One of my earliest memories from pediatric residency was physically restraining a crying, screaming, shaking child who needed a blood draw for cancer. I knew we were doing the right thing. But we were also doing the wrong thing for his psychological development. Sadly and predictably, that child developed post-traumatic stress disorder and needle phobia.
Healthcare professionals systematically underestimate needles as a cause of pain. Needles are the most common office procedure. They underpin modern diagnostics and therapeutics. Yet needle fear is nearly universal in young children. Studies show nearly two-thirds of children and one-fourth of adults have a fear of needles. Poorly managed childhood procedures can have lifelong consequences, including anxiety, healthcare and vaccine avoidance. The CDC vaccination schedule and childhood medical care mean that children will typically experience over 50, and perhaps as many as 100+, needles during childhood.
How can you help your children better experience needle procedures? Here are my top evidence-based recommendations. The CDC and many hospitals have great guides as well. (I use the term parent, but this is interchangeable with caregiver; many times children come to needle procedures with someone else.)
1. Prepare: Lay the groundwork.
How children behave is heavily influenced by parents. If you’re scared, your child will be too. Educate yourself to feel more at home. For example, if your child needs a vaccine, look at the CDC’s advice for parents so you know what to expect. You can gather the things you need such as topical local anesthetic cream and favorite toys. Don’t make a fuss if your child is mildly unwell, they can still undergo blood draws, vaccinations, and so on. Make a plan so you and your child feel in control.
Words have power. If your child is old enough to talk, make sure you use truthful, neutral language to discuss needles. Needles can hurt, pinch or sting, but they won’t last long. Avoid shot or pain. Try poke, pressure, or needle. Use positive language to discuss the procedure: “You can do this.” Also to discuss the benefits: “The vaccine will keep you healthy.”
2. Game day: The best possible care during your procedure.
Depending on your child’s age, there are some great strategies that can make the procedure go much more smoothly. I like the No Needless Pain initiative by Stefan Friedrichsdorf. It provides a framework for four non-negotiables. These bundles of care are effective in reducing pain yet adoption has not been universal.
Ask for better care. You’ll be doing not only your child a favor, but also set higher standards of care for everyone who comes after you. It only takes one poor procedure to potentially start the cycle of pain, fear, avoidance, and anxiety; you want this to be done properly.
Here are the four non-negotiables:
First, if your child is 2 years or under, a sucrose (sugar) solution a minute or two before the procedure can reduce pain. Breastfeeding can also help.
Second, topical local anesthetics can reduce pain. Lidocaine 4 percent is available over the counter without a prescription and requires 30 minutes to work – make sure you discuss this with your physician first. Thirty minutes is a long time, allow enough time for it to work.
Third, comfort positioning. Positioning or embracing your child appropriately gives them a sense of security, reducing the feeling of vulnerability, and gives you something positive to do. The CDC have a great guide here.
Fourth, age-appropriate distraction. Toys, videos, books, deep breathing, blowing bubbles, singing, having the child count – all of these can be effective to redirect attention and reduce pain. We’ve pioneered the use of virtual reality for needles, showing reductions in pain, anxiety and the need to restrain children. If available, this can be one of the most effective distractions particularly if the procedural content is matched to the procedure to avoid surprising the child.
3. Afterwards: Aftercare for needles
Phew, you’re done. Calm young infants by swaddling them. Hugs, cuddles, and whispers can help soothe older babies. For older children, praise them and consider using positive phrases: “You are brave.” Don’t apologize, that’s what we do when we’ve made a mistake or done something wrong.
Some children may meet the criteria for needle phobia and may benefit from a mental health professional, for example, a therapist.
There’s a lot you can do to help your child with needle procedures. You know your child best, and your healthcare providers need your input so your child can have the best experience possible. By approaching needles positively, you can help set up your child’s healthcare experiences for life.