It all started when Élyse was two years old. While on vacation in the US, her parents, Shawna and Justin Clouthier of Peterborough, Ont., took her to a hospital because they thought she had ingested some of her grandmother’s medication. Blood work had to be done, but the nurse couldn’t find a vein.
With each poke of the needle, Élyse would cry. Each time the nurse failed to find a vein, she would leave the room, waiting for the toddler to calm down. But as the ordeal dragged on, Élyse grew increasingly distressed, crying and fighting with each attempt until the nurse finally found a vein.
Now, four years later, Élyse's fear of needles is so bad that her father has to hold her in a bear hug in order for her to get a shot. “Every time we have a flu shot, it turns into a fiasco,” says Shawna. “Élyse is a calm little kid, but she goes completely berserk. It’s sad and scary. And unfortunately it keeps happening.” Worse: Her younger sister, Gisèle, thinks she, too, should be scared of needles, and is terrified of her upcoming fifth birthday because it means she’ll have a round of immunizations.
If there ever was a textbook case of needle phobia, this would be it. While there may be a biological predisposition to be afraid of certain things—like the pain associated with needles—most people acquire their phobias. Fears and phobias can stem from a traumatic childhood experience, says Christine Chambers, a child psychologist and professor of paediatrics at Dalhousie University in Halifax. “I’ve worked with hundreds of children and adults with significant fears. Almost all of these individuals can trace their fears back to one poorly managed procedure as a child,” says Chambers.
The implications go far beyond being scared of a needle prick: Not only do some adults avoid healthcare due to their fear of needles, but research indicates that poorly managed pain in early childhood can change how people feel pain, and may even make them more vulnerable to it later on.
The good news is that, with a few simple strategies, parents can ease their child’s fears, help manage the pain, and reduce the risk of their child developing a phobia.
How to make it better
Canadian children receive around 20 routine vaccinations before the age of five, not including annual flu shots (which are recommended for everyone older than six months of age, with some exceptions). So needles are a fact of life, and vaccinations are essential to fighting the spread of viruses like measles and whooping cough. However, there are several things that parents can do to ratchet down the tension and help ease the pain and trauma of needles. The techniques for creating a calmer environment and reducing pain depend largely on your child’s age.
Babies Physical contact is key. ImmunizeBC recommends parents stay calm and cuddle their baby in an upright position. Soothe babies by breastfeeding before, during and after the shot, if possible. Or you can give babes some sugar water, which releases natural pain-reducing chemicals in the brain, just before the shot. (To make your own sugar water, boil water for two minutes, then mix 10 mL of the water with 1 teaspoon of sugar. Let cool before offering to your baby.) Topical anesthetic creams can be applied 30 to 60 minutes before the injection (the time varies by brand)—ask the pharmacist to help you select a product, and talk to your doctor about where to apply the cream. But don’t reach for the oral painkillers: The Public Health Agency of Canada says there is no proof that they help lessen pain during a vaccination.
Toddlers Prepare your little one by talking about getting a needle ahead of time—for some kids, that will mean minutes ahead of an appointment, but if your child tends to like lots of notice for new experiences, you can start discussing the vaccination a few days before. During the needle, encourage deep breathing by blowing on a pinwheel or blowing bubbles. You can also distract them by counting, playing a game or singing. Again, topical anesthetics can be applied 30 to 60 minutes before the shot, but skip oral painkillers.
School-aged kids Deep breathing and distraction are the main tools for coping with the pain. Do a deep breathing exercise by having them imagine their lungs are balloons. Distract them with jokes, music or a new app. Explain beforehand that needles are necessary, and assure them that the pain is fleeting. You can apply topical anesthetics before the appointment. Feel free to offer a treat, like ice cream or a comic book, afterward—just make sure you present it as a reward for a job well done, instead of a bribe, Chambers says. For example, say, “We can get a treat when your vaccination is done,” rather than “You can have a treat if you get this vaccination.”
Following vaccinations, the Canadian Paediatric Society says parents can give their child acetaminophen for a fever or for pain at the injection site (for babies, this is indicated by fussiness and crying). And the US Centers for Disease Control & Prevention recommends a cool, wet cloth to help with redness, soreness and swelling at the site.
What if they’re afraid?
By working together, parents and healthcare providers can help assuage a child’s fear of needles. Let the nurse or doctor know of any issues your child has in advance so the appointment can be better managed. Sometimes the strategy can be as simple as having the doctor tell a joke that distracts the child, says Janna van Tonder, a physician in Okotoks, Alta. Or it could mean having a nurse and doctor steady the child while the parent is nearby. “Every child is different,” van Tonder says.
What should you do if your child is inconsolable? You won’t be able to talk a screaming child into calming down and agreeing to a vaccination, says van Tonder. She says that it’s better to help hold your child still (but never pin her down) to get the injection over and done with; if that isn’t sufficient, then parents should step aside or leave the room to let the nurse or doctor take over. “Drawing out the experience is not good for them,” she says.
The need for intervention often decreases as children age and can better understand what’s happening when they get vaccinations or blood work done. But Chambers notes that’s not always the case. “I wouldn’t say any particular age group is immune to these types of fears,” she says.
There are also some important things to avoid, says Chambers. If a parent is scared of needles, someone else should be on needle duty. Don’t promise extravagant gifts, because they will be expected each time. And don’t try to convince your child that it won’t hurt, adds Chambers. “Parents reassure their children because they hope it makes kids feel better. It actually makes them feel worse,” she says. “When parents reassure, it seems to signal to the child that the parent is feeling nervous or worried. That increases the child’s anxiety.” Instead, tell them it will hurt a little bit, but it will be over quickly.
Chambers says it’s also important to talk with your child after the visit, from the toddler years onward. She recommends parents praise children for good behaviour, and for trying their best, even if they were scared. “Reframe it in a positive way. Focus on what went well,” she says, adding that hopefully this will set them up to be less fearful next time around.
Battling needle phobias
In a small percentage of cases, an everyday fear balloons into a phobia, where children cry uncontrollably, kick, scream, flinch, fight or vehemently resist needles. “Some children can’t even say the word ‘needle.’ Even the smell of an alcohol swab can set them off,” says Chambers.
The good news: An extreme fear of needles can be overcome in a short time. With the help of a psychologist, children can learn coping skills to help them defeat their fears, says Chambers. “Some individuals will struggle for years with needle phobia, and don’t realize that with the support of a trained professional it could be treated in a month or two,” she explains.
A version of this article appeared in the February 2015 issue with the headline "Get your best shot" on pp. 26-28.