So you’ve made it to the blood test conversation. Maybe the diagnosis is fresh, maybe you’re a few months in, maybe medication is on the table next week. Either way, your paediatrician has said the words “we should probably get some bloods done,” and now you’re sitting at the kitchen table at 10pm Googling what on earth that actually means.
We see you. Bringing receipts.
This is the article we’d send to the friend who texts us at midnight asking what to ask for. Practical, evidence-led, no scary tangents. Here’s what’s actually worth requesting, what you can probably skip, and what to do with the results once they land in your inbox.
First, the unpopular truth. You might not need bloods at all.
Hot take incoming. Nutrient-level blood tests aren’t always necessary.
A thorough dietary assessment, paired with a careful look at your child’s signs and symptoms, can tell a skilled clinician an enormous amount. We can spot iron-deficiency patterns, zinc deficiency clues, and B-vitamin issues from food intake and presentation alone, and decide together whether bloods will actually change the plan.
If the trauma of the needle (for them and for you!) outweighs what we’d learn? You can have an ADHD diagnosis and start medication without a single blood test. The Australian Evidence-Based Clinical Practice Guideline for ADHD doesn’t mandate them either. You’re allowed to say no, and you’re not failing your child by protecting them from a hard appointment.
That said, some tests genuinely earn their needle.
The bloods that are worth the trip to pathology
These are the ones we can’t read from a food diary or a careful symptom history.
- Coeliac screening. Coeliac disease has a higher rate of co-occurrence with ADHD, affects nutrient absorption, and can quietly drive symptoms like forgetfulness and irritability that look suspiciously similar to ADHD. Genetic testing is one-and-done for life, which is a nice bonus.
- Iron studies, especially ferritin. Not just serum iron. Ferritin tells us about iron stores, and low ferritin has solid links to worsened ADHD symptoms and restless sleep.
- Thyroid panel (TSH, free T3, free T4). Thyroid issues can mimic ADHD almost perfectly. It can be nice to rule them in or out before assuming everything is dopamine.
- Vitamin D. Australian kids are surprisingly often deficient, even up here in sunny Queensland. Easy to fix, big payoff.
- Zinc and copper, tested together. These two balance each other out. Testing one without the other is like checking your bank balance without knowing your rent. Useful, but missing the context.
- Homocystine. Depends on presentation and family history. We’ll guide you, not throw the whole pathology form at the kid.
Optimal vs reference ranges and why “normal” isn’t always good enough
Here’s where we get a little fierce.
The reference range printed on your lab report is built on a population average, and that population includes plenty of people who aren’t thriving. “Within range” tells you nothing about whether your child is actually optimal.
Take ferritin. Most Australian labs only flag a problem below 15-20 µg/L. But research has consistently shown ADHD symptoms can worsen when ferritin sits below 30 µg/L, and many clinicians aim for 50-80 µg/L in symptomatic children.
So when your GP rings to say “the bloods are all normal,” that’s not the end of the conversation. Ask for a copy of the actual numbers. Or send them to us, and we’ll happily walk through them with you.
Don’t just throw a supplement at a low result
A low number is a clue, not a prescription. Low iron could mean low dietary intake, poor absorption (hi again, coeliac), inflammation skewing the reading, hidden blood loss, or even a genetic variant affecting transport. Each cause needs a completely different approach. And the wrong supplement at the wrong dose can do real harm, copper toxicity from over-zincing your child, for one example we’d rather not see in the clinic.
This is why we look at the whole picture before reaching for a bottle. If you’d like our actual take on which supplements have evidence behind them for ADHD, we’ve written about that here.
A quick word on the small human getting the needle
If you do go ahead, set them up for success. Numbing cream applied 30-60 minutes before (ask the pharmacy for EMLA or AnGel). Book a paediatric pathology clinic if you can, the staff are trained for kids, the chairs are smaller, and there’s usually a sticker reward system that would humble Bunnings. Schedule it after something fun, not before. Bring snacks. Always snacks.
If your child is truly traumatised by needles, trust that instinct. Skip them entirely, or break them into smaller batches across a few visits. There’s no clinical scenario where this single decision will derail their care.
If you’d like someone in your corner to actually read these results properly (not just tick “within range” and move on), book an appointment with us. We bring receipts. And snacks.
