When it comes to going to the pediatrician’s office, one of the first questions your child may ask is, “Am I going to get a shot?” If your child is less than 6 years old, the most likely answer is “yes.” Some children are OK with this answer but others, like my own 10-year-old, completely fall apart.
From birth to age 18 years of age, a child receives approximately 56 doses of immunizations covering 16 different diseases. Vaccinations are actually considered the most common painful needle procedure worldwide. Significant needle fear typically develops in early to middle childhood (with a peak age of onset between 5 and 10 years).
While most of us understand the importance of vaccines, especially in the current health crisis, some parents refuse or delay immunizations due to this injection-induced anxiety, pain and fear.
One survey of pediatricians in 2013, found that pain or discomfort from a child having too many vaccines at one encounter accounted for 75% of refusal for vaccines. Another study in Canada found that 24% of parents and 63% of children reported having a fear of needles—and this led to 7% of parents and 8% of children being noncompliant with vaccinations.
The pain and lasting fears of shots
My son has asthma and really needs the flu vaccine, but he outright refused to get the flu shot. Unfortunately, he has had some negative experiences with ER visits, IVs, lab draws and hospitalizations, so he is horribly afraid of needles. Fortunately, I was able to reach out to my pediatrician and arrange for him to get the flu mist, the vaccine given by nasal spray.
Since I am a physician, it is easier for me to navigate the health care system—but as a mom, my doctor hat can easily fall off.
I know other parents feel the same way as me and would love to know how they can help their child during immunizations and lab procedures. Interestingly enough, that study in Canada found that 70% of parents have never received education on how to support their child during immunizations and would value this type of information.
Although pain from needles typically resolves fairly quickly, the emotional trauma of unmanaged pain, most notably a fear of needles, can have a much longer-lasting impact.
For some, pain and fear are not over when the needle procedure ends because the memory of the experience lingers. And not only can a fearful event occur through a direct experience (such as experiencing pain or bleeding), it can also happen by watching someone else (like an older sibling) have a bad experience, or simply hearing about someone else’s bad experience.
It’s not just the moment of injection that can be fearful. Kids can be apprehensive in the waiting room. Kids could get fearful about seeing blood, seeing the point of the needle, seeing the needle inserted, being “poked” multiple times and being restrained so the procedure can be successfully completed.
Over time, unmitigated pain may increase fear, which in turn, may increase pain at future procedures.
Parents may struggle with a flailing child, a child running away, hiding under a desk (I did that as a child), fainting or requiring restraint. These consequences result in an unpleasant, potentially distressing, experience for the child, the health care provider and the caregivers. These traumatic events may also lead to health care phobia and avoidance of necessary medical treatments.
Making shots easier for your child
To mitigate these negative effects, some of the providers at Cook Children’s Health Care System have adopted a tool called “The Comfort Menu.” (This is currently in the rollout phase for clinics and the medical center, with a goal to have it available in all locations.)
It includes a menu of options the child and/or parent may choose to ease procedural pain and fear. Choices may include breastfeeding, which is very safe and soothing for a child during vaccines; comfort holding; distraction; consumption of a sugary solution before the shot; Buzzy, a bee-shaped device that uses cold and vibration to replace pain with sensations of temperature and movement (available at local drug stores); and a numbing, cold spray (literally a cold spray that is directed toward the skin at the site of the injection—our patients like to think of it as the “Frozen spray”) and creams.
Studies show these methods can actually increase pain-relieving chemicals in the body and disrupt the pain signal that gets sent to the brain. So prior to any procedure or vaccine, a member of the health care team acknowledges the patient or parent’s fear and pain concerns, explains the health benefits, and discusses the actions that the parent, child, and healthcare provider can take to reduce pain.
Ideally, parents and children collaborate with their medical team to acknowledge that unmanaged pain hurts more than just the child’s body.
While not all offices, clinics and immunization drives may take this approach, there are things parents can do to diminish their child’s fear and pain. Whitney Brosey, certified child life specialist and comfort menu coordinator at Cook Children’s Healthcare System, offers some tips for parents:
Call your clinic ahead of time and ask what to expect at the visit. “Will my child get shots? How many? Do you have anything to help them not feel the shots as much?” (This would be the Buzzy, cold spray, shot blocker, numbing cream or sucrose solution.) If you plan to breastfeed during the shot, tell the office and medical staff. The more prepared you are as a parent, the more in control you will feel about the appointment and the less anxious you and your child will be.
Be honest. If your child asks if they will get a shot, tell them the truth. You may say, “I am not sure, but I promise we will find out and it won’t be a surprise.” Or if you know you are going specifically for a flu shot, you may say, “Yes, you are getting your flu shot today. I want to do everything I can to help keep your body stay healthy.”
Do not plan appointments around your child’s nap time and meal times. Having an appointment scheduled for vaccines when your child should be sleeping may make the visit a lot more challenging. The same goes for a hungry child. It’s more challenging when your child is “hangry”!
Leave siblings at home. It’s much easier as a parent to bring only the child or children who need to see the doctor. Any additional children in the room can take away your attention from your littles who need you the most.
Bring an item for distraction or comfort. Toddlers may need multiple items to keep their attention, while a school-aged child or adolescent would do just fine with a tablet, phone or music.
Communicate any special needs with the clinic before coming to the appointment. If the waiting room is overwhelming or too stimulating for your child, ask to wait in the car until it’s time. (Your clinic may be doing this anyway during the pandemic.) If your child loves dinosaurs and that will help the staff build rapport with your child, tell them. Sometimes just getting in the door of the doctor’s office is the hardest part, but if the clinic can be prepared to help support or acknowledge the needs of your child, the transition can be so much smoother.
Ask to learn about comfort positioning. The most vulnerable position for a child is laying down, so we try and avoid that whenever possible. Comfort positioning is a great option to help a child feel safe and more in control. Examples of comfort positioning are sitting in a parent’s lap, sitting next to a parent, and a mother breastfeeding her baby. Your doctor’s office can teach you how to hold your child.
Act happy and be calm. Remember, your child follows your cues, so use positive and encouraging words. Make eye contact, even with small children.
Remember that care after the shot counts too. Reinforce that you are proud of your child, hold them and soothe them. Take time to consider how the appointment went and what should be done differently or stay the same at the next visit.
The Centers for Disease Control and The American Academy of Pediatrics advocate for pain reducing measures during procedures such as immunizations. So, while getting a shot may not be fun, it can be less painful and traumatic for everyone involved.
Dr. Artee Gandhi is guest contributor and mom, as well as Cook Children’s Healthcare System’s medical director, pain management.
Photo courtesy of Cook Children’s.