CHILDREN AND SKIN PRICK TESTING
It is not uncommon for skin prick tests to be performed on children. Though the test may sound frightening, most children cope very well. This is because the discomfort caused by skin pricking is short lived and does not linger. This is not to say children never become distressed during skin prick testing, some do. They simply tend to recover very quickly (within a minute or so), upon test completion.
It is important to realise children often express or use the word “pain” to describe fear, distress and anxiety. Skin prick testing is not typically described as a “painful” procedure. A child’s anticipation and anxiety is often much worse than the actual skin pricking.
Provided below is information on what to expect at your child's allergy appointment, how to prepare for your child's allergy test, and methods for reducing your child’s anxiety and comforting your child during testing.
WHAT TO EXPECT
WHEN YOU ARRIVE
Upon arrival, you and your child will be greeted by a receptionist and asked to fill out a new patient registration form. You will then both meet with the doctor for your child’s initial allergy assessment. The doctor will take a careful medical history and ask a series of questions, to gain a complete understanding of your child’s symptoms and assess the likelihood of allergic disease. The doctor may look inside your child’s nose with a small fibre-optic camera.
After consultation with the doctor, should allergy testing be indicated, you and your child will move through to the nurse’s room for your child’s skin prick test.
THE SKIN PRICK TEST
Skin prick testing involves the introduction of small amounts of suspected allergens onto and just below the surface of the skin. A series of small, superficial breaks in the skin are made with prickers which have been dipped within allergen extracts. The exact number of pricks performed will depend upon the specific panel of allergens being tested.
There is no blood and are no needles involved within skin prick testing. Skin prick testing is performed using prickers which bear a resemblance to toothpicks. The prickers are pointed, however do not usually draw blood, as the breaks made in the skin are only shallow. Discomfort caused by the skin pricks is short lived and does not linger.
For older children and adults skin prick testing is usually performed on the inner part of the forearms. For younger children, it is usually suggested the back be used. Performing skin prick testing on the back enables the young child to sit on their parent’s lap and be cuddled throughout the procedure.
Upon performing the skin pricks, a timer is turned on and the skin is observed for 15 minutes for signs of a wheal and flare reaction (raised lump, with surrounding redness). Wheal and flare reactions are usually indicative of a positive reaction to an allergenic substance. Positive reactions should not hurt, however may feel itchy. Patients are asked to refrain from touching or scratching the test area throughout the observation period.
Once the results of the skin prick test have been recorded, the nurse may apply a steroid ointment to help soothe itchiness. The doctor will then meet with you and your child, to discuss the significance of the skin prick test results.
Please note: The results of your child’s skin prick test will be interpreted by the doctor in the context of your child’s medical history, symptoms and allergen exposure. A positive skin prick test does not automatically denote the presence of a clinically relevant allergy.
PREPARING YOUR CHILD
It is important to provide your child with an explanation about the procedure prior to it being performed. What to tell your child and when, will vary, depending on your child’s age, maturity, temperament and past experiences. As a parent, it is ultimately your decision how much information you give your child and when you tell them.
WHEN TO HAVE THE CONVERSATION WITH YOUR CHILD
As a general rule, for children under school age (less than 6 years old), it is appropriate an explanation be given just before the procedure takes place. For school aged children (6 years and over), it is better to explain the procedure and prepare the child 2-3 days prior to their appointment.
WHAT TO TELL YOUR CHILD
Why skin prick testing is needed and how it will help them
“We need to do the test so we can find out what is causing your nose to be blocked all the time, and we can help you breathe better.”
“We need to do the test so we can find out what is causing your skin to be so itchy”
“We need to do the test so we can find out what is causing your eczema and we can make your skin feel better”
“We need to do the test so we can figure out what food is making you feel sick.”
“We need to do the test so you can get better and not feel sick anymore.”
What a skin prick test is and how it is performed
“The nurse is going to draw some numbers on your arm/back. Next to each number the nurse is going to prick/poke/scratch your skin.”
Reassure your child there are no needles, and they will not bleed.
What the skin prick test will feel like
Promising a child a procedure will be pain free is not encouraged. An honest alternative may be to say something like: “Some children say it is a little bit uncomfortable/ouchy, other children say it tickles.”
(use whatever word you and your child use to describe discomfort/pain)
EXPLAIN THROUGH DEMONSTRATION
If your child is particularly fearful of needles or anxious about medical procedures, you can simulate how the test is performed by pressing a clean toothpick gently on your child’s skin.
Reassure your child:
– there are no needles
– they will not bleed
– the test is over very quickly
– you will remain with your child the whole time
If you are aware of another child or family member who has undergone skin prick testing in the past, it may be useful to tell your child, to give them more confidence.
“Did you know Jeremy from school has had the same test done before?”
“Emily from dancing had this done last week!”
ON THE DAY OF YOUR CHILD'S ALLERGY TEST
WHAT TO BRING
At our clinics we have a small range of toys for your child to play with during the 15 minutes after his or her skin prick test is performed. We also have some stickers and lollies (e.g. jellybeans) that we are happy to offer your child (with your permission), as a reward after the test has been performed.
Please feel welcome to bring with you to your child’s appointment:
– your child’s favourite toy/book/game
– a gadget (i.e. phone, tablet) for your child to watch a video or play a game on
– a reward for your child for after test completion
COPING WITH YOUR CHILD'S DISTRESS/DISCOMFORT
It is not uncommon for parents to feel guilty as a result of their child’s distress. It is important to remind yourself:
– You are a good parent!
– You have your child’s best interests at heart!
– Your child’s distress is temporary.
– A child’s anticipation and anxiety is often much worse than the actual skin pricks.
WAYS TO REDUCE YOUR CHILD'S DISTRESS AND COMFORT YOUR CHILD DURING AND FOLLOWING THEIR SKIN PRICK TEST
Stay calm yourself
One of the most important things you can do to help your child cope is to stay calm yourself. Children can read body language very well. It is important to communicate to your child that the procedure is something they can handle.
Focus your child’s attention away from the procedure and discomfort, onto something more fun and engaging. This may be achieved by:
– Watching a video, playing a game
– Asking your child questions which require more than a yes or no answer
– Initiating a story your child can take part in telling
– Talking about rewards e.g. stickers, babycino, visit to the park
A positive reaction to an allergenic substance may become raised, red and itchy, like a mosquito bite (but will not hurt). It is natural your child may want to scratch the test area. Methods of distraction which require the use of your child’s hands are always recommended.
Be sure to point out to your child how well they have done. Use this opportunity to praise your child and build their self-esteem. Praise your child on their accomplishment.
– Reassure your child how brave he or she is
– Reassure your child the procedure will be over very quickly/is almost finished. “The nurse is very fast!”
– When the skin pricking is complete, reassure your child there will be no more pricks, just a short wait. “After 15 minutes the doctor is just going to have a look, no more pricks! And then we can go home.”
A positive reaction to an allergenic substance may become raised, red and itchy, like a mosquito bite. If your child expresses concern, you can reassure them:
– The nurse will take away the itch at the end with some special cream.
– The reactions will disappear (usually within a couple of hours of testing).
Should your child become distressed during their skin prick test, it may be useful to encourage them to take one or more deep breaths. Concentrated breathing is a useful technique for calming the body and the mind. Taking controlled breaths helps to slow breathing, lower the heart rate and blood pressure, and reduce muscle tension. Redirecting your child's focus to their breathing may also help to disengage them from the distracting thoughts and sensations associated with their allergy test.
Physical contact can have a great calming effect for both your child and yourself. Maintain physical contact with your child during the procedure by holding their hand, having them sit on your lap, or giving them a cuddle.
You may have organised a small reward for your child for after their allergy test/appointment. Fantastic idea! Recognition of efforts and rewards are great for self-esteem and can be great incentive for children to cooperate. It is important though, that you communicate with your child, and are clear about your expectations of them during the appointment e.g. "You need to stay still." "No scratching."
Discussing your child's reward may also serve as a useful distraction during testing:
“Which sticker are you going to choose?”
“Are we going to go to the park after this?”
“What flavour milkshake are you going to choose?”
WHAT NOT TO SAY TO YOUR CHILD
As mentioned above, promising a child a procedure will be pain free is not encouraged. An honest alternative may be to say something like: “Some children say it is a little bit uncomfortable/ouchy, other children say it tickles.”
Nor is it encouraged you mislead your child about attending the appointment e.g. telling them “It’s time to go to Toys R Us!” and taking them for an allergy test instead.
It is natural for parents to empathise with their children during times of distress, however excessive reassurance and apologising is not helpful e.g. "I know it hurts." "I'm so sorry you have to do this." Comments such as these can actually increase your child's distress by focusing their attention on their fear and discomfort. It is more appropriate to encourage and coach your child to cope.
During testing, if your child is coping well, avoid comments like "You haven't even flinched!" "You are not even crying." Comments such as these imply there is something to be feared, and often trigger children to become more distressed.
If you have any concerns about your child’s allergy appointment and skin prick test, please do not hesitate to contact us prior to your child’s appointment.