Testing can be a little frightening for children at first, and the experience can be as hard, or harder, on the parent as it is on the child. Children behave like children—most are resistant at first, but resigned and somewhat cooperative eventually. If the parent is firm but comforting when necessary, the child usually has an easier time accepting the idea of being stuck. Young children usually have a lower tolerance for testing than adults have, and I recommend that a young child not be expected to test for more than 3 or 4 hours at a time. They generally let you know when they’ve reached their limit. All cooperation ceases and each stick becomes a battle. Sublingual testing can be done if we are looking for specific symptoms, but this type of testing requires the parent to be very alert to changes in the child. Skin testing and waiting for delays is usually more accurate. We don’t want the child to remember his visit to COEM as a traumatic experience, so we’d rather leave a few things for a later time if the child seems to have used up all his tolerance. Most children on a return visit remember the location of the play room with all the toys and head straight there, dragging Mom with them. That’s the way we want them to feel, that this is a fun place to be. I understand that when patients travel long distances to get here, they want to accomplish as much as possible, but there is a fine line sometimes between necessary pain and cruelty where young children are concerned. To ask a child to endure testing past the point where he seems able to tolerate it is not usually advisable. After consulting with the doctor, decide what things are most important to test at this time in case some things have to wait until later.
Sometimes it seems to be an efficient use of time for a parent and child to test at the same time, but it doesn’t usually work out as a good thing for either one. It is difficult for a parent to monitor their own symptoms, and be attentive to what’s going on with the child (or children). Testing can affect concentration, mood and rational thinking, as well as the body. We often provoke symptoms not usually considered allergy related. Young children cannot always tell us how they feel. It takes a parent who knows her child to pick up on some of the signs of distress children exhibit while being tested. It takes an alert parent to monitor a nonverbal child, and a parent who is being tested is not always alert. Even if a child can tell you what he feels, sometimes he is not a reliable witness. Usually Mom knows how much confidence can be put in what her child tells her. Children are often eager to please, and if they think they are supposed to be symptomatic, they may complain of something they are not really feeling. Again, it takes a parent who knows her child, and a parent who is concentrating on the child and not herself to let the tester know what is going on with the child. And the parent who is primarily concerned with the child’s symptoms may not let the tester know what is going on with her symptoms. We rely on both whealing (skin reactions) and symptoms provoked during testing. Both the parent and the child may get inaccurate testing results if they test at the same time.
If several family members come to the office at the same time, it would be advisable to spend a little time before the visit planning how to make sure everyone gets maximum benefit from the time spent at COEM. In the long run it may be best to schedule separate times for some of the family members.