Our practitioners conduct a complete history and physical examination, and order specialized tests of blood, urine, stool, and sometimes hair, to assess for abnormalities in the child’s nutritional status, immune system, gastrointestinal system, and even DNA. These specialized tests uncover issues that may be causing unusual sensitivities to environmental toxins, contributing to chronic allergies to foods and inhalants, chronic viral infections, or even brain inflammation and autoimmunity. This section provides helpful information about the testing process. The samples for some of the tests, such as urine, stool and hair, will be collected by you at home, and shipped off directly to the lab.
For the blood tests, we recommend that you schedule an appointment to come to the Developmental Spectrums lab for the blood draw. Our phlebotomists are experienced at drawing blood on our sometimes difficult kids with ASDs, and are familiar with the complicated processing requirements of our tests. If sedation is necessary for the blood draw, that can be arranged. The initial tests require several tubes of blood. If a child weighs less than 40 pounds, we divide the labs into two blood draws. Be aware that, collectively, a typical set of initial tests can cost up to $2000, some of which may be covered by insurance, but usually not all. If that is an impossible amount of money for a family, our practitioners try to get as much useful information as possible from less testing. We have helpful information sheets on how to survive the blood draw with the least possible trauma, and how to do the paperwork required on the test kits.
Info on Completing Test Kits
Developmental Spectrums Tips & Suggestions for Successful Blood Draws
First, always be honest and direct with your child about what you are doing. Prepare them in advance for what is going to happen. Do not lie to them or deceive them because you are afraid that they will be upset. It is much better to deal with honest upset, than to develop mistrust in the relationship. Explain it even if you don’t think they understand you – often they understand more than we think they do.
For many kids, writing a “social story” about “X Goes for a Blood Test”, telling every single step of the process, and reading it over and over will help allay any fears. The fear of the unknown is worse than fear of the procedure. If kids understand what is going to happen next, they are much calmer.
We offer numbing gel for those who feel that it may be helpful. Apply a liberal amount to the inside bend of both arms, up and down the arm a few inches, about one hour in advance of the procedure. You can re-apply 30 minutes before if it has all soaked in. This way, the area should be completely numb, and the child will not feel any pain. There may be a bit of discomfort from the tourniquet that is applied to the top of the arm to enhance the veins, but you may rehearse this step with the child at home by going through the sequence with an actual rubber band on their arm, and using a fake needle, like the blunt end of a pen.
Although sugar is not usually our friend, in the case of blood procedures, it can be. I recommend some sweet treat in the mouth that won’t be choked upon for the draw, like a lollipop, or my son’s personal favorite – dairy-free chocolate chips from Whole Foods. I plop one chip at a time into his mouth until it is over, and he is happy.
Some older kids may be able to handle sitting in a parent’s lap and facing out toward the phlebotomist (blood-drawer), but many kids find this frightening, and it is a more difficult position to hold a child who is going to be a fighter.
For kids who may struggle, I recommend drawing blood at a lab that offers a bed (which we do at Developmental Spectrums), where the child can lie down comfortably, and a parent can climb up on top and use their body weight as restraint – more like a strong cuddle. It is much more comforting to a child to be restrained this way than to be held down by strangers, or tied down or wrapped in a “papoose” – although sometimes these devices are helpful. If more than one adult will be necessary for restraint, you will need to bring them. Most other blood centers only have staff to hold the arm and do the actual draw – not hold a fighting child.
While on top, the parent can position their head between the child’s face and the phlebotomist, so that the child is not looking at what is going on. The parent can speak into the child’s ear with comforting phrases, or sing songs to distract them. Even counting can work. Or bring a DVD player and your child’s favorite movie to watch.
For procedures like this, bribery can be a help. Promise some big reward afterwards – a coveted toy, or trip to the park, or favorite food, for example. Build up this anticipation before the actual appointment.
We don’t want blood draws to be traumatic, because we will need to do periodic redraws to check on the status of treatment. If you follow all of these tips, drawing blood doesn’t have to be a negative experience at all!
Tips for Collecting Urine and Stool from Children
How to Collect Urine and Stool Samples from Children
Like anything else with kids on the spectrum, frequent practice and desensitization can make the difference between success and failure in collecting the proper lab samples. Do several practice runs before the crucial sample collection time, to figure out what works best for your child.
Urine samples must be completely free of any stool or other contaminants. Stool samples that have urine on them can sometimes be salvaged by removing the top layer of the stool and collecting from the inside of the sample. Always collect stool from an area of the sample that is not touching anything else.
For Potty-Trained Children:
Try getting one of the plastic “hats” that insert under the toilet seat from your local hospital or medical supply store.
Try lifting up the seat of the toilet and wrapping plastic wrap across the bowl, with a small sag in the middle, to collect the sample(s).
You can collect a sample from a clean potty chair.
For Children in Diapers:
Stool: Collect the stool sample directly from the diaper, trying to find a spot that is not touching the diaper itself (diapers have antibacterial substances in them).
Urine: Urine cannot be squeezed out of a diaper or underwear. Try one of the urine bags attached to the child. You can cut a hole in the diaper so that the urine bag hangs outside where it has room to expand when full. Just make sure to cover it with long or loose clothing so that the child is not tempted to pull it off. The bag can be left inside the diaper if it is emptied frequently.
An alternative method is to find a small plastic cup, place the bottom of the cup at the correct location in an open diaper, use the bottom of the cup to draw a circle and cut a hole in the diaper. Then place the plastic cup in the hole in the diaper, and put it on the child, positioning it strategically to collect the sample. The cup can then be emptied and put back into the diaper until all the necessary urine is collected.
For girls, you can cut a slit about one inch wide in the diaper area that is between the legs, and hand-sew a zip-lock plastic bag in an open position to the two sides of the slit. You may have to sew several diapers in advance to make sure that you don’t miss any samples. You must empty immediately to prevent the bag from tearing.
Another more difficult alternative is to keep the child “bottomless” and follow them around with a cup to catch the urine flow. Some children will “pee” when they are put into a warm water bath, so you can stand your child in warm water, and even try pouring it down their back to induce urination.
Instructions for Successful Suppository Insertion, please read this document prior to the use of any suppository.