Gloria describes the way I get blood samples for PKU screening, except that I haven't bothered warming the baby's foot for the last few years.  Turns out that the reflex vasodilation that occurs when the baby is swallowing milk regularly is more than adequate to ensure a successful stick.  If there are several other tests to be run and we need more than the usual amount of blood, I do warm the foot if it feels cool to touch on arrival, but not otherwise.  Tenderfoot lancets are expensive but they work better than the old ones we had before, where we frequently had to use two or more to get enough blood.  They also have a less traumatic blade so the wound heals more quickly than the ones we had before.

My colleagues in the postpartum clinic, and many in the community, all do the heel sticks with baby at breast, which also gives us an easy opportunity to discuss any problems the mother is experiencing, or just to observe without them feeling like they are on display having their breastfeeding technique scrutinized.  But I think I am the only one who is too lazy to make a heat pack for the baby's foot for the sake of four good-sized drops of blood.

The other nice thing that happens is the mother often realizes for the first time that breastfeeding is more than food, and that she has what her child needs.  For some of them it is the first time they have supported their child through something they thought would be difficult, and if it is a good experience, it bolsters their confidence as parents.

Some of our lab techs have seen how well this works from a purely technical standpoint and they encourage mothers to breastfeed the baby during heel sticks.  If you observe when babies start to show signs of distress in connection with old-fashioned blood sampling, you realize that many of them are crying before you get anywhere near their foot.  Being taken away from the arms of their mothers is worse than the actual lancet stick.  Anyone observing what happens in our practice would be unconcerned about the baby connecting any trauma with breastfeeding, because *no trauma occurs*.   Babies almost always cry when we take their clothes off and weigh them, and almost never when we take blood samples.

Since breastfeeding is something the baby experiences all the time, in all kinds of places and circumstances, while PKU testing happens once, I am not worried that the baby will connect the trauma of a heel stick with breastfeeding.  I might consider it differently if the baby were undergoing many many blood tests over days and days, and was offered the breast just before each one of them, but I don't see those situations.  

Rachel Myr
Kristiansand, Norway

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