When Chessa Rader brings her 1-year-old triplets in to get their vaccinations, it’s an event.
“They poke them one at a time, and then you have to take care of them while the other ones get poked,” the Burnsville woman recounted. “One starts crying, then the other ones start crying before it even happens. It makes me sad when they get shots, because they’re so sad.”
For Kristen Ries of Inver Grove Heights, the experience of bringing her children in for shots is getting a little easier as her children, ages 4 and 2, get older — but it still can be a difficult experience.
“The younger one knows what we’re doing and is scared, usually, and doesn’t want to [get a shot],” she said. “I reassure them and hold them and tell them it’ll be quick, then it’ll be over.”
Needle pokes can be a major source of distress — and not just for kids. Studies estimate that a quarter of American adults have a fear of needles. Those needle phobias can lead to people hesitate before seeking medical care and vaccinations, or to avoid them all together.
But needle pokes, such as shots and blood draws, don’t have to hurt.
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The research on effective ways of alleviating needle pain has been available for 25 years, said Dr. Stefan Friedrichsdorf, medical director of the Department of Pain Medicine, Palliative Care and Integrative Medicine at Children’s Hospitals and Clinics of Minnesota.
Children's Minnesota launched its Comfort Promise initiative in 2013, vowing to do everything possible to prevent and treat pain — including pain from vaccinations or other shots. Friedrichsdorf said that goal required department-by-department culture change. They use five research-based practices that take away needle pain — five simple steps anyone can do.
Numb the skin
Apply 4 percent lidocaine cream to the skin 30 minutes before the shot. This cream is widely available over-the-counter for a cost of about $7 to $15, and the cost is covered by insurance in the state of Minnesota if a doctor prescribes it. If you’ve come to the doctor’s office for a well-child check-up that includes shots, ask for numbing cream at the start of the visit to allow the lidocaine time to work.
Breastfeed infants or provide sugar water
Allowing babies to breastfeed during a needle poke, or giving them a few drops of sugar water prior to injection, has a hugely calming effect. Friedrichsdorf reported that, after some initial concerns about new procedures taking up too much time, Children’s Minnesota’s neonatal units were among the early adopters of pain-reducing procedures.
“A few drops of sugar water a few minutes prior to procedure, in addition to numbing cream of course, now has meant that in our neonatal intensive care units in our hospitals, most babies now simply sleep through the procedure,” he said.
Hold or seat the child comfortably
Seat your child on your lap or, if they prefer, allow them to sit by themselves. Hold children so they feel comfortable and secure but not constrained. For infants, skin-to-skin contact with a parent is the most comforting hold, Friedrichsdorf said.
“Never, ever, ever, ever — as in, never ever — hold down a child,” Friedrichsdorf insisted. “People falsely assume that the best way is to just pin them down, to restrain children and sort of do it fast.”
In research, children who were held down during painful procedures report feeling ashamed, humiliated and powerless, as though they had lost control of their own bodies.
Offer age-appropriate distraction
It’s a time-honored approach to dealing with pain: think of something else.
For infants, a distraction can mean holding them gently and making comforting sounds. For young children, possibilities include watching spinning lights, blowing pinwheels or bubbles, and reading books or stories. Need a distraction on the fly? Hold up your finger or a pen, and ask your child to pretend they’re blowing out a birthday candle. And of course, phones and tablets also make excellent distractions.
How you talk about shots matters
Before going to the doctor, give your child the amount of information they need to be comfortable. Some might want to know exactly what to expect. Some might prefer not to. But remember: don’t lie. Don’t tell them that a shot won’t hurt unless you are planning on using numbing cream, and don’t tell them there’s no shot in their future if you know otherwise. Who wants unpleasant surprises?
When you’re at the doctor’s office, district your child with happy conversation about fun things they’ve done or are looking forward to. Don’t apologize for being there; anxious words from you can increase your child’s anxiety.
After the doctor’s visit, praise your child for how brave they were. The way you talk about shots afterward can help create a positive memory.
Friedrichsdorf said parents and caregivers have the power to create culture change by asking for numbing cream, sugar water or any of those other techniques; don’t hold back for fear of inconveniencing your medical provider.
The shuffling required to position an infant or set up a distraction is far quicker and less stressful than calming a distressed child afterward, he said — and that’s less painful for everyone.