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Coronavirus Disease 2019

Working Through Needle Fears, One Step at a Time

Using exposure therapy to help children prepare for their COVID-19 vaccination.

Key points

  • Exposure is an effective tool to address a child's fear of needles. It breaks down a feared situation into a series of manageable steps.
  • Some example exposures include having a child look at pictures of needles, watch videos of needles, and talk about shots.
  • If at-home exposures are not effective in reducing needle fears, parents can consider a cognitive behavioral therapy program.
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The Food and Drug Administration recently cleared Pfizer’s COVID-19 vaccine for emergency use among children as young as 12 years old. Although both encouraging and exciting, this news may be met with some trepidation among children and adolescents who struggle with a fear of needles. These kids are likely the same ones who in the past worried days ahead of shot appointments. They may also have needed to be held down to receive a shot or skipped required shots entirely due to their fears.

How to Address a Fear of Needles

How can children and teens overcome needle fears? Evidence indicates that exposure is key. To do exposures, we take the feared situation (in this case needles) and break it down into a series of manageable steps, which therapists call a “fear ladder.” We then start at the bottom of the fear ladder and work our way up, moving to the next step after the previous one no longer feels as anxiety-provoking.

Below, we list out a sample fear ladder to address needle worries. Kids should pick where they would like to start, and then plan to practice that step at least a few times over the course of a week. The child can write down “fear ratings” throughout the exposure (i.e., every minute or so) on a 0 to 8 scale, with 8 being the most afraid they can possibly be in that moment (picture “looking into the mouth of a lion” level fear). It is often thought best for the exposure to continue until the child sees some reduction in their distress rating; this reduction will help them to know that they are starting to get used to the feared situation and to learn that they can cope with their fears. The goal overall is for the exposure to ultimately feel “boring” and to provide the child with a sense of new mastery, which are signs that it is time to move on to the next one.

Sample fear ladder:

  1. Say the word needle out loud or draw the word in bubble letters on a piece of paper and look at it for several minutes.
  2. Look at a picture of a needle for 10 to 15 minutes. Note: This can be a clipart picture found on Google or a picture of a real needle, depending on what feels more anxiety-provoking. The goal should be ultimately to look at a real picture of a needle.
  3. Look at pictures of a needle touching a person’s skin for 10 to 15 minutes.
  4. Have a conversation with someone about receiving a shot.
  5. Watch a YouTube video of a person getting a shot. Note: This can be a cartoon video or maybe a video of an animal getting a shot at the zoo, if that is an easier place to start. The goal will be to ultimately work up towards watching a person receiving a shot.
  6. Drive to the doctor’s office and sit in the parking lot.
  7. Purchase a fake needle online or use what is available in the home (e.g., a knitting needle; a pen that resembles a needle). Plan to sit next to this needle, touch the needle, and work up to having the needle touch your skin for 10 to 15 minutes.
  8. Have a caregiver or friend hold the fake needle to your skin for several minutes.

Other Ways Parents Can Help Reduce Fears

It may also be helpful to have the child write out a story about what they think might happen at the doctor’s office and while getting a shot. They will want to go through this story in some detail, walking through every moment, from parking, to walking into the office, to sitting in the waiting room, etc., right up until the shot is complete and they are going home. Children can then re-read this story or record it and listen repeatedly until the story begins to feel less anxiety-provoking.

For parents of children with needle fears, it will be helpful to think through ways that bravery can be encouraged. This often means gradually stopping any behaviors that help the child to avoid the anxiety-provoking situation. For example, parents may find that they are not telling their children about upcoming doctor’s appointments or not using the word “shots” or “needle.” This accommodation can mitigate a child’s distress immediately but serves to maintain their needle worries over time. Parents can start by having a conversation about shots with their child, maintaining an attitude of “I know this is hard and I know you can do this” throughout the conversation. It may also be helpful for parents to remind themselves that the actual experience of getting a shot, while difficult, will help to provide evidence that the child’s anticipated catastrophe did not happen.

If you find that at-home exposure is not working, you may want to consider finding a cognitive behavioral therapy (CBT) program. A CBT therapist will help you to identify some coping skills that can be implemented to address needle fears and will set up other in-session exposure tasks. Some resources to find a therapist are available through the Association for Behavioral and Cognitive Therapies and the Anxiety and Depression Association of America.

To find a therapist, please visit the Psychology Today Therapy Directory.

More from Philip C. Kendall, Ph.D., ABPP and Lesley A. Norris, M.A.
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