Cook Children’s Comfort Menu Eases Pain, Anxiety for Children Getting a Shot
When it comes to going to the pediatrician’s office, one of the first questions your child may ask is, “Am I going to get a shot?” And as parents, we generally say, “I’m not sure.”
That answer leaves us typically feeling uninformed and helpless. But if your child is less than 6 years old, they are likely to get an immunization that is injected, not including the flu vaccine or HPV vaccine.
From birth to age 18 years of age, a child receives approximately 56 doses of immunizations covering 16 different disease states. While most of us understand the importance of vaccines, especially in the current health crisis, many parents refuse or delay immunizations due to Injection-induced anxiety and pain. Vaccinations are actually considered the most common painful needle procedure worldwide, with an estimated 12 billion injections given per year.
A recent study from the University of Toronto surveyed a total of 1,973 individuals. The study found that:
- 24% of parents and 63% of children reported having a fear of needles.
- 7% of parents and 8% of children reported noncompliance to vaccines due to needle fear.
- Regarding influenza immunization specifically, an absolute 10% increase were willing to be immunized if the vaccine could be administered in a non-painful way compared to usual practices.
- 46% of parents reported being very confident in their ability to make their children’s immunization injections less painful and frightening.
- 70% reported they never received any education on how to reduce pain.
- 79% reported they would like to learn ways to do so.
- 70% of parents reported they would be less anxious about their children getting immunizations if they were given in a non-painful way.
Although pain from needles typically resolves fairly quickly, the emotional trauma of unmanaged pain, most notably a fear of needles, can have a much longer lasting impact.
For some, pain and fear are not over when the needle procedure ends because the memory of the experience lingers.
A fearful event can occur through a direct experience (such as experiencing pain or bleeding), watching someone else (like an older sibling) have a bad experience, or simply being given negative information.
As a consequence, this leads to significant needle fear and health care avoidance into adulthood. Needle fear typically develops in early to middle childhood with a peak age of onset between 5 and 10 years of age.
In addition to fear of pain, children may also be apprehensive regarding other factors related to needle procedures, such as sitting in the waiting room, seeing blood, seeing the point of the needle, seeing the needle inserted, being “poked” multiple times, and being restrained.
Over time, unmitigated pain may increase fear, which in turn, may increase pain at future procedures. Parents may struggle with a flailing child, a child running away, hiding under a desk (I did that as a child!), fainting, and/or requiring restraint to successfully complete the procedure. These consequences result in an unpleasant, potentially traumatic, experience for the child, the health care provider, and the caregivers.
To mitigate these negative effects, the providers of Cook Children’s Health Care System advocate for their patients by utilizing a tool called “The Comfort Menu.” Ideally, parents collaborate with their medical team to acknowledge that unmanaged pain hurts more than just the child’s body. So, how do we (parents and health care team) make it less scary:
- Call your clinic ahead of time and ask what to expect at the visit. Will my child get shots? How many? Do you have anything to help them not feel the shots as much? Do you use “The Comfort Menu?” The more prepared you are as a parent, the more in control you will feel about the appointment and less anxious you and your child will be.
- Be honest. If your child asks, “Am I going to get a shot?” Tell them the truth. You may say, “I am not sure, we will ask the doctor, but I promise we will find out and it won’t be a surprise.” Or if you know you are going specifically for a flu shot, you may say, “Yes, you are getting your flu shot today. I want to do everything I can to help keep your body healthy.”
- Do not plan appointments around your child’s nap time and meal times. Having an appointment scheduled for vaccines when your child should be sleeping may make the visit a whole lot more challenging. The same goes for a hungry child, more challenging when your child is “hangry!”
- Leave siblings at home. It’s much easier as a parent to bring only the child or children who need to see the doctor. Any additional children in the room can take away your attention from your littles who need you the most.
- Bring an item for distraction or a comfort item. Toddlers may need multiple items to keep their attention while a school-aged child or adolescent would do just fine with a tablet, phone or music.
- Communicate any special needs with the clinic BEFORE coming to the appointment. If the waiting room is overwhelming or too stimulating for your child, ask to wait in the car until it is time. If your child LOVES dinosaurs and that will help the staff build rapport with your child, tell them. Sometimes just getting in the door of the doctor’s office is the hardest part, but if the clinic can be prepared to help support or acknowledge the needs of your child, the transition can be so much smoother.
- Discuss “The Comfort Menu” with the medical team to learn of options available to make the visit as easy and comfortable as possible. For example, the nurse may recommend what has worked well for other children such as Cold spray, Buzzy, numbing cream, items for distraction, sugary drink, and breastfeeding. This is also an opportunity for you and your child to voice what has worked well in the past.
- Ask to learn about comfort positioning. The most vulnerable position for a child is laying down, so we try and avoid that position whenever possible. Comfort positioning is a great option to help a child feel safe and more in control. Examples of comfort positioning are: sitting in a parent’s lap, sitting next to a parent, and a mother breastfeeding her baby. Your doctor’s office can teach you how to hold your child.
- Act happy and be calm. Remember your child follows your cues so use positive and encouraging words. Make eye contact, even with small children.
- Remember that care after the shot counts too. Reinforce that you are proud of your child, hold them, and soothe them. Take time to consider how the appointment went and what should be done differently or stay the same at the next visit.
At Cook Children’s we believe that every child should have equal opportunity pain management, every time.
Artee Gandhi, M.D., Medical Director Cook Children’s Pain Management/Endowed Chair Center for Pain Management and Integrative Health
Whitney Brosey, CCLS, Comfort Menu Program Coordinator
For more about the Pain Management Program at Cook Children's, click here.
Taddio A, Ipp M, et al. “Survey of the prevalence of immunization non-compliance due to needle fears in children and adults.” Vaccine 30 (2012) 4807–4812.
Kennedy A, Basket M, Sheedy K. “Vaccine attitudes, concerns, and information sources reported by parents of young children: results from the 2009 HealthStyles Survey.” Pediatrics 2011;127:S92–9.
Taddio A, Chambers CT, Halperin SA, Ipp M, Lockett D, Rieder MJ, et al. “Inadequate pain management during routine childhood immunizations: the nerve of it.” Clin Ther 2009;31:S152–67.
Jacobson RM, Swan A, Adegbenro A, Ludington SL, Wollan PC, Poland GA, Vaccine Research Group. “Making vaccines more acceptable-methods to prevent and minimize pain and other common adverse events associated with vaccines.” Vaccine 2001;19:2418–27.
Woodin KA, Rodewald LE, Humiston SG, Carges MS, Schaffer SJ, Szilagyi PG. “Physician and parent opinions: are children becoming pincushions from immunizations?” Arch Pediatr Adolesc Med 1995;149:845–9.
Madlon-Kay D, Harper P. “Too many shots? Parent, nurse, and physician attitudes toward multiple simultaneous childhood vaccinations.” Arch Fam Med 1994;3:610–3.
Diekema DS. “Improving childhood vaccination rates.” N Engl J Med 2012;366:391–3.
Guerra FA. “Delays in immunization have potentially serious health consequences.” Paediatr Drugs 2007;9:143–8.
Craig KD. “The social communication model of pain.” Can Psychol. 2009;50:22–32. 40.
Hadjistavropoulos T, Craig KD, Duck S, et al. “A biopsychosocial formulation of pain communication.” Psychol Bull. 2011;137:910–939.
Pillai Riddell RR, Racine N, Craig K, et al. “Psychological theories and biopsychosocial models in paediatric pain.” In: McGrath PJ, Stevens BJ, Walker SM, et al, eds. Oxford Textbook of Paediatric Pain. Oxford, UK: Oxford University Press; 2013:85–94.
McMurtry C, Riddell R, et al. “Far From “Just a Poke” Common Painful Needle Procedures and the Development of Needle Fear.” Clin J Pain Volume 31, Number 10S, October 2015