Joseph Gonzalez-Heydrich, MD who is director of the Psychopharmacology Program at Children Hospital Boston responded to the following question:

How do you deal with children who require blood tests, but are scared or phobic of needles?

Peter is a 13-year-old boy with a history of temper outbursts, learning disabilities, and refusing to go to school. I suggested that we start him on Tegretol because of the severity of his temper (i.e. he would break furniture) and the swings in this mood. This medication requires regular blood tests. His parents agreed but did not know what to do to get him the necessary blood tests. Peter was very scared of needles. They said that prior to previously needed blood tests they had gone through days of terrible tantrums followed by trips to the hospital or clinic where he would run away or need physical restraint to draw his blood.

I suggested the following via e-mail:

"…Give Peter the choice of who is to do it, his pediatrician or here at the hospital or who ever is close. If he chooses the hospital then call the laboratory and arrange to come in the day before for Peter to watch other kids coping with it. Promise him no needles on that visit. The second visit is the one where he gets his blood drawn. If his pediatrician is going to do it then you can ask him if he can pre-treat Peter’s arm with Emla or something like it; it’s a topical anesthetic cream. It won’t block all the pain, but it may make Peter feel better in that everything is being done. If none of this works then I would suggest making an appointment with our medical coping program…"

The father subsequently reported that Peter had his blood drawn without incident. The father was very proud of the way he had accomplished this. He had arranged for the Emla cream and went searching for a local phlebotomist (blood drawer). When he visited a local laboratory, the blood drawer was someone with whom he immediately felt comfortable. When he got Peter to go with him to the lab, he also arranged for the same blood drawer to come sit for a moment in the waiting room with Peter. The blood drawer told Peter how she was going to put the Emla on first and how she would use a little needle to draw his blood. Peter went back to the lab area and had the blood drawn with some visible anxiety, but in good control of himself.

Blood drawing is now accomplished easily. Peter’s temper tantrums and mood swings have improved on his new medication. Best of all the parents and Peter have gone on to tackle his school refusal.