“I don’t want that needle!” (AKA Do fewer things)

We (doctory, paediatric types) tend to pride ourselves on minimising distress to children and young people wherever possible. A couple of social media interactions over the last few days have made me re-question that – this one

and the follow-up

 

Now that’s a great time to re-acquaint yourself with the guest blog from Sian about asking questions to children, and perhaps some stuff about the use of pain relief in venipuncture, and then take on the challenge of that last question

“..is this absolutely necessary”

What does ‘absolutely necessary’ mean? Is there ever a blood test that is absolutely necessary?

Taking an extreme example, you have a toddler presenting with clinical pallor over 3-4 weeks, bruising spontaneously, lethargy, and palpable liver and spleen. (I’m really hoping that acute leukaemia is on the top of your lists here …) If you couldn’t do a blood test, could you still manage this situation?

What about a child who’s hot, annoying, breathing a bit quick and looks a tad dry?

What about a teen who’s finding getting up in the morning a struggle, is tetchy and snappish, and constantly complains to anyone who will listen about tiredness?

We’re always going to live in a world of compromises. If you’re visiting a child who’s receiving end of life care at home, you’re going to act differently than if it’s a previously well child attending the acute assessment area. If you have a radiographer two doors down from your clinic, you might think differently about a chest X-ray than if you’re in a GP clinic. Now question yourself why – what’s making you make that call differently. Is convenience and expectation the driver or is it clinical need?

  • Bob Phillips

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