Let’s face it: No kid looks forward to getting a shot. Nearly all toddlers and almost half of 4- to 6-year-olds are afraid of needles, a phobia that peaks around ages 5 to 10, research shows. And some reallllly hate them—crying, clinging, having flailing tantrums when it’s time for those routine immunizations.
It’s no picnic for us moms and dads there in the waiting room either.
Here’s the surprising thing about all that misery: It not only stresses everybody out but can make the shots feel more painful and make kids afraid of doctors and nurses—even to the point where, down the road as adults, they’re less likely to get blood tests and routine vaccinations or follow recommended medical care.
But we can do something about that!
Researchers are puzzling out how parents can make the experience better—right from the start, says psychologist Rebecca Pillai Riddell, York Research Chair in Pain and Mental Health at Toronto’s York University.
She and her colleagues have tracked more than 200 infants receiving their 2-month, 4-month, 6-month, and 12-month immunizations at York’s brilliantly named Opportunities to Understand Childhood Hurt Laboratory—yup, the O.U.C.H. Lab.
First they noted how the babies expressed pain when they got the shots: How much did they cry? What were their expressions and their other body language saying? This gave them a measure of pain. Then they followed up at ages 3 or 4.
Guess which preschoolers hated shots the most?
“We guessed that infants who expressed the most pain would be the ones who were most afraid or anxious as preschoolers,” Riddell told me. “We thought that they might have a ‘body memory’ about the experience that says, ‘I may not be able to talk about it, but I know I don’t like being here!’”
But no. It turned out that the pain level didn’t matter. The best predictor of how well an older child reacted to shots, they reported in the journal Pain, was how the parent had responded to him or her as a baby before, during, and after the shot. They saw this clearly by 12 months.
“Pre-needle distress leads to more post-needle pain,” Riddell says. “But parents can make things better!”
With the right attention, many kids are only briefly distressed by a jab, and many don’t cry at all.
In other words: The best pain management for kids is…us!
The key thing to avoid is…
Nothing alarms kids like parents reassuring too much, she says. That’s saying things like “It’s okay…don’t worry…it’ll be fine!”
“We don’t say that when our child is walking down the street—we only say it when there’s a perception that it might not be okay, and kids are sensitive to that,” she told me. “If you and I were having a martini on a Friday night and I started saying, ‘It’s okay, it’s okay,’ you might think, ‘Gee, I haven’t been worrying about this but maybe I should!’”
Warning most kids too early also builds anxiety, especially if it happens the night before the shot. That morning is plenty of time for most kids to process it, and some need even less, Riddell says. Experts suggest telling an older child that a vaccine is “a medicine to keep you healthy” and that it might pinch or push on the skin for a few seconds.
“The amount of information needed depends on the child,” she adds. Her 8-year-old is an “anxious bunny” who worries but doesn’t mind shots when she knows what’s coming. Her 6-year-old is more easygoing but has more fear. Both like a heads-up, so they can prepare in their own ways.
Other big no-no’s: Fibbing (“It won’t hurt a bit!”), belittling (“Oh, don’t be a baby; it’s just a shot!”) and apologizing (“I’m so sorry we have to do this!”).
This works way better. And it’s easy as A-B-C-D.
The York lab recommends this simple strategy at the doctor’s office from babyhood on up:
A is for Assess your own anxiety. Many of us had bad shot experiences and still hold painful memories that we bring to the party. “But the more stressed we are, the more stressed they are,” Riddell says. Try to keep a normal voice and stay calm and upbeat (without being artificially cheerful). Even babies respond to our tone before they can understand the words.
B is for Belly breathing. Just take a deep breath through your nose (so your belly rises), hold for a count of three, and exhale. Repeat a few times. This lowers cortisol levels and calms your heart rate. You can teach an older child how to do it too.
C is for Calm, close cuddle. Use a “hugging hold” before, during, and after the shot. (Some older kids may want to sit alone.) This keeps the arm or thigh where the shot goes accessible—be sure to hold the limb down gently but firmly—and makes your child feel more secure. Most providers are fine with this. Also keep your child upright. Kids feel more afraid and out of control when they’re alone, held down, or lying on their back.
D is for Distraction. With babies, try breastfeeding or giving a pacifier during the shot. Also good: singing, pop-up books, rattles, and bubbles. Invite an older child to pick the special distraction, like bringing a favorite toy or book or a small bubble machine. (Here even health professionals say sure, bring on the smartphone or tablet!)Another good distracter: Rubbing the skin (not where the shot is) before, during, and after the shot. That’s because the pain and touch signals follow the same pathway, so your hand competes with the needle for attention, says pain expert Anna Taddio of the University of Toronto. She heads an education effort called Help Eliminate Pain in Kids & Adults.
If siblings are getting shots at the same time, the less anxious one should go first— and that’s not always the older one, Riddell notes.
“Parents can really help make things better.”
When you think about it, almost all of our kids’ earliest doctor visits involve some amount of pain due to all their routine immunizations. That poses the potential for a lifetime of negative impressions of doctors and nurses—the very people we want our kids to think of as our helpers.
“If I were to follow these preschoolers up to age 18, I bet I’d see the same pattern in which ones don’t like needles, doctors, or nurses,” Riddell told me.
All the more reason to take the trauma out of the equation, jab by jab, hug by hug.
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