Here we go again...

Well, yesterday was rotten. It started Friday when we had a playdate with a little boy from school. Pajama Monster had a great time but got way too wound up and started acting out by ripping things, pouring juice into their carpet and repeatedly sticking the cat's loose catnip in their shoes. We ended the playdate and I tried to get Pajama Monster back on track, but he continued to be off for the rest of the day. When he's in that state he just does lots of little things he know he shouldn't do. It's the push buttons, stick your feet on the table, throw the toy in the trash kind of behavior. He does each behavior very deliberately and is delighted when we see it. Saturday was a constant series of such small acts of defiance. We managed to go out to eat but Pajama Monster had to be taken out of the restaurant at one point because he wouldn't just sit and eat but insisted on deliberately doing the opposite of everything he was asked to do, loudly.

On Sunday Pajama Monster started again acting out in little ways, then threw a bunch of the sugar packets in the trash at the coffee shop, refused to take his time out and was generally rude and loud and defiant. He's been hitting off and on for the last several days as well. That was the end of our family fun for the day. When he acts like that we have to give up all family plans to go out to eat or visit a park, etc. and just go home. If we don't it gets progressively worse and always ends in him screaming and hitting and unbuckling himself and running frantically doing as many bad things as fast as he can. We took him home from the coffee shop and tried to get him calmed down but the rest of the day was just a series of little incidents of him picking at people, being defiant, and trying to make everyone upset. They weren't horrible individually. They were just constant little things like pulling all the towels down so I'll have to pick them all up and put them away again or yelling and being loud whenever we tried to sing Peep her lullabies at bedtime. It wasn't full strength Pajama Monster, but it feels like we're headed there.

This morning I woke up and had to walk him through potty and toothbrush time. He claimed he didn't have to urinate. I asked him to play for a little while and eat his banana as I nursed Peep. When I came back I found that rather than playing he had elected to squat in his doorway and urinate into the hall carpet. He has a potty in his room and is across the hall from the bathroom. There was no reason and he wasn't remotely sorry. He just wanted to be rotten, yet again.

I feel like this is just our reality. We all get dressed and ready to go do something as a family and then Pajama Monster starts acting out and we all just get to sit around the house wishing we could do the same things everyone else gets to do. I have this fantasy of walking along at a beach or science museum or zoo or campground with my husband at my side and our two babies running around exploring. It's just a fantasy though because the reality is that my husband wouldn't be there. He's unwilling to be out somewhere that far from home with Pajama Monster because then we're stuck there dealing with him when he acts out and he's much harder to contain. The reality is that we usually don't get to go at all, and when we do it's just me with the two kids trying to contain Pajama Monster so he won't just suddenly start running around trying to break, damage and destroy.

For almost three weeks it felt like we had an answer. Pajama Monster was playing and laughing and reading his first Dr. Seuss book all by himself. He was snuggling and arguing with his sister and playing with her and apologizing when he did something wrong and getting excited about playdates, but then it just seemed to start swinging back the other direction. I'm afraid the psychiatrist will suggest adding yet another med into the mix. I don't even want the ones we're already using. I'm not sure how much worse things will get on the Depakote. So far things are looking better than they used to, even if they're not what I was hoping for. How much does it have to help to be worth giving to a four year old? My thought is that it would need to help a lot to be worth the risk.

I feel like I spend part of my days angry and most of the time heart sick. I just want him to go through the day without gleefully going out of his way to make everyone's life miserable. I can handle fighting with his sister and the occasional pushing or hitting, and tantrums when he doesn't get his way. I can handle the testing limits and the questioning things and even the whining, but this is different. He gets a look on his face and you realize that he can't be trusted for a second because if he has a pencil he'll use it to stab holes in the couch and write on the walls. If he gets a bath he'll bale the water out all over the floor. He'll take the dirty diapers and hide them under the couch and smear his own poo everywhere. He'll throw garbage in your tea when you're not looking and then knock his sister into the wall because he doesn't like being told he can't have another pencil. They're not huge things but they're constant. I'm trying so hard to help. We've spent years trying to help him name the feelings he gets when he's acting out and trying to get him to tell us when he's feeling that way. We've worked on countless calm down strategies and methods for us to soothe or help him self soothe. I play with him and comfort him and cuddle him and read to him and do art projects and activities and outings with him, but nothing changes. In the middle of every moment is the knowledge that he still will routinely ask for a kiss and then spit on my face or pull my hair when I lean down. Knowing that I have a bad back and it hurts me if he jumps when I hug him, he'll consistently as for a hug and then just jump and pick up his feet, whenching my back but secure in the knowledge that I'll throw my back out rather than let him fall. But what's my choice? Should I refuse to ever hug or kiss him? I'm just not willing to do that, so I get spit on and hurt and spend my days scrubbing poo, because I'm Mommy and that's what he seems to think I deserve. Some days I think he hates me, but then I have to sit and remember his illness. No one would choose this. It's not his fault. He doesn't hate me. It just feels that way.

Attachment and Reconnecting

I know I'm getting ahead of myself since we don't know that the Depakote will continue to work. If he continues to do better and then worse we can't keep upping the dose or it will become unsafe. That's just not an option. Still, he's my baby and I'm going to hope this time because I feel like I have to. I love him and I want this for him so badly there aren't even words.

As Pajama Monster has more days that bring no more than normal Preschooler problems I'm beginning to look more at our attachment. I feel that being forced into the position of warden for so long, just to keep the family safe, has done damage to our bond. Pajama Monster is still a snuggle seeking, Mommy loving, little boy, but I've noticed him seeking out more mommy cuddle time lately and being more upset if I'm not available all the time. I think he's wanting to strengthen his sense of trust and attachment and I want to help him with that. I'm beginning to be able to go back to more AP methods of discipline. We still have time outs, but they're more rare, as Pajama Monster has become more responsive to invitations to problem solve together and reminders of how his actions make people feel. He's more easily redirected with silly games and new activities.

I find that I'm struggling with my own fears any time a behavior looks like one of his old problem behaviors. For example, when he was getting ready for a full scale destructive, hitting, etc. fit, one of the first things he'd often do is flip open the gas tank door on our car. Usually it was the gas cap several times then running and hitting while I buckled him in, then unbuckling himself over and over while screaming at the top of his lungs and kicking my seat and knocking the head rest up so I couldn't see behind me. He'd also harass and attempt to hurt his sister if he could reach her, and generally be as rotten as possible till I could carry him, pinching and screaming and hitting, into his room where he's poo or urinate on everything. The action of flipping open the gas tank door itself does no harm, but we didn't want him opening the gas cap, so he has been asked to leave it alone. It's just an association, but when he did this yesterday I could feel my adrenaline rising. I was able to ask him if he was hoping for a good ride home playing games with Mommy or a bad ride home, and what things he'd like to do. He made up a silly game of Mommy saying "Microwave, Microwave, What are you toasting?" and he'd answer with various silly options. We had a good ride home playing the microwave game and a nice evening, but my initial gut response was to overreact because jumping to maximum containment was what had always been required in the past after this small act. I can't overlook my gut responses because they'll help to tell me if we are having a bipolar episode, but I don't want to overreact just because things have always been bad in the past. I'm sure that as thing/if things continue smoothly over time I'll begin to lose the knee jerk panic reaction, but for now it's something I really have to work on.

We've always used attachment (or what I consider respectful parenting) approaches as much as is safely possible, but here are some attachment techniques that I'm beginning to resurrect:

* Reminding of the impact of his actions and checking to see if that's what he wants
* Offering a silly distraction or humor to diffuse a situation
* Sitting with Mommy to calm down when he's getting wound up
* More snuggle reading time, mostly because he doesn't spit on or pinch me lately
* Offering help problem solving
* Calling a re-do because we're not working as a team

Wish me luck and I'd love to hear anyone's experiences as you navigate through the roller coaster of life with a disabled child.

A Bump in the Road

Last weekend was not good. It wasn't full strength Pajama Monster rotten, but my husband and I saw it as an indication that these last few weeks were possibly just the good end of a swing and we were headed straight back into hell again. Saturday felt very ADHD. He wasn't malicious but just very impulsive and whiney. Sunday brought us back to bipolar land with it's destruction and urinating on the heat vent, etc. We've been mostly poo and urine behavior free for the last several weeks. We had about 2-3 days of rotten and increased the dose to 4 pills of Depakote (actually available in a one pill time release formulation now)on Sunday. This wasn't related to the swing, but rather just the schedule we'd already agreed on with the psychiatrist. Things have been mostly positive since. The kids have been playing together with only minor sibling issues. For example Pajama Monster pushed Peep off a step this morning because she wouldn't move when he asked her to. He did admit it though and took his time out and went back to normal life. For the first time time outs are starting to feel like they were intended to be: a short break for Pajama Monster to pause, calm, and change his behavior before coming back to play. For over a year now they've felt like nothing more than a way of containing him when he's attempting to hurt us and destroy things.

We'll do a blood draw (and McDonald's trip) early next week to make sure things are still in a safe range. We're seeing no signs of side effects, but this isn't something to chance. If things continue to work Pajama Monster will stay on the same dose and do blood draws about twice a year to make sure everything stays at safe levels. It makes me cringe to have him on Depakote, or any med for that matter, but he feels like a happy, creative, bright, funny little love again. I still see no signs of flattening or drowsiness or fatigue or spaciness on the Depakote, so I'm just going to pray that maybe this really is the answer we've been looking for.

That's not what "Sensory Friendly" means

In the area I live in we have a local play area that consists of a few giant rooms full of bouncy houses, bouncy slides, etc. Normally there is also loud music and crazy lights going on. In an effort to be autism friendly they have stared opening their doors once a month for a "sensory friendly" bounce time. The problem is that this means everything is as usual minus the crazy lights and a bit of the volume. What that leaves is 3 giant rooms full of incredibly brightly colored bounce houses, still loud music, fans to inflate the houses, fluorescent lights, screaming and running children and general chaos. I appreciate their attempts to make the environment more friendly for children with sensory issues, but they obviously don't understand what sensory processing disorder means. If I only had to worry about rooms with bright flashing lights and blasting music I just wouldn't take my son to any rock concerts and we'd all be fine.

Sensory processing disorders can take many forms. In Pajama Monster's case it means that he has poor motor planning and doesn't seem to be able to filter outside stimulation very well. He essentially doesn't know where his body is, and so steps on other children, trips, falls out of his chair, Godzillas his way through other people's games and is generally clumsy. He also has a lot of trouble on play equipment and is therefore unable to join in with other children on playgrounds. That's all the motor planning piece. The filter problems essentially leave him feeling overwhelmed and frantic when he's exposed to noise and visual stimulation. I think this is why the supermarket is so difficult. It's full of bright lights, loud sounds and lots and lots of bright packaging. Our current method of grocery shopping involves an MP3 player with headphones, sunglasses and a thick green smoothie with a skinny straw. I'll sometimes substitute almonds for the smoothie. The sucking and chewing stimulation is soothing.

Imagine you're in a room full of people all trying to get your attention while you try to read something important from a book that keeps flashing random pictures at you as someone taps you on the shoulder incessantly. Imagine the stress you'd feel trying to sort through the chaos to the information you really need. For some children this is just their average day. Everything they encounter is one more "look at me!!" If you sit and listen for a moment you'll probably hear the noise of your heater, perhaps cars outside, maybe the computer fans. If you focus you can probably feel the seams on your clothing and your hair brushing your neck. Imagine if every one of these sensations was vying for your attention. I think that's part of my little Pajama Monster's life. Fortunately Pajama Monster's case isn't as severe as some children I've met, but it certainly influences his coping skills. For now it means that no matter how much fun sensory bounce may be, I usually need to stay away because we will have a meltdown of epic proportions and meltdowns are damaging to a child's self esteem long after the meltdown has ended.

One large frustration right now is that all the providers seem to be playing hot potato with the sensory problem. I've been told by the pediatric Psychologist, the school OT, the insurance OT and the initial IEP OT that they believe there are sensory issues involved in Pajama Monster's problem. Unfortunately unless he can't use a pencil the school won't touch it. The psychologist simply isn't qualified to treat it, and the insurance OT doesn't treat sensory processing disorders.

With so many things going on at once how do I tease out sensory issues from ADHD from Bipolar disorder? Well, I may not always be right but it's partly gut instinct and partly that sensory leaves Pajama Monster with a "deer in the headlights" look of panic on his face. ADHD leaves him with an "Oh no! I forgot!" surprised look, and bipolar leaves him looking both delighted and crazed. I'm not sure where the heartbroken and panicked look over trivial things comes in, but I suspect anxiety, perhaps because he's feeling off kilter becasue of sensory or ADHD issues. I suppose it's fortunate that for most of these the most helpful thing I can do is hug him.

Impact on Mommy

I should probably start by saying that I realize my husband is equally impacted. For a long time he talked about wishing he could stay at work because dealing with Pajama Monster can be so horrible, and quite honestly after a day of Pajama Monster I'm not always the happy and encouraging wife I'd like to be.

I went into motherhood expecting some stretch marks, etc, but I thought that the majority of the impact would be from the pregnancy and possibly the delivery. I've found that for every year Pajama Monster ages I seem to age 5. When I gave birth at 29 I could have passed for 23 pretty easily. Now I look older than I am. My hair is thinner. I'm exhausted all the time. My face looks thinner and older. To cap it off, I've been having dizzy spells so often that I've ceased to even note them. I'm pretty sure the dizzy spells are coming from neck tension and stress, but that doesn't make them any more fun. I realize that at 34 I was bound to start showing my age, and self care certainly tends to fall by the wayside when you have little ones, but this feels far in excess of what I'd expected. I think it's just that with stress, worry, and depression, my constant enterage, I'm bound to be in worse health. I'm not depressed by nature. It's just hard to see the bright side when you're scrubbing poo out of a stinking carpet for the 6th time that week while your husband holds your son in a restraint to keep him from smearing the poo on you and Daddy.

Depakote for my Preschooler: Still Promising

OK, I think I may be ready to get my hopes up a little. It's been several weeks now. We're up to 3.5 pills and things are better. They're not perfect. Pajama Monster has normal preschooler naughtiness, which is fine. He also has weepy moments where he gets "stuck" on something and really needs time to calm down. We use the explosive child model for those. The third and final behavior problem seems to be the old Pajama Monster problem, and that's where we're seeing the most improvement. We're seeing less of the random defiance, less manic laughing, less seemingly random or just bizarre destruction. The poo smearing and urine behavior are still there, but marginally better. Evenings after about 5PM are the hardest, though I wonder if that's related to the Adderall wearing off completely. We may switch from Adderall to Strattera after we see what's going on with the Depakote for another month or two. The best part...people are starting to comment that Pajama Monster seems to be doing better. Oh please, please, please be the right answer for my little baby!

Depakote: Better but not great

I'm not sure how this roller coaster will end, but the Depakote does still seem to be helping. Last night Pajama Monster poured urine into a mechanical toy firetruck and later in the evening he smeared poo into his carpet and window. I made him clean it last night so we could start fresh in the morning. Today we had a good morning and went to play at a coffee shop/play area. Fun was had by all. We came home and Peep took a nap while Pajama Monster ate lunch and played outside. All was well till I attempted to go grocery shopping. Peep started screaming and I discovered that Pajama Monster had bitten her because she was sitting too close. I removed Pajama Monster and attempted to grab the last few list items. Pajama Monster proceeded to waffle between defiantly throwing things on the floor, and contentedly walking with the cart. On the way out he threw a stack of gift cards in a nearby trash can. We went home without further incident and Pajama Monster spent the next 15 minutes in his room in time out with the door open. He was sent back to time out about 8 more times over dinner for things like throwing his fork and various defiance. The sad thing, this is still better. During a normal Pajama Monster incident there would have been much more violence both toward myself and Peep, and he would have smeared poo or vandalized something in time out. He also would have been horrible on the ride home and would have escalated steadily the entire time at the store and would currently be going out of his way to make my life unpleasant instead of playing with his sister as he is currently doing. All in all it was terrible grocery store behavior, but really, not unmanageable, certainly not compared to what I'm used to. It's not the miracle pill so far that I had hoped for, but it's still better, assuming this isn't just a mood swing that just happens to coincide with the Depakote instead of being caused by it. I just hope things don't get worse from here. There's still every possibility that the psychiatrist will increase the dose in another week, which may improve things as well. I hate to get my hopes up, but this time I think I may still be seeing a glimmer of hope. We'll see what bedtime brings.

Medication vs. Overmedication: How to tell the difference

I was doing some random web surfing and came across the case of Rebecca Riley. You can google it or find an article here http://en.wikipedia.org/wiki/Rebecca_Riley The photo in this post is of little Rebecca, not Pajama Monster or Peep.

The upshot is that a little girl who was only 4, Pajama Monster's age, died after her mom and dad and psychiatrist drugged her to death. I'd like to say that I don't understand how this happens. After the fact many people spoke of the child walking into walls and needing to be carried because she was in a stupor. The sad fact is, I've seen this. I knew a child who was drugged to the point of inducing seizures and was functionally a zombie. Fortunately she had a very good psychiatrist who stopped the medication as soon as I reported this. The sad thing was that I only saw her after 9 months on those meds, and neither school, nor parent had said a word. The parents opposed stopping, but the psychiatrist didn't give them a vote, because he wasn't ok with drugging children into submission.

The point of my story? Not all pediatric psychiatrists are pill crazed maniacs. Actually, most aren't. An appropriately medicated child should seem normal. You should have no idea that they are taking anything. They shouldn't seem sedated or lethargic or have memory lapses. They shouldn't be extremely quiet and easy to manage. If you can tell they're on medication, especially at 4, then something is wrong. Talk to your doctor and tell them that zombie-preschooler isn't ok. Try a different dose or a different medication. How do you tell if they're overmedicated: when you see the meds and not the kid, or when anyone has any idea after meeting your child that he/she is on medication. That's how you can tell. Your child should have personality, and lots of it. If they don't, something is wrong. You should also never medicate anything that can be handled by other means. If your child isn't sleeping, move the bedtime, try a new bedtime routine, star charts, etc. If your child sasses you, use behavioral techniques or I'm sorry but you may need to grow a thicker skin. Meds are for problems that are hurting your child and making them non-functional. They're for the 2 hour fit and smashing walls and stabbed my sister with a fork kids. They're not a shortcut to compliant kids without the hard work of parenting. Most of us have climbed this mountain with caution and forethought and love, but sadly a few just want meds to shut their kids up and they're the ones that everyone sees when they think of childhood medication. They're also often the ones whose kids are reacting to poor attachment and poor parenting and don't really need the meds in the first place.

A child that is sleepwalking through their childhood is missing more developmental stages than I can count. As they fall farther and farther behind they will appear more and more immature relative to their peers. Also, don't mistake sedation for "good behavior." Many parents respond to this lack of development by requesting more meds. If your 8 year old has been a med-zombie for 3 years and acts like a 5 year old, tantruming and not sharing and poor manners...it's because he is 5. He's missed 3 years of his life and is stuck at the last developmental stage in which he was fully conscious. The problem is that even un-zombied he will have trouble catching up because severe immaturity is not well tolerated by other kids. Teasing and shunning will make him even more socially awkward. The safest bet is to never put him in that situation at all.

Rebecca Riley's case was tragic. It was horrible and there is simply no excuse for something like that happening, but it isn't a portrait of pediatric psychiatry. It is a portrait of medical abuse facilitated by a monster or an incompetent, possibly both. Sadly, people point to this as the reason children shouldn't be given meds. It isn't a reason to avoid medication. It's a reason to avoid incompetent psychiatrists (If they let you pick the meds and dosage, possibly even giving your child other people's meds...go elsewhere and also report them!). It's also a reason to watch your child carefully for sedation and other side effects. It's a reason for trying everything psychotherapy has to offer before even considering medication and for having a very thorough, not just one visit, evaluation done before considering medication. It's a reason for being open about your parenting, even the parts you're not proud of, and for allowing your child's team to talk to school and daycare, etc before prescribing medication. Medication isn't always the answer. It frequently isn't the answer. Think long and hard and try everything less drastic before considering medication, but don't rule it out because one parent did something truly horrible, That's like avoiding bathtubs because Andrea Yates drowned her children in one. Like Andrea's children, it was the sickness of her parents that killed Rebecca Riley.

In summary:
1. Don't mistake sedation for "good behavior"
2. Never try meds before you've tried every less invasive method. Yes, I know it takes a long time.
3. Never be afraid to seek a second opinion if the meds seem too much
4. A sedated kid is not a properly medicated kid
5. Meds are not a parenting shortcut and should never be used as one.
6. Some kids truly need meds. I know what that feels like. Have some sympathy for parents trying to find help for their child. Giving your child medication can be a decision made of love. Don't judge based on a glimpse. A bipolar child is bi-polar, meaning 2 polar opposites or 2 opposite ends of a spectrum. They bounce between extremes so of course they have wonderful moments. For many of us the decision to try medication is painful and frightening. Judgement only makes an already difficult decision that much more painful. Try to see things through our eyes before you tell us what we should be doing. We'll try to do the same for you.

Depakote update

It's been almost a week on the 3 pills Depakote dosage. We've had some ups and downs, but the downs seem less extreme and more brief. Last night Pajama Monster smeared poo again, but it was about 3 tiny fingerprint spots on his floor, one small streak on the wall, and a handfull of little fingerprint spots on the window. Normally these incidents are epic and require at least an hour of carpet shampooing and wall scrubbing and window cleaning etc. I'm not thrilled that it's happening at all, but this is MUCH better. I'd also found 2 tiny poo marks on one of his outlets earlier in the week, but other than that he hasn't had any poo incidents in almost a week. We had an incident on the bus with Pajama Monster refusing to sit in his seat, but he wasn't violent and it sounded like he was just trying to sit in a different seat. The busdriver informed me that if she has to get the teacher for help again Pajama Monster will no longer be allowed to ride the bus, but as we walk to school in the mornings anyway, that would just be an excuse for me to get a little more exercise. On the list of things I'm stressing about, walking 1/4 mile in the sunshine with my kids for the next 6 weeks doesn't even register.

Apart from the decreased violence and the crying over things (which I think may be part of Pajama Monster or Adderall and not Depakote related) Pajama monster has been feeling like a normal 4 year old boy at times. Right now he's playing with the stacking cups with his sister on the kitchen floor. The strange thing is, he's been playing with her for almost an hour. Normally they'll play for about 5 minutes and then the screaming and bullying will start. In short, he doesn't seem sedated or flattened or numbed or zombied or any of the other things I was afraid of. When he's not acting out in his old ways, which he's been doing much less over the last week, he just feels like a very bright, funny, creative and loving little boy. Welcome back, Pajama Monster, please stay!

Oh Please, Please, Please! (Depakote)

Pajama Monster had his depakote level blood draw last Thursday. The level was 40, with a normal range starting at 50. We were advised to increase the dose to 2.5 pills for 3 days, then up to 3 pills. We started 3 pills Sunday. Over the last several days things have seemed better. Pajama Monster has crying/panicked fits over seemingly trivial things, but can be calmed down with patience, especially if I catch it early. I've also been working to really minimize any unexpected changes. I'm not talking about large changes. We've always prepared him for large changes. I mean the small ones such as me throwing away his empty yogurt container after breakfast or vacuuming his room. He seems to need extra warning for these changes or else they can start a crying fit. Other times he hardly seems to notice them. Apart from that, things have been better. We haven't had a poo or urine incident in 2 days. I'm hoping and praying that this will make the difference. He's continuing on the Adderall as the ADHD does seem to be a consistent struggle for him. I'm not expecting that Pajama Monster will have "perfect" behavior. He's a 4 year old little boy. I don't mind that sometimes he gets mad or doesn't want to listen or won't share. That's what I expect. He's 4 (and I realize he'll still do things I don't want him to at any age. He's his own person.). I just want to be able to do the things most other families can do. I want to be able to go to the park and go grocery shopping and let the kids play together in the yard. I want to be able to check on him when he sleeps without being afraid of what I'll find.
If this is enough to stop the destruction and poo smearing and seemingly random defiance then I'm done adding meds. I know many kids have a very complicated "cocktail," but I'd rather handle the crying and need for very very gentle handling around changes without any additional meds. He can function like that, and so can I. That's no judgement against parents who have their children on more complicated cocktails. You have to provide your child with what is appropriate for his or her specific neurology. I'm just hoping that we won't need more. I'm afraid of the impact on Pajama Monster's development with all these meds, but I see the impact of growing up completely unable to function in normal society as worse. As long as he can function, the rest comes down to parenting, as my husband says. I know I'm getting far ahead of myself, but I'm hoping so much that this time the med will help and it won't just be another piece of a mood swing that we're seeing. Our pediatric psychiatrist wants Pajama Monster to continue on the 3 pills for 2 or more weeks and then consider increasing to 3.5 or 4 pills if no side effects appear. We will also do another blood draw to check levels. Oh Please work! Please! Please! Please let this all be over!

The last blood draw was no problem at all. Pajama Monster handled it better than most grownups. I'd laid the groundwork by mentioning there is a policy (my policy) that states: Kids who get blood draws get to go to McDonald's afterwards. Pajama Monster actually began asking if he could get a blood draw so we could go. The actual blood draw caused no more than an "ouch." We of course praised him up and down and then went for lunch at the McDonald's play place. I'm not normally a fan of feeding the kids fast food, but in this case one small McChicken and a few french fries made a terrible ordeal no big deal.