Helping babies and kids cope with needles

Canadian immunization guidelines recommend that a child should receive more than 20 needles before the age of 18. Those early immunization experiences can make a child anxious about receiving future needles, but you can help your child through the process.

Research from the Centre for Pediatric Pain Research in Halifax shows that telling a child not to worry can actually have the opposite effect – and increase anxiety. “Parental reassurance makes kids feel worse and have more pain during needles,” says Dr. Christine Chambers, professor of Pediatrics and Psychology at Dalhousie University. “We’re not really sure why, but there is some evidence that it serves as a signal to children that their parents are feeling anxious.”

If, like 10 percent of the adult population, you have your own fear of needles, a little deep breathing could help. “It is critically important that parents manage their own anxiety when they take their child for needles,” says Dr. Chambers, who is also a Canada Research Chair in Pain and Child Health.

Establishing these practices from day one can make needles easier as your child grows. Dr. Chambers encourages using topical anaesthetic creams, such as EMLA, Ametop or Maxilene. “They have been shown to significantly reduce pain. Many parents are surprised to learn that these creams are so readily available,” she says. They can be purchased over the counter and should be applied to the skin approximately an hour before the procedure. Consult the pharmacist to ensure proper application, says Dr. Chambers.

Physical body positioning is also important. Dr. Chambers and her colleagues recommend cradling and breastfeeding and/or feeding sugar water (one packet of sugar with two teaspoons of water) for infants undergoing painful procedures. “Not only are these comforting to the child, they are actually analgesic (which means they reduce pain).”

Pay attention to what you say after the procedure, too. “Our research has shown that what children remember about a painful procedure (vs. what actually happened) is a very powerful predictor of how much pain children will experience at a subsequent procedure. Take a moment after the procedure to praise your child for a job well done and remind them how well they coped. It might influence how well they cope next time,” says Dr. Chambers.

Tips for helping older kids deal with needles

The following guidelines have been adapted from Toronto Public Health to help your child develop strong coping skills for future procedures and prevent them from developing a fear of needles:

• Talk to your child about the vaccination. Explain what immunization is and how it can help to keep them healthy. 
• Explain that the medicine will be put into their arm. Don’t tell them that it won’t hurt. Say that the pain lasts a short time and feels like a “sting” or a “poke”.
• Prepare school-age children in advance. Tell toddlers and preschoolers just before the procedure.
• Encourage your child to bring several items along that will interest them or provide comfort: a favourite book, electronic game, stuffed toy or blanket.
• For added comfort, over-the-counter medications can be used to numb the area.
• Stay calm. Your child will be able to sense your fears or worries, which will intensify his own. Involve your child when speaking to the doctor or nurse by having them share a recent accomplishment, fun activity or upcoming event.
• Have your child sit upright when receiving a needle. Tell them to take a few deep breaths. This will reduce their pain and stress. Have them blow on objects like pinwheels, party blowers or bubble wands just as the needle is given – it will help take their mind (and their eyes) off the needle. Sing a favourite song or read a favourite book.
• Positive reinforcement will make children feel confident about the coping skills they have learned and will make them feel better prepared for their next immunization.
• Acetaminophen or ibuprofen can be used afterwards to ease fever, irritability or soreness. However, experts don’t recommend giving these medications prior to the immunization.

More information for helping children cope with pain is available from the Centre for Pediatric Pain Research at IWK Health Centre in Halifax.

Originally published in ParentsCanada magazine, November 2012.