Subcutaneous injections

Some children require medications given by subcutaneous injection (shot under the skin) during their treatment. For example, Neupogen (G-CSF), a colony-stimulating factor that is often used to boost the white blood cell count, and methotrexate are usually given by injection.

We found that giving 4-year-old Joseph as much power in the process as possible really helped. The shots themselves are non-negotiable, but there are many parts of the process where the child can have some control (where to put the EMLA cream, where to be sitting for the cream and/or the shot, who holds him, what Beanie baby to hold during the procedure, etc.). We also made sure to have a consistent little treat available afterwards, although this became unnecessary after a while. Even at 4, Joseph loved money, so for a long time he kept a pint jar, which would travel to the hospital and back home again, and he'd get to drop in a nickel for each pill successfully swallowed (a huge chore for him) and a quarter for each shot. Of course, adults would look very surprised when we told them we gave Joseph "quarter shots." Something tells me the bar scene will be very confusing to him when gets to college.

To minimize pain caused by subcutaneous injections, apply EMLA cream one to two hours before administration. Parents can also reduce pain by rubbing ice over the site to numb the area prior to injection. Other ideas are on the Internet at http://webpages. charter.net/drshrink/gcsftips.htm.

My two boys have ALL. Brian and Kevin both receive[d] IM methotrexate as part of their protocols. Brian, because of his age (12), was very macho about it, used "freezy" spray to numb the thigh, then giggled or made funny faces while the methotrexate was pushed. He had no aftereffects. Kevin, only 4 when they began, still doesn't like them. There were three or four months of overlap, when both boys got shots at the same time every week. This made it easier for Kevin, but he still insisted on an ice pack and freezy spray. Now, he uses the spray only.

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