by Stark to Health & Fitness (22 answers total)

Let the kid press the "pricker" button. That way, he has some control.
posted by heathrowga at 2:35 PM on July 25, 2017 [3 favorites]

Is he panicking about his finger being pricked or about the meaning of the test?
posted by the agents of KAOS at 2:43 PM on July 25, 2017 [2 favorites]

Best answer: Type 1 diabetic here, I was this way. A lot of it had more to do with frustration and feeling like I didn't have a choice and I was different. I got a fifteen minute warning. "Dinner's in an hour. At the next commercial it's time to test your bloodsugar." They would hand me the kit and just wait. It also helped that I didn't want it cutting into the TV show I was watching (Wishbone). Also maybe try admitting that it stinks. I had a lot of negative feelings about being diabetic and hearing my mom say "This sucks, I know it's not fun. If I could take it away, I would." made me feel like I was less alone. She also compared it to ripping off a bandaid, because the panic was the worst part and that was reinforcing itself every time. On a more practical end, obviously make sure you're using the lightest prick possible to get blood. My dad went through a phase where he thought if he used the highest setting, he could get the most blood like that was the goal? And obviously it's not. My fingers would ache.
posted by Bistyfrass at 2:47 PM on July 25, 2017 [8 favorites]

How old is he?

Does he know what the test does and checks for?

Have you tried doing the test WHILE he's distracted (watching TV, talking to mom/Dad, etc)?
posted by Hermione Granger at 2:48 PM on July 25, 2017

Best answer: Give him techniques to manage the physical aspects of his panic. Breathing exercises (a pretty simple one is breathe in four counts, hold it four counts, let it out four counts, repeat cycle four times, you can use a chart or toys to help him see these counts) having him choose comfort objects to gather and surround himself with, fidget and sensory toys to focus on with his other hand, talking through and visualizing his panic in a narrative way (when i was small i liked the idea of blowing up a bubble with my "scaredness" and letting it float away above my head), even doing a little ritual dance to psych himself up and get the fear out. Help him understand that the panic and fear are responses his body is making and he can do different things to channel it and get done what he wants to get done.
posted by Mizu at 2:57 PM on July 25, 2017 [2 favorites]

It might also be worth looking at ways to make it less scary or painful. A family member has used this lancing device which they find to be far less painful than the one that came with their meter. It doesn't totally eleminate the problem, but it makes it more tolerable.
posted by primethyme at 3:17 PM on July 25, 2017 [2 favorites]

Best answer: We have a type 1 kiddo, diagnosed at 6, and I second the recommendation to let him press the pricker button. If he doesn't want to, he can at least count down for you.

Unfortunately, it generally takes more than 15 pricks before kids get used to the process, but then they DO and most just don't mind anymore, so you're in a bit of a no-man's-land. (I really hope everything's fine, but if he DOES have diabetes, don't worry, it's not going to be like this forever.)

A few other practical ideas:
- What gauge are the lancets? If you're using the ones that came with the glucometer, they're unnecessarily terrible. If you can manage it at the pharmacy, get him some 32G ones. (We trained the school nurse, afterschool, etc. on me and I can vouch for the difference.)
- Make sure you're pricking towards the side of the fingertip, not right in front.
- How deeply does he sleep, and can one of the calibration points be while he's sleeping?
- I imagine you actually need 3 glucometer measurements/day for the doctor just as more-standardized data, but if the goal is just to calibrate the CGM, two should be completely fine. The important thing is actually to calibrate at a time when the CGM reading is stable, and more often (beyond twice/day) doesn't help.

Best of luck and sending warm thoughts your way!
posted by cogitron at 3:18 PM on July 25, 2017 [6 favorites]

Best answer: When my son was hospitalized and needed frequent injections, they used a Buzzy-Bee - it's supposed to help with the pain (not sure it did with my son, but he was getting blood draws and IVs put in, which I'm pretty sure is more painful than a finger prick) - you may find it helps, and it definitely made it less scary.
posted by Mchelly at 3:29 PM on July 25, 2017 [3 favorites]

Best answer: I have to test as a type 2 on insulin and didn't for many years because the bloomin' lancet pen hurt a lot. As someone who overcame a very natural reluctance to hurt myself with a sharp several times a day, I can say that the shallowest setting possible on the side of the finger (nowhere near the pad or the tip of the finger, which is where a lot of health professionals seem to aim for) and on different fingers for each test helped me a lot. Make sure the sharps are changed regularly - blunt hurts. I eventually built up small callouses on the fingers I used most and now it's almost painless.

Poor little chap - if it might help, you can tell him there's an old lady in England (and lots of other people too) who's felt the same as him and is sorry he's having to do it, but she knows he's trying really hard and is sending him her very happiest wishes.
posted by Martha My Dear Prudence at 4:09 PM on July 25, 2017 [9 favorites]

Try different fingers and the sides of the tip of the finger and a less deep setting on the auto clicker. I had less pain doing my ring finger on the sides than on the tip. (when I was sorting out my blood sugar. I am not diabetic.)

Can you give a small reward for each time? A small toy? Points towards a big toy? Extra TV time?

Explain how cool the tech is and how blood sugar works? Have them put a star on a blood sugar chart and see the trends? I think as a kid I would have found it interesting to be more involved in why that stuff had to happen - hell - I still am. (And have had tons of medical tests my whole life.)
posted by Crystalinne at 4:23 PM on July 25, 2017 [1 favorite]

For real about getting a good lancing device. The gauge as well as the design can be remarkably different in terms of pain (and usability for your son to use himself). I don't know the brands above myself, but I like OwenMumford's small gauge lancets. Hopefully your doctor is taking this all into account and has recommended a good type to you.
posted by Tandem Affinity at 4:34 PM on July 25, 2017

Does he have to prick his finger? I remember when the Red Cross switched from a finger prick to an earlobe prick for their drop of blood--so much less painful!!
posted by epj at 4:45 PM on July 25, 2017

Best answer: My DD went through finger pokes 5-8 times a day at one point for managing hypoglycemia. She's not a particularly fearful kiddo, but she did not like it (esp right after a fairly traumatic admission).

What helped with her (age 5) was:
-The best poker we could find. For her it was not the one that came with the kit, it was the one touch delica with micro fine lancets. This lancet was easy for her to do it herself.
-We let her do it herself. As much as possible. As early as possible. IE: I said, like the third time we did it "well, if you don't like me doing it, you need to learn to do it yourself". At 5 she was totally independent in testing her own sugar, and telling me if she thought it was low. The school were not impressed by this :-(
-We tried to never refer to it as a 'test'. She has an idea she could 'fail' a test. It was always "It's time to do fingers" or "we need to check your sugar". I don't know if this helped, but I try to be mindful of the language.
-We talked about how she would feel better (have less barfs) if we could keep her sugar in range. She loves doing 'science' so we played up 'lets see if we can guess what your sugar will be" both for the science aspect and to teach her an awareness of what 'low' feels like for her.
-Choosing which finger, and if I count '1-2-3' or just do it, if she doesn't want to do it herself. The control really does help.

There are days when she fusses when we do have to check still (mercifully only if she is 'sick' or we think shes metabolically stressed), and I just repeat, it's not a choice, but you can choose to do it yourself.

This is hard. You have my sympathies. And I will think easy finger poke thoughts for you!
posted by Northbysomewhatcrazy at 4:53 PM on July 25, 2017 [5 favorites]

Best answer: T2 diabetic here, and I agree with the advice above, especially ALWAYS pricking the side of the finger and the lowest lancet setting. The more input/control he can have re: where/when/how, the better.

I test my blood glucose at least four times a day and barely notice it (five years in) but it hurts (and bleeds) for a long time after they do it at the endocrinologist's office. I STRONGLY recommend you using the Accu-Chek FastClix lancing device. Instead of a little squeezy/clicky thing, it's like a Sharpie with a cartridge of six lancets (all hidden from view), and a dial function to determine how deep the lancet goes, from 1-5 with half-steps (so basically ten different settings). With his little hands, using the sides of his middle and ring fingers only for testing only and the lowest lancet setting, the less pain (and less blood), the better.

But also consider this -- visceral distraction is a huge benefit. I know you're only doing this for a few weeks, but if he turns out to need more testing beyond this, consider Buzzy. It works for adults as well as kids -- I've seen it demonstrated at our diabetes expo, and it really lessens the anxiety. I wish I'd had one when I was first diagnosed, not for the finger sticks but for the insulin injections.

Sending the little guy hugs from one finger-pricker to another.
posted by The Wrong Kind of Cheese at 4:55 PM on July 25, 2017 [1 favorite]

Teach him to do a long exhale.

Do the needle prick while he's exhaling - it hurts way less.

I was taught this trick when donating blood. It really works (because vagus nerve).
posted by metaseeker at 5:21 PM on July 25, 2017 [1 favorite]

Cannot link on my phone but you might want to check out the Freestyle Libre device. My friend's kid is diabetic and it's genius. No finger pricking at all. The only downside is the price. The kid is 3 years old. We're not in the US, not sure if it's approved in the US for young children.
posted by M. at 11:31 PM on July 25, 2017

T1 here! Echoing everybody who's advised making sure that the pricking is as gentle and comfortable as possible. I actually stopped using a lancing device years ago in favor of wielding a lancet by hand. Even on the lowest setting, any device I tried felt like it was pounding my finger like a hammer. I wash my hands with soap and warm water before testing whenever possible, instead of wiping with alcohol. It makes the blood come more easily and it's just more comfortable all around.

Is there a special song you can sing or poem you can recite during the test, to make it a sort of friendly ritual? Distraction with TV, music, or jokes is also a good option.

I had a friend with a T1 daughter who used to give her doll a finger stick with an old, empty lancing device every time she had one herself.

And oh, good lord, yes, although I was older than your son I was so pissed off about the whole thing that I found myself skipping tests just to spite… I don’t know who, but it's not like I was thinking rationally at the time.

P.S. the ring finger on my left hand is now known as “Old Bleedy,” because I can always get a healthy drop of blood there even when the other fingers are acting like turnips.
posted by The Underpants Monster at 12:40 AM on July 26, 2017 [1 favorite]

Demonstrating on Mum and Dad first (without any reaction)

My instinct as a dad is that you not showing any reaction is kind of a lie that it doesn't hurt. Clearly the kid knows it hurts. Maybe instead demonstrate yourself going "oo, ouch, that hurt a bit, but wait, the pain's gone away already! Wow that was over quick!".

Cannot link on my phone but you might want to check out the Freestyle Libre device. My friend's kid is diabetic and it's genius. No finger pricking at all. The only downside is the price. The kid is 3 years old. We're not in the US, not sure if it's approved in the US for young children.

The OP says issue is that a finger prick is required to calibrate the CGM. The Libre (which tests sub-cutaneous fluid, rather than blood) is great but it definitely can show different readings from a more accurate finger prick. The Libre reading can lag behind the direct blood test and it's useful to get a feel for how the Libre reading relates to the blood test reading.
posted by EndsOfInvention at 3:05 AM on July 26, 2017 [1 favorite]

And seconding trying different prickers, the wrong setting or the wrong strength of pricker can hurt a lot more than it needs to.
posted by EndsOfInvention at 3:06 AM on July 26, 2017 [1 favorite]

Get him bubbles to blow and a candle to blow out. He gets to choose which one he wants and his goal is to take a DEEP breath and blow as HARD as he can. It's a breathing exercise and also distracting.
posted by yes I said yes I will Yes at 5:17 AM on July 26, 2017 [2 favorites]

Best answer: I have type 1 - sorry that your child has to go through this. It also occurred to me that I'm unfamiliar with having to calibrate 3 times a day. I use Dexcom's CGM and that requires 2 calibrations per day. Of course you may have different requirements. I would also mention the possibility of testing on a forearm or upper arm - so-called secondary site testing. I believe this is not officially ok for calibrating CGMs, since it's not as accurate as a fingerstick - and would be less accurate if the blood sugar is changing rapidly. However, that said, I made a decision for myself to do arm testing only, for more than a decade now. I test first thing in the morning, when generally my glucose is pretty steady, and another time in the afternoon or evening when I'm also fairly certain that my levels are steady. So again while I don't know whether that would be doctor-approved, it's something to consider - I have gotten to the point where, if I use a lancet set to a relatively shallow depth, I rarely feel the prick. I've even tested my children sometimes on their arms, and they've agreed that it's pretty painless - of course that was with me operating the device, and I guess I have a good deal of experience by this point. As far as a distraction technique, sometimes for blood draws I forcefully scrunch up my toes and wiggle them around - I think I read that somewhere as something to try, and it can't hurt! Good luck.
posted by chinston at 10:29 AM on July 26, 2017 [1 favorite]

Response by poster: Thanks for all the responses. We settled into a pattern of five minutes of TV watching while holding a small ice pack, then pricking the sides of the fingers using different fingers each time. The suggestion to let the arm rest at the side and then squeezing down the arm was useful as well. There was still a fair bit of reluctance for the first prick but on the occasions where we didn't get a good blood output he seemed happy enough to get another needle prick. He got a small sweet reward after each test.

Buzzy looks like a great idea and we will certainly consider getting one if we have to do this again (there wasn't a way of getting hold of one in the time frame of this test).

We were using what was provided by the NHS - the Accu-Chek FastClix lancing device. Unfortunately he wasn't keen on using it himself and I think the clicking mechanism was too stiff for him to use. Otherwise it was great.

We finished the last blood test this morning. There was a brief rebellion this evening as he realised that he wasn't getting television time or a sweet; he started complaining that he wanted to get another finger prick! So overall a success.
posted by Stark at 1:15 PM on July 30, 2017 [3 favorites]