Behavior & Development • Jul 10, 2015

Taking the OUCH! out of vaccines

They hurt, right? They do. Are they worth it? Yes. No question.

Life saving benefits aside, a child gets 12-20 vaccine injections by the time they are 2 years old.  Approximately 25 percent of adults have a phobia of needles. Is there a connection? Probably. Maybe you are one of the many caregivers who lives with a fear of needles, not only for themselves, but for their children.

Despite knowing how necessary vaccinations are and not questioning my decision to provide them for my child, it was still hard to hand my child over to medical staff knowing he did not understand why he was being hurt. It was a helpless feeling.

It was once thought that infants and young children experience less pain or won’t remember pain. Researchers now know that the opposite is true. Infants and young children are more sensitive to pain than adults. Their brains and nervous system are still developing and are very responsive to painful stimuli. The development of the brain’s pain controls, which help to distinguish between small pains and dangerous pain, are slower to develop. Repeated exposure to certain types of pain will increase, as opposed to decrease, a child’s response to that pain. It does not build a stronger/braver child or result in the development of a high pain tolerance, as one might expect.

Parents aren’t helpless in this. There are things we can do to decrease the anxiety and pain associated with the “pokes” (vaccines and blood draws) a child will experience repeatedly in their early years. These techniques are also helpful for teens and adults. Here is a proven list of things you can do to minimize your child’s experience of pain with needles. Small things can make a big difference.

  1. Numbing: Application of a numbing cream to the skin prior to insertion of the needle for a vaccine or a blood draw will decrease the pain your child experiences. It will not take it away completely, but will decrease it significantly, to the point they may not care. Lidocaine 4% cream is available over the counter at drug stores, on amazon.com etc. Apply a blob about the size of a nickel or quarter, to the skin over the area of the anticipated needle poke (thighs, upper arm, where the elbow bends, or other).  Do not place over injured or unhealthy skin without talking to your doctor. Wrap the area carefully with plastic wrap to hold it in place. Be sure it isn’t too tight. You can apply to two sites at a time (ie both legs). Place cream on 30-60 minutes before the anticipated procedure. The medical staff can wipe it off easily just prior to the procedure so they know what area has been treated. Do not leave it longer the 2 hours. It works for about an hour after removal.
  2. Sugar syrup/Breastfeeding: Sucrose syrup is known to decrease pain in infants <6-12 mos. Given in very small amounts on a finger or tip of a pacifier it activates pain relievers in the brain. Starting this ~2 minutes before the injections or other poke significantly adds to reduction of pain. Breastfeeding just prior to and during the procedure offers a similar effectiveness in pain reduction. It may seem like a weird thing to do during a vaccination, but if you can handle it, so can the staff at your pediatrician’s office. The less they cry, the less you cry.
  3. Positioning: This is another area where history has made things worse for our kids. The practice of pinning a child to a cold table and holding them down adds to the anxiety and pain perception. Most kids would freak out if you did that without a needle. I know I would freak out if some one did that do me. They do have to hold still, certainly, but this can be accomplished in less distressing ways. For infants <6mos, try snuggling them while breastfeeding, or swaddling them with a single leg exposed while in a parent’s arms. For toddlers/preschool age, try having them sit upright in a parent’s lap. The parent can secure the child’s legs between their own and snuggle the child’s arms if needed.  Children feel safer and less vulnerable when with their parent and in an upright position. For school age children, try giving them the choice of a parent’s lap, sitting in their own chair, or lying down. For teens, upright and with a parent nearby is usually best. They may want to lie down, especially if they are a “fainter.”
  4. Distraction: Distraction techniques are a huge help for all ages. The less the child is focused on the anticipation of pain or the actual pain itself, the better their experience. Your phone/tablet is your child’s pain preventing friend. For infants, try toys with flashing or spinning lights. Breastfeeding is also a distractor for this age. A favorite blanket, toy or other security item is helpful, as are singing or playing a familiar song. For toddler/preschool age, try bubbles, pinwheels, books, toys, music, or an app game. The interactive nature of the item is helpful.  “Balloonimals” is an example of a simple interactive app that is great for this age. For school age and teens, allow them to watch if they so choose, but allow them to distract themselves prior to and during if they so desire. This is the one time to let them put on the headphones and keep the phone even, if the nurse or doctor is in the room. Books and electronic devices are most effective in these ages.

Other tips: Do not lie to your child and make promises you can’t keep like, “You won’t get a shot,” or, “It won’t hurt.” Avoid statements that may seem shaming like, “Don’t be a baby,” “Be tough,” or “Toughen up.” If your child fears that they will disappoint you, their anxiety level is likely to increase further. Surprisingly, children who were told that the pain would only last a little while seemed overly anxious and focused on the pain. Framing the pain in an understandable context like a “little pinch” if asked can be helpful, but distraction before and during is most effective.

The bottom line is that you and your child are not helpless. These strategies work especially when implemented from early infancy.  The added benefit of a sense of trust and control when interacting with medical staff has life long health implications.

Comments

  • persnickety

    Honestly, vaccines last like what? 30 seconds of a pinch? Even I get nervous right before the needle goes in, it’s a needle!, but, seriously, why can’t you teach your kid to suck it up for 30 seconds? They fall down and don’t cry, or get a little scrape and get right back up again, then why can’t they not burst into tears over one little pinprick? Honestly too, who has time to build up a full blown cry in 30 seconds or less? Maybe “not being a baby” is just the motivation they need to learn a little self-control. Praise them when they don’t cry, and question them about their reaction if not. Heightening your pain threshold takes time and a lot of self-control, but it is achievable for all people. Plus, 30 seconds of a pinch is short enough to hold back those tears. Being nervous is one thing, but crying and screaming is a whole other! Little children are capable of more than we think, if we hold them to a higher standard, maybe they just might meet it…