Vaccine hesitancy comes in all flavors. It’s not always concerns about safety that causes children, teens, and parents to hesitate or even refuse vaccines. Sometimes it’s about pain. Or simply discomfort. Or anxiety. It’s perfectly natural, of course, to have a fear of needles. It’s rare that a child enjoys the pain of an injection (although those kids, even at young ages, are out there).
Sometimes the fear and anxiety of needles really can manifest itself as a sincere phobia. In those cases, the fear is so overwhelming that it changes family decision-making around vaccinations and leaves children unprotected. It can torture parents when they have to scoop their kids up from under the chair. And parents get embarrassed when their child/teen becomes combative with shots. Sometimes they avoid coming back to clinic simply to avoid the conflict. Makes sense in a hectic world.
However recently in clinic I took care of a teen soon after she’d had a terrible experience with Influenza (the “flu”) and it’s changed how I care for my patients. She was an asthmatic, high school student. Because of her asthma, her doctor had recommended a flu shot. Even though doctors recommend flu shots for all children between 6 months of age and 18 years, we work very hard to get high-risk patients protected. Children and teens with asthma are more likely to have a severe pneumonia after contracting Influenza. We worry about children who wheeze and have asthma (even mild asthma) because it can land them in the hospital and/or can cause a life-threatening illness.
Most parents with asthmatic children get flu shots yearly, early in the season. But not all.
When I saw the girl in clinic she was exhausted and stressed, confused and scared. Through the course of her Influenza illness she had missed 2 weeks of school and lost over 15 pounds. She was still coughing a few weeks later. I looked back to the chart note visit prior to her infection where her pediatrician had recommended the flu shot. “She’d declined,” it said.
“Why?” I asked.
She stated that she was terrified of needles. Because of her persistent asthma, she wasn’t allowed to get the nasal-spray flu vaccination (wheezing is a contraindication) so the shot was her only option. “Had you told the doctor your reason for saying ‘No?'” I asked. “Yup,” she said. But no plan of action was made to support her.
So here’s the thing, we know that fear and anxiety about injections worsens when a parent is scared, too. When I asked her mom if she was scared, she nodded. Often, the declination for vaccination prolongs if parents are scared of the injection. Again, it makes sense. But after the experience of the illness, she and her mom were very motivated to figure out how to get the shot next year.
During the injection, parental demeanor clearly affects the child’s pain behaviors. Excessive parental reassurance, criticism, or apology seems to increase distress, whereas humor and distraction tend to decrease distress.
Tips To Support Your Child When Fear Of Needles Arises
- Don’t make promises for “no shots” any time going to the clinic. You never know what plan will be recommended and what shots you’ve missed. If you make and break that promise, trust is broken. Don’t joke about the doctor or nurse giving a shot as punishment either. NO SINGLE shot is ever given to make a child uncomfortable–don’t create that myth as it sets your child up to believe the doctor may harm them.
- Fear of needles is real. Validate your child when they state they are terrified. And then talk directly with the clinician about ways to support your child during the shots.
- Consider using an anti-anxiety medication (something like Ativan, Valium, or Xanax) when true needle phobia is present. I’ve worked with a pediatric psychiatrist for numerous patients in my clinic to develop a plan for anxiolysis (breaking anxiety) to support them getting recommended care.
- Consider using a numbing cream (something like EMLA or vapocoolant spray) to numb the skin prior to the vaccination. You’ll need a prescription from your clinician to do so but often the cream provides a bit of comfort, a sense of control, and boosts confidence for anxious or fearful children/teens.
- Consider deep breathing and other behavioral modifications including distraction at the time of injections to support your child. Consider seeing a behavioral health clinician as well.
- Consider the “cough trick.” I offer the cough trick to all of my patients and teens nervous about shots. Studies (and reports from my patients) confirm it works brilliantly!