Reducing Distress in Children During Venipuncture

When it comes to pediatric patients undergoing venipuncture, it should be every phlebotomist’s top goal to reduce a child’s fear, pain, and distress, But studies show that age is a significant factor in how they behave, their level of distress, fear, and perception of pain.

Most children have some fear of needles. It is natural to feel uneasy about having a blood draw. If your child is feeling uneasy, you can work together to develop a plan to deal with his/her emotions. This will help your child feel more in control.

Physically restraining a fearful child during the venipuncture procedure is in no way an ideal situation and could be a disaster in the making! Rather, when dealing with a fearful child, it is best to try to control fearful rejection and manage defensive behavior through parental coaching, distraction, and positive reinforcement.

The pain associated with immunizations is a source of anxiety and distress for the children receiving the immunizations, their parents, and the providers who must administer them. Preparation of the child before the procedure seems to reduce anxiety and subsequent pain. The limited available data suggest that intramuscular administration of immunizations should occur in the anterolateral thigh for children <18 months of age and in the deltoid (upper arm) for those >36 months of age.

Although there are few studies of preparation for pediatric immunizations, In addition, parents should be provided with techniques (breathing techniques, reading or telling a story, or involving the child in a fantasy) they can use to “coach” their children through the procedure, to promote coping.

Behavioral interventions for venous access should be implemented from the point in time when the procedure is initially scheduled until the procedure is complete. Preparing the child and the family for the event is important while also taking into consideration the timing, format, and content of the intervention. Providing distraction and coaching for the child in coping skills throughout the venous access procedure will prove helpful in managing fear, anxiety, and pain.

When a child’s level of distress in anticipation of the venipuncture is on the rise, it can be a rather difficult task for the phlebotomist and parent to make the blood collection process go over smoothly! It should come as no surprise that the use of physical restraint, such as the child being placed on the parent’s lap, and tightly held down, will only increase the child’s negative response and psychological suffering.

Research shows that managing both the anxiety of anticipating a procedure as well as the pain caused by the procedure itself is the best way to keep pain under control. The simplest thing you can do to help your child keep anxiety at bay is to stay with them. Your presence alone can actually reduce the amount of pain your child experiences by reducing their anxiety. One study found that children who were prepared for a blood draw had less distress before and during the procedure than those children who were unprepared.

The above mentioned is a simple approach to greatly reduce a child’s distress, and the parent’s and phlebotomist’s anxiety and stress during venipuncture,it is not routinely used everywhere there is blood to be drawn!

Celeste Botonakis

On the Nursing Assistant Guides blog, certified medical assistant Celeste Botonakis explores the daily life of a CMA. She'll keep you up-to-date with the latest on what’s happening in the field, and provides tips for those who are interested in becoming a medical or nursing assistant. Celeste has served in the medical field for over six years, and is passionate about helping people. She currently works at CSR Primary Care in Skokie, Illinois. Click here to learn more about Celeste Botonakis and