Getting shots, or the pain and fear associated with them, is one frustrating association children have with seeing their doctor. There are some ways to make this better. Diminishing shot anxiety is a huge goal for parents and pediatricians. If expectations are clear, everyone can leave a visit after shots feeling more successful.
- Prepare: Do your best to prepare yourself for a visit where there will be shots. Bring your husband/wife/partner, friend, or relative with you for support. If you act or feel nervous, your child may pick up on this. Even infants pick up on nervous cues. It is well known that parental behavior influences the amount of pain and distress from shots. In one 1995 study, 53% of the variance in child distress during immunizations was accounted for by maternal behavior. Geesh! So, if you’re freaking out, your child may be influenced. A Pediatrics review article in 2007 found that excessive parental reassurance, criticism, or apology seems to increase distress, whereas humor and distraction tend to decrease distress. First shots for new parents are often nerve-wracking. Layer your support and tell your pediatrician you’re nervous so they can provide reassurance and support. Bring a new toy for your child, plan a joke ahead of time. Scripting may truly help.
- Distraction: Use distraction whenever possible. Squeeze your child’s hand during shots, sing songs together, blow on your baby’s face, or talk about plans you have later in the day during the injection. Discuss your favorite spots or places you’ve been together. Also, consider the “cough trick.” A study in Pediatrics out earlier this year found that children (age 4-6 and age 11-13) who were coached to cough during the injection experienced less pain from the shot. Consider coaching your kindergartner, 11 year-old, or even 16 year old (!) to use this skill. Adolescents are often very nervous about the expected pain of immunizations. Coughing to decrease discomfort may be a great “trick.” In my experience, the waiting and anticipation of shots is far worse for kids than the actual injection. Like so many things in parenting, knowing what to expect is essential for your child. Transfer control (when you can) to your child; it can dramatically change the visit and the experience of getting shots.
- No Promises: Never make promises that your child won’t have a shot at a doctor visit. Plain and simple, it’s a lose-lose most of the time. Each visit is a chance to “catch-up” on missed doses or recommended doses due to current recommendations (they change frequently). My recommendation is to avoid making a promise you can’t keep. Focus on rewards after visits, instead. Promise things like a trip to the park or a stop at your favorite coffee shop, a sticker, or allow your child to choose what’s for dinner after the visit.
- Medications: I recommend you don’t give acetaminophen (Tylenol) before shots. New research in infants finds that pre-medication may dampen the (desired) immune response after shots. Up to about ½ of infants will have an elevated temperature after immunizations. This is a normal inflammatory response to the shot, proving the vaccine is working to protect your baby against future infection. The elevated temperature (usually around 99 or 100 degrees) subsides within a day or 2. If your baby is otherwise comfortable, soothe them without the use of medications. However, some injections are more likely to cause higher temperature elevation. MMR vaccine, given at 12 to 15 months and and again to complete the series between age 4 and 6 years, can cause fever (lowgrade) between 5-15% of children, and rarely cause high fever (over 103) 5 to 12 days after the shot. If temperature is elevated over 101 degrees, I would suggest using Tylenol to relieve discomfort for your child.
- Never Punish: Don’t ever use shots as a form of punishment. Never say, “You’re going to get a shot if you’re not good.” Pediatricians hear things like, “Sit down or the doctor will give you a shot,” and squirm. I usually clarify directly with a child when I hear similar things, explaining that shots are never something I would do to cause them pain. Shots clearly aren’t punishment; viewing them as such can confuse the experience at the office for children and adolescents.
- Control: Let your child be in charge whenever possible. Older children should tell the MA or nurse which arm to start with, or on what count to give the injection. Be honest and tell your child the shot will likely hurt and may leave them sore. Reassure them that the injection is quick.
Another idea for pain relief during shots includes using prescriptions for numbing medications like EMLA cream or vapocollent spray that can be applied to the skin prior to a shot. Research and some children feel this can be very helpful! One deterrent for me in recommending EMLA routinely is that although EMLA or numbing sprays affect the surface of the skin, they doesn’t numb the area where the needle goes into and the area where the medicine is injected. Therefore, it may not relieve much of the pain associated with injections. For some children, I worry EMLA be instructive, teaching children shots are something to fear. However, I have given prescriptions for EMLA to some families and have received good feedback. Others didn’t see to notice much of a difference. Part of me thinks it is about a child feeling in control. If you think your child will really benefit from EMLA or Vapocollent, talk with your doctor ahead of the visit to request a prescription and instructions on use.
Pain research also finds that young infants can acquire pain relief from concentrated sugar (Sweet-ease) in their mouth. If interested in using sugar to ease an infants discomfort, consider dipping the pacifier in sugar water (your pediatrician may have this on hand) just prior to to giving shots. It’s possible that the experience of that sugary dip may distract and relieve pain associated with vaccinations.
Lastly, some offices allow breastfeeding during the time of immunization. Many mothers report that this skin-to-skin contact, reassurance, and cuddling helps both of them during the shots. Ask your pediatrician to breastfeed during shots if you think it will help calm you down, too!
What have I missed; what have you done that worked?