Ways to get PCR test for a resistant child other than force?

January 13, 2022 2:15 PM

My 5yo son's class has to quarantine. He's never had a PCR test. He is vaccinated (x2) and the school isn't requiring a PCR test for him to return after 5 days of quarantine, but a time will come when my child needs the PCR test. He is very resistant. What are my options besides the use of force/restraint, other than what I've already tried?

I have tried bribes. I showed him what it's like on my own nose with a qtip. I suggested he could do the swab himself and would settle for the rapid test at home. I showed videos for children about nasal swabs to test for COVID.

He also refuses medication even when he feels terrible. Times when he has to have it anyway, we've had to use force and it's pretty traumatizing for everyone involved when we have to do that. He said he's scared he will die if he gets the PCR test. I explained that it can't do that.

If I (or other adults) have to restrain him and he jerks during the swab I worry he'll get injured. This will strengthen his resistance. So I am wondering from you all what other options there are when the above doesn't work, besides restraints or "comfort holds"?

posted by crunchy potato to Human Relations (28 answers total)

There is the option to test with a saliva sample - you may want to explore that option if it is available in your area.
posted by _DB_ at 2:22 PM on January 13, 2022 [7 favorites]

My state's department of health services has a contract with Vault to distribute free saliva-based PCR tests via mail. My kid's school required a negative just to come back from winter break, which they were very grumpy about because we hadn't seen anyone or gone anywhere, but taking the test was still a total non-event once I'd coaxed them over and loaded up a video to watch during it. It looked like Vault sells them normally for $90, which includes the lab services and shipping, and I realize that's a lot of money, but at least it's something you could have on hand and doesn't require any swabbing.
posted by teremala at 2:22 PM on January 13, 2022 [4 favorites]

Best answer: I don't have any hacks to make a nasal swab non-frightening for a young kid who finds it frightening. I've resorted to physical restraint more times than I'd like, when there was no alternative.

But there are alternatives. What alternatives exist depend on what is licensed where you are. Assuming it's the US, the least frightening option is the mail-in DxTerity PCR test. You spit in a cup an mail it in. It's $85 on Amazon. Not sure about insurer reimbursement.

Our daycare is using a mouth/gum swab, which is probably the next level up from spit in a cup, but seems to be much less traumatic for most kids. Access to that kind of test will depend on location. Maybe your kid's family doctor has pointers.

And I appreciate the "he's going to need to learn eventually" motivation, but my view on a lot of these things is: my four year old is going to need to learn to drive eventually, but I'm not preparing him for that now. He's not ready.
posted by caek at 2:24 PM on January 13, 2022 [9 favorites]

I have a five year old child too. When we've had to take the kids to get tested, the nurses don't bother wasting time asking us to restrain our child. I don't think you can rationalize with a child's mind to somehow see a mutual benefit. They're going to act on their fears as they're five years old. Restraining my child is for a greater good of being tested, so I don't bother having guilt or worries in placing them in a restraining hold. As they get older, I figure they'll be easier to rationalize with. The probability of a swab complication is low if they're in a good comfort hold, so I don't tend to worry about swabbing complications.

The kids will cry over the vaccine shots and show a lot of fear, but they're still going to be placed in a comfort hold to get the event over with.
posted by DetriusXii at 2:27 PM on January 13, 2022 [6 favorites]

Best answer: If you have no other options for testing, I would start now with a very gradual de-sensitization of putting a swab in his nose, and when I say “gradual,” you may need to start with touching a swab to part of his face that isn’t his nose once a day, then a few times a day for maybe a week, then moving on to touching the outside of his nose, then the edge of his nostril, then the inside. Don’t move on in the progression until he’s super comfortable with the step you’re on. Make it quick and neutral (not emotionally charged, not a big deal) and reinforcing—do it while you play a fun video or song, during a fun activity, or at a time when he gets to access something novel. Take it slow to stay successful. Let him do it himself, if he would rather. This is going to take awhile but in the long run it will be easier on both of you.
posted by corey flood at 2:33 PM on January 13, 2022 [20 favorites]

Best answer: De-sensitization. Give him a q-tip to hold, then use one to swap your nose. It can tickle, but will not hurt. Describe it. Ask him to try swabbing an apple that you've cut a hole in (or whatever). Let him try a q-tip in his own nose. Ask him to let you put the q-tip in his nose but not swab. Each step shows that if someone is even remotely cautious, it's boring and safe. Give stickers or similar as rewards at each step. See if you can find videos of kids being swabbed. Make it a daily event to practice getting ready for being tested "because this is how we keep everybody safe, like Nan and GrandPop and Mom and Dad and Auntie Theora".
posted by theora55 at 2:43 PM on January 13, 2022 [18 favorites]

Best answer: It's for sure time for his favorite toy to take a covid test. And every toy. First you administer and then he does. And guess what toy gets after a nose swab? Two M&Ms! (Insert favorite candy/sticker/very precious reward as appropriate.)

I would start now making a game of it. Get a stuffed animal (maybe one of yours if you have any, or one that belongs to another kid in the house or borrow one or whatever). Use a q tip and set up a whole fake thing. It's fun and light. No pressure. You can announce this is happening without talking about him needing to do it. "Guess what? Teddy is going to take a covid test. Teddy, it's okay to be scared. Teddy, does that feel a little bit weird? It's going to be over in 15 seconds!" And then go through the whole fake thing with the nose swab and then Teddy gets the M&Ms but guess who actually gets the M&Ms? Your kid! Then Teddy gets more M&Ms when the covid test timer is up. Good job, Teddy!

Make it a game, just about every day, with little tasty special small treats for Teddy/other toy/kiddo. Start doing this now before you have to do the test. Keep it as light and silly and fun as possible.
posted by bluedaisy at 2:53 PM on January 13, 2022 [13 favorites]

For me, it would have helped to know what the inside of the nose really looks like and how the pressure of the swab will affect the tissues in there. Also maybe how nerves work, where mucous comes from, how a PCR test works -- basically, it's very scary to have stuff done to you when you don't _understand_ what and why, and I think some people are more attuned than others to recognizing when they don't know things.

So, might as well start off with some (less disturbing) images of the inside of the nose and even explanations of how it works.

This might help with medication, too. Basically, you and your son would have to become way-above-average experts on medical/anatomical stuff. This should give more of a sense of control.
posted by amtho at 3:19 PM on January 13, 2022 [2 favorites]

With my 5 year old I used the tried and true method of "look, I can do it or Daddy can and I think you are more comfortable with me", because I am generally more gentle and patient than said Daddy, and that was enough to get him to hold still the first time. Once he did a couple, he realized it's not so bad, and now it's really not a big deal. It helps that my kids get nosebleeds, so they have ample experience with me swabbing Vaseline into their nostrils anyway and the sensation isn't that different.

Ultimately the worst part for just kids is just the fear that it will hurt. Once they know how much it hurts and how long it lasts they are much easier to bribe and cajole.
posted by potrzebie at 5:13 PM on January 13, 2022 [1 favorite]

My kid is younger, but has had many many covid tests (her parents are "essential workers" so she goes to daycare, she is too young to get vaccinated or wear a mask). She hates the tests, but also hates vaccines, having her diaper changed, having her nails clipped, etc. These are things that have to be done despite her protest in order to keep her healthy. Your kid may not like the covid test, but it has to be done 🤷‍♀️
posted by i_am_a_fiesta at 5:24 PM on January 13, 2022 [11 favorites]

When my kids were that age, I used to bribe them with "doing a good job!" for shots or whatever. A milkshake is very cheap to get them to deal. :)
posted by heathrowga at 5:39 PM on January 13, 2022

Best answer: Ultimately the worst part for just kids is just the fear that it will hurt.

The phrase that the wonderful, gentle nurses that test the kids at my kid's school every week use is "we're going to TICKLE YOUR BOOGERS". Because tickling doesn't hurt, and it's kind of fun.

YMMV, but I rather liked the turn of phrase, and it seems to work.
posted by toxic at 5:45 PM on January 13, 2022 [10 favorites]

You say you've tried bribes but are they like really GOOD bribes? I used to get strep all the time as a kid and I was A NIGHTMARE about getting the strep test where they swap the back of your throat (it HURT and was unpleasant and, I must confess, I was a dramatic and stubborn child). My mom bribed me once with a whole entire new Barbie and it worked, I was totally compliant. I really wanted the Barbie. As it turns out, I basically behaved forever with strep tests ever after?
posted by Countess Sandwich at 5:49 PM on January 13, 2022 [5 favorites]

I use serious bribes. Candy immediately after, in the car, they can see, ice cream later that night, TV time, video game time. ALL OF THEM, as long as it takes less than 5 minutes. All or nothing, you either do it without fuss or you don't get any of them. My usual bribes are only one of those, and very rare. My kids are slightly older though.

We also talk a lot about how it's like someone else picking your nose, and how you can be "saved by the boogers" if you have some snot in there, as soon as they have some of it, they won't poke you more. The comparisons to nose picking and how it's a time we will pick your nose all help.
posted by lab.beetle at 6:12 PM on January 13, 2022 [1 favorite]

As a starting point, maybe you could simply listen to his fears, and let him express them without rushing in to 'solve' and 'cure' his fears/ concerns/ misconceptions?

It sounds like he is being hammered with facts, but maybe that's not what he needs. Maybe he just needs to be heard and have his fears acknowledged.
posted by lulu68 at 6:31 PM on January 13, 2022 [7 favorites]

I have had trouble with my 4 year old, who is similar to your kid. What worked for us: talking about it and practice. We talked about what was going to happen during the test. We talked about why it’s important to get the test. We told him that he wouldn’t be able to go back to school until he had one. That sort of thing.

And then we practiced with a qtip. I went very slowly and stopped when he asked. I let him try too.

When it comes time to take the test, he still resists a bit and is afraid that it will hurt (he had a bad experience with a test, which is the source of most of his resistance). But I remind him of what we did when we practiced and go slowly and tell him that I won’t hurt him, and so far we get through it. I specifically go to self administered test sites so that I can do it for him instead of having a nurse or someone else do it.

We’re asking a lot of these little guys, and they don’t understand everything that’s going on. Good luck!
posted by Maeve at 8:08 PM on January 13, 2022 [5 favorites]

He said he's scared he will die if he gets the PCR test.

Do you know why he thinks this might happen? To me, this doesn't sound like he's scared of the physical process of the test, but rather some confusion about what it represents. I'd try talking to him more about this, and trying to figure out how he's thinking about it. Like lulu68 said, focus on trying to understand at first, rather than trying to explain why it's not dangerous/etc.
posted by wesleyac at 8:27 PM on January 13, 2022 [4 favorites]

Response by poster: Kudos to those that can hold the stance of "it's for the good, so it is what it is and we are doing it because it has to be done." I'm not easily that type of parent in situations like this. I was raised with abuse, so anything where I'm overpowering my child even for his best interest is hard.

Also, I'm surprised my child isn't more distraught over living through the pandemic itself, and all that's come with it. I don't want to add to his pain if I can help it. There's plenty of time for him to learn to do hard, scary things when there's not a pandemic going on.

These are all great ideas though, especially the playful exposure therapy approach and having the toys do it. I did try super mega bribes. Usually that's ice cream but he's been throwing up so that won't work this time.

My district has no saliva tests, sadly. But it's good to hear of some companies offering them to the general public.

I do need to explore more with him the fear of death. We did talk about the feelings but I'm not very clear on that part of the situation.

Thank you for the replies and the compassion.
posted by crunchy potato at 9:33 PM on January 13, 2022 [1 favorite]

Our doctor suggested a drowsiness inducing antihistamine, with a trial run before hand, to ensure it doesn't have the opposite effect, for a needle. In the end the antihistamine had no effect at all (she was neither hyper nor drowsy) but she did like talking it through with our gp, in a way that seemed different to talking to us. Maybe if you have access to tele health and a good gp that could be an option.
posted by jojobobo at 10:00 PM on January 13, 2022 [1 favorite]

Best answer: I personally would not use force or otherwise bypass bodily consent until the point of actual medical necessity, or other potentially life-altering effect.

"Can get cleared to return to school some days sooner", for one example, would not be medical necessity. "Has symptoms and we want to know if it's covid" would not be medical necessity unless the result affects treatment or others at risk. "Needs a test to access medical case" would be necessary; "needs periodic testing to access a year of education" would be another kind.

I know there can be strong practical reasons short of that my criterion, and I'm not standing here judging, but this is what I try to stick to.
posted by away for regrooving at 10:57 PM on January 13, 2022 [6 favorites]

You could try a booger hunt.
posted by warriorqueen at 2:20 AM on January 14, 2022 [2 favorites]

Best answer: In terms of his feelings and fears, this sounds like a good time for some gentle art or play therapy. The Teapot Trust has some really good resources for this, structured around pandemic wellbeing for young children, including videos from art therapists to follow along with some fun exercises and downloadable worksheets and guidance for you, in their Art Therapy at Home page. See if he's interested in talking about his feelings this way. It may give you some insight.

You sound like a good, loving parent. This whole thing is so hard, especially with your background and on top of your own stresses, please take time to take care of yourself as well.
posted by fight or flight at 5:41 AM on January 14, 2022 [1 favorite]

Agree with wesleyac, explore if possible why he is afraid to die from a PCR Test.
Some of my (ex) inlaws actually believe that testing will make you deathly ill (they found this one Telegram i think). Anyway, If there is any Chance he could have overheard adults mentioning this, even if to express how much bs this is, he might be afraid it was true.
posted by 15L06 at 6:01 AM on January 14, 2022

Best answer: anything where I'm overpowering my child even for his best interest is hard.

My child had a fierce needle phobia and I remember when we forced a blood draw when he was little. It was truly terrible. I don't know if it made his needle phobia worse, but it lasted for YEARS. He would tense up for vaccinations and avoided needed bloodwork in his teens. He once walked out of the doctor's office when we were supposed to go to a lab (and this kid isn't generally what I'd call rebellious). He finally was motivated to deal with this as an older teen when he needed a blood draw for something where he felt like it was important, and he reached out to his doctor, who prescribed him one Xanax. My kid had a non-traumatic experience with a needle for the first time in his life. He got another Xanax for his first Covid shot. Since then, he's needed a few more shots and has decided not to ask for a Xanax and I think that has been fine for him.

I'm not sharing this to suggest you get a Xanax for your little one for the nose swab. Rather, I'm saying that I think it's completely reasonable not to want to overpower your child for something where they are so scared. I definitely recommend my earlier suggested play therapy approach (especially since it seems like you have time to let this play out a bit). I'd try M&Ms because they are super tasty and can be dolled out in very small doses.

If this was an emergency and your kid was stuck in some terrible place then of course you'd overpower them. But trying to avoid that, and to find a better path, is completely and absolutely reasonable. I wonder how this might have gone differently for my son if we had approached this differently when he was a little one (he was 5 then, same age as yours now).

You could also try to see if you could find a therapist who works with kids to give you some coaching on this (to work with you, not kid), but I know it's hard to make appointments right now. Good luck.
posted by bluedaisy at 9:40 AM on January 14, 2022 [3 favorites]

You could make a game out of the entire process.

Like the person above suggested, you could make it a booger hunt. Like - set up a series of swabs, the entire family/group could do it at once, and the person with the most awesome booger? Gets a prize! Then, make it a great prize that the kid will enjoy, and have the kid 'win' often.

Then, when it's time to take the home test? That can be the Special Bonus Round - because his boogers have been SO impressive in the past? They're being sent away for Special Judges to examine, and he will get an even BIGGER prize, for participating! The Covid test isn't a Covid test, it's an Awesome Booger Test.

You might have to develop a tolerance to looking at snot, but it's gotta be better than physically restraining the child to get the test done.
posted by spinifex23 at 10:41 AM on January 14, 2022 [1 favorite]

> He said he's scared he will die if he gets the PCR test.

Do you know why he thinks this might happen? To me, this doesn't sound like he's scared of the physical process of the test, but rather some confusion about what it represents. I'd try talking to him more about this, and trying to figure out how he's thinking about it.

Thirding this. It sounds like he's been putting together some deductive reasoning about medical stuff in general that has taken a few left turns in logic, like kids do when they're trying to make sense of complicated and contradictory things. He's undoubtedly picking up on the pandemic anxieties of the adults around him, and he's also at an age where he's starting to be aware of death and afraid of it. No wonder he's got the cause-and-effect a little twisted up.
posted by desuetude at 11:03 AM on January 14, 2022 [3 favorites]

Response by poster: Thank you all. I did ask why he thought it would kill him and he was worried that he would stop breathing. I decided not to push it but will keep talking about it. I have told him there will probably be a point where he will have to do it to be able to do something else that's important to him.

Thank you for all the suggestions. We will make good use of the home art therapy. Unfortunately I've used m&Ms for other reinforcement efforts and he got saturated with them so they won't work anymore.
I'll probably work some PCR tests into our pretend play as well. Maybe we can build a Lego doctor's office.
posted by crunchy potato at 9:11 PM on January 18, 2022 [1 favorite]

I did ask why he thought it would kill him and he was worried that he would stop breathing

Hmm, maybe he's got something jumbled around what is meant by "test?" What context does a little kid even have for that word? A test is something you have to do in school to prove that know something/can do something and if you can't, you fail.

It's several leaps back in a more literal direction to understand that "test" in this case means "use a chemical process to see whether this snot has a very specific thing in it, and that thing proves that your body has COVID." And also, importantly, there's nothing wrong with his snot either way.

I'd probably bust out the kiddie microscope at this point and show all of the things you can find in pond water if you know what to look for, and then move on to introduce the idea that "test" in a scientific sense just means a way to look for one specific thing.
posted by desuetude at 9:27 AM on January 19, 2022 [1 favorite]