White Coat, Black Art·The Dose

How do you make vaccinations hurt less for kids? Health-care experts share their tips

Dr. Brian Goldman, host of White Coat, Black Art, spoke with clinical psychologist Christine Chambers about techniques to make vaccines hurt less.

Positive language, topical anesthetics, even distracting them with a video can help: Dr. Christine Chambers

Solome Walker, 9, looks down at her bandage after getting her first Pfizer-BioNTech COVID-19 shot at a vaccination clinic for young students on Nov. 13, 2021 in Louisville, Ky. (Laura Ungar/The Associated Press)

Parents across Canada are booking kids from ages five to 11 for COVID-19 vaccinations. It's an exciting time for families who've been waiting for the protection afforded by the vaccine — but maybe not so much for kids anticipating a needle in the arm.

Dr. Brian Goldman, an emergency physician at Sinai Health System and host of White Coat, Black Art, has written articles and given lectures and workshops on acute pain management. He spoke with Christine Chambers, clinical psychologist at Dalhousie University in Halifax and scientific director for an organization called Solutions for Kids in Pain, about techniques to make vaccines hurt less. 

Here is part of their conversation from The Dose.

Stress or anxiety will increase the experience of pain associated with needles, won't it? 

Absolutely. We know this about pain. It's a very subjective experience. In fact, the official definition of pain acknowledges that it's not only a sensory experience, but it's an emotional experience. And we know that mood, anxiety, depression can all make pain worse. 

There are some simple techniques that vaccinators can use. One thing I do, for instance, is at the moment I'm giving the injection. I gently tickle the skin close to the injection site as I'm giving the vaccination. That floods the sensory nerve with signals that help block out the pain from the needle.

What techniques do you find most effective? 

Another simple thing is just the positioning of the child. We know, for example, that when children are seated as opposed to lying down, that that actually reduces the pain of the needle. 

In general it's believed that children feel a little more in control when they're seated and they're upright and they can see everything that's going on as opposed to when they're lying down. We all feel more vulnerable when we're lying down. 

Dr. Christine Chambers is a clinical psychologist and professor at Dalhousie University. (Submitted by Christine Chambers)

Dentists would not be able to do what they do without giving needles of local anesthetic. What can vaccinators learn from dentists? 

Dentists really know that it's important to take pain management seriously or that people won't come back. One of the strategies that's been found to be effective is the use of numbing creams or patches. You can purchase topical anesthetics at your local pharmacy without a prescription. The product has to be applied 30 to 60 minutes before the needle.

Dentists have long put up videos. Kids can watch cartoons. I've certainly heard of some dentists using imagery, getting kids to imagine that [they're in] a magical place.

Distraction is one of the most effective strategies for supporting kids during medical procedures:

  • Watch a video.
  • Listen to music through headsets.
  • Play with a toy that encourages deep breathing, like getting kids to blow some bubbles or blow on a pinwheel [to relax].

And it can go beyond just even the breathing. We often talk to kids about how they can relax their muscles by turning their arm into a spaghetti noodle, or tensing it like a robot and then relaxing it like a noodle.

I had an MRI of my spine yesterday. I have sciatica on my left side and it really hurt having that MRI, because I had to remain in one position for a long time, and I had to practice a whole array of techniques that you're talking about. Breathing, mindfulness. I turned the pain into a dragon. "I'm going to slay you!" It helped. 

Encouraging that kind of positive self-talk or imagery with kids is so important. Often the first thing a kid asks when they hear they're going to the doctor is, "Will I be getting a needle?" Often that can be related to a cascading of anxiety. 

We know that not only do emotions make pain worse, but our thoughts can make pain worse. Helping kids to develop really positive self-talk around this and empowering them to be able to be proactive and solution-focused in their approach to vaccination is important. 

What else can parents do to help reduce vaccine pain for their kids? 

Sometimes parents get so nervous about how to manage their child during procedures and vaccinations that they avoid just having a direct conversation. You know, [they might say], "Guys, I'm going to be booking your COVID vaccinations sometime in the next couple of weeks.... Let's talk about having a plan."

Also, I mean, I'm a child psychologist, so I can say: bribes do work! And I don't mean big bribes, but I mean giving your child something to look forward to, whether it's a special treat [and] special time together. We would frame that all as positive reinforcement.

Children need to go back for a second dose, so it's really important that we talk about what went well. There's some research that shows that kids who walk away from painful experiences and remember it in a very negative way are more likely to have more pain the next time. 

You say that parents should use neutral language. Can you give me an example of a do and a don't? 

Use language that, for example, gives suggestions on how to cope. Or distracting talk like, "What are we going to do afterwards?"

Parents are very inclined to say things like "It'll be over soon. You're OK." But there's a lot of research that has shown that when parents reassure, it actually makes their kids feel worse. Part of the research has identified that when parents reassure, kids are picking that up as their parent being anxious. 

I always recommend to parents that you really keep your own anxiety in check, that you use the same strategies that we recommend for children for yourself. 

A woman and child peer out their car window as bubbles are blown into their car during a ceremony celebrating the end of Ramadan in Brooklyn, New York on May 24, 2020. Blowing bubbles encourages children to breathe deeply and relax during vaccinations, according to Chambers. (Kathy Willens/The Associated Press)

What are the signs that a child has developed a more serious fear or phobia of needles? 

Being fearful of needles is normal. But generally speaking, we would consider it to be at a phobic level when the child is actively avoiding, or parents actually can't get their child in. 

There are some parents who are feeling like they might have to hold their child down, which is something that we would actively try to avoid wherever possible. While it may allow the child to get through that procedure, it's incredibly traumatic and tends to set up a lot more difficulties down the road. 

Often there is a need to work with a registered psychologist over a couple of sessions to engage in what we call exposure-based therapy. 

The pain of vaccinations and other needles can be reduced. Can the pain always be reduced to zero? 

No. We have to be really realistic. [But] there are things that we can do differently to promote better outcomes. The experience they're having with this vaccine is going to impact their perspective and how they interact with the health-care system moving forward.

It's really important that we take that long view in mind and make vaccination experiences as positive as possible for these children. 

Produced by Rachel Sanders. Q&A edited for length and clarity.

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