Fort Worth, Texas,
14:43 PM

How to Help Young Children Cope with Vaccine Anxiety

Written by: Jean Yaeger

Now that children as young as 5 can get the pediatric COVID-19 vaccine, parents might be wondering how to make the shot as smooth and painless as possible.

It’s not uncommon for kids to be nervous about needles. So the experts at Cook Children’s offer some advice to provide reassurance and support throughout the vaccination process. Honest conversation, creating a comfort plan, and distraction techniques can help put children at ease. Reinforcing a positive mindset helps too: You can do this!

“If you go in with the high expectation that your child can handle this and our staff is going to take good care of your child and make it as comfortable as possible, the kids will rise to the occasion,” said Kim Mangham, M.D. at Cook Children’s Pediatrics Keller Parkway.

The U.S. Centers for Disease Control and Prevention (CDC) on Nov. 2 approved a lower-dose Pfizer-BioNTech vaccine for ages 5-11. Children ages 12 and up were already eligible for immunization against the virus that causes the illness known as COVID-19.

Dr. Mangham said some of her younger patients have been eager for their turn at vaccination. “Some of them are so excited about being protected,” she said.

Clinical coordinator Trish Skelly, LVN estimates she has given hundreds of COVID-19 shots to 12-year-olds and teens through Cook Children’s during the pandemic. It’s a two-shot vaccine, so Skelly gets the chance to follow up when the patients return three weeks later for the second round.

“Usually, I ask how they did after the first one, and they say it was a lot better than they expected,” she said. “They’re handling it much better than the adults with the side effects.”

To help alleviate fears about the shot, Skelly wears her fun nurse’s scrubs and relies on an assortment of aids including stickers, suckers and a topical spray that feels like ice on the skin, relieving the needle’s sting. Most of her patients opt for the nicknamed “Elsa spray” or “magic spray” before the injection. Skelly also answers any questions that come up.

“I explain everything I’m doing when I’m doing it so that there’s no surprises. Most of them don’t even feel it. It’s actually an easier shot than the flu vaccine,” she said.

As coordinator of the Comfort Menu program at Cook Children’s, Whitney Brosey works to educate medical personnel about techniques that can make children feel less leery about going to the doctor. And Brosey promotes the strategies that caregivers can follow – at every point from scheduling the vaccine appointment, to the shot itself, to the 15-minute monitoring period afterward -- for a happier end result. Let’s take a closer look at each stage.

Get Ready, Get Set

Parents should start by informing themselves about the vaccine, Brosey recommended. Next, try to schedule an appointment time that doesn’t interfere with sleep, meals or extracurricular routine so that the child isn’t hungry/cranky and coping poorly.

“If you have to wake them up from a nap or if they have to miss one of their activities, there's going to be added disappointment,” she said. “As much as possible, don't disrupt their normal schedules, so that they don't have added stressors.”

When is the best time to give your child advance notice of a vaccine? It depends, Brosey said, on the child’s personality. Some kids might worry excessively if they know multiple days ahead of the appointment. Brosey informed her 8- and 6-year-old daughters the night before their recent flu shots.

“It’s important to tell kids what is happening to their body. Surprises are fun, but not when it comes to things at the doctor” in order to build trust in medical experiences, she said. “I want to make sure that my kids feel like it's OK to feel nervous or it's OK to be a little bit scared, but to have time to process those feelings so that then there's also time to come up with a plan to help it not be so scary.”

Don’t wait to break the news until you arrive at the doctor's office or vaccination clinic, she said.

More pointers beforehand… Explain in simple words that vaccines help keep our bodies from getting sick. Friendly resources include “Daniel Goes to the Doctor” for younger kid and an animated video from the American Academy of Pediatrics. Allow your child to make appropriate choices, such as whether to bring along a special blankie or stuffed animal from home.

“One of my daughters had dance class after her flu shot, so she wanted to get it on her right leg because she does all of her turns on her left leg,” Brosey said. “That was the control piece for her. She felt empowered.”

And Go

Once at the clinic, parents should talk with the medical staff about the preferred approach for their child’s vaccine. Find out if cold spray or other options are available for comfort. Parents might want to call ahead if the child has developmental delays or sensory needs, Brosey said. Be your child’s advocate.

“Sometimes parents feel like they're being a difficult parent by saying what works, or they think that they're inconveniencing someone, and that is not the case,” she said. “We trust that they know their child best. We want you to communicate with us and have a conversation with us about your child. If you want to hold and hug your child while they're getting their vaccine, then you communicate that with the medical team.”

Distraction is key, according to everyone interviewed for this article. Distract your child by playing a game like I Spy. Sing a song or listen to music. Recite the ABCs backwards. Prompt your child to talk about a favorite memory. Brosey calls this therapeutic conversation.

To keep the child from feeling overwhelmed, only one parent should speak to the child at a time, she said. Reinforce the message of the child’s main job – to hold still. Recognize it’s OK if they cry. If possible, don’t bring siblings who aren’t getting vaccinated, because total attention belongs on the child receiving the shot.

TLC after the Shot

Brosey recommends coloring books or games to pass the time during the 15-minute observation period after the COVID-19 vaccination. Follow up your child: Do you feel like that went well? Or what could we have done differently? Give a treat or some extra one-on-one time later at home.

“It’s so important to help your child return back to baseline after they've gotten nervous or scared. It's almost like the next step in distraction,” she said. “And so I may say, ‘Hey, we can run by the donut shop!’”

Also, let your child know they might experience soreness or other side effects the next day. Brosey said it’s important for the child to report to you if they don’t feel well.

Although CDC approval of the pediatric COVID-19 vaccine is new, kids usually have some familiarity with getting immunized against other illnesses. Brosey said parents should use age-appropriate vocabulary and detail to help explain the purpose of vaccines. The bottom line is to work out a comfort plan, collaborate with the medical team, and stay positive.

“When it comes to coping or how children perceive shots, they're not too big at 11 to be scared,” she said. “We care about our kids' emotional safety. We don't want to have a traumatic experience. We want them to feel safe and we want them to feel heard and seen and acknowledged, and all of that can be done.”

Cook Children’s aims to provide an emotionally safe experience for you and your child. Here are some tips to make the vaccine visit as easy and comfortable as possible.

Inform your child in advance, but not too early.

For example, if the appointment is first thing in the morning, tell your child the night before. That way there is enough time to answer questions and come up with a comfort plan.

Not sure what to say? Try this: “We need to go to the doctor to get some medicine to help keep your body healthy.” Be prepared for your child to ask if they’re getting a shot. Answer honestly.

Your child might cry or say “I don’t want to go.”

Follow these steps to comfort them:

Step 1: Acknowledge they are scared. Let them know it is OK.

Step 2: Come up with a plan:

  • Offer choices: Does your child want to sit in your lap or sit next to you when they get the vaccine? Do they want to watch or look away? Right or left? Do they want the medical team to count “1-2-3” before giving the vaccine?
  • Talk about coping strategies such as relaxing breaths, cold spray, bringing a comfort item from home (teddy bear or squeeze ball for instance), or distractions such as I Spy or a favorite song.

Step 3: Communicate with your medical team what you think might work best. Speak up!

Prepare your child for what they might feel.

  • The needlestick can be uncomfortable, like a pinch or a poke. But your comfort plan should help so they don’t feel it as much.
  • Localized discomfort at the injection site is common. You might say, “Some kids say their leg/arm feels sore after getting their vaccine” or “Some kids have told me they didn’t feel good after their vaccine. If you don’t feel good, please tell me.”

Visiting Cook Children’s? Ask us about our Comfort Menu. We believe “Every child deserves an equal opportunity to have their fear and pain addressed. Communicate, collaborate, and create a comfort plan that works for them.” -Comfort Menu Mission Statement