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Key points
- For children and parents alike, getting a "shot" can cause anxiety, distress, and discomfort.
- Clinical practice and solid research provides a guide for helping children cope and cooperate with the COVID-19 vaccination.
- By being honest, prepared, and calm, parents can help reduce their child's distress and discomfort.
Our 9-year-old son got his first dose of the COVID-19 vaccine last week. When I told him it was his turn, he jumped for joy as if I had told him we were going on a big trip. Perhaps in his 9-year-old mind, it opened up the possibility of going somewhere exotic or maybe just the possibility of doing any of the things he’s been missing, like going to an indoor birthday party, or to a friend’s house, or to the movies. As a mom and a pediatric psychologist, I realize that while some children will be as excited as mine to get their COVID vaccine, many others may be hesitant or even fearful when told it’s their turn to get an injection. Some may even experience excessive fear or phobia and will need some extra support from a professional.
I don’t anticipate our 4-year-old will be quite as enthusiastic as her big brother when it’s her turn—her recent flu shot led to several days (yes, days) of periodic distress and crying, but it turns out that had more to do with her fear of removing the Band-Aid she’d received following the immunization than the shot itself. In fact, two weeks later, she’s still talking about the long-removed bandage, so I know we have some work to do to prepare for when the vaccine is approved for her age group or she turns five, whichever comes first.
What calms my fears as her parent, is that I know I can lean on good clinical practice and solid research to help guide me, and that’s what I want to share with you. Here are some tips from research and practice on how we can help children (and their parents) cope and cooperate with the distress and discomfort of routine medical procedures like immunizations:
Tip #1: Be honest.
It’s no accident honesty is my first tip. Honesty really is best when it comes to vaccinations and other medical procedures, and the COVID vaccine is no exception. Telling a child that "it won’t hurt” or “it’s not a big deal” is not being honest. It will hurt (even if only momentarily) and it is a big deal (even if there are bigger deals). Being dishonest invalidates your child’s experience and can undermine a child’s trust in adults and medical professionals. Instead, be honest and informative. Saying something like, “It will likely hurt, but it will be over quickly and will help protect you from getting sick,” will appropriately prepare a child for the pain associated with the injection and also help them focus on the benefits of the vaccine. The same goes for potential side effects. Saying something like, “You may feel tired or achy after, but that’s normal and will go away,” can help reduce a child’s fears about the after-effects of the vaccine.
Importantly, let your child guide the discussion. In response to their questions, offer age-appropriate information and answer the question they ask you, being careful not to overload them with information. Giving children the information they are seeking can help reduce their anxiety and distress.
Tip #2: Time it right.
While I wish I could tell you there’s a formula for when to tell your child it’s their turn to get the vaccine, there really is no such thing as perfect timing. However, we do know from clinical experience that children who receive “surprise” vaccinations may be more likely to experience distress and have poor responses to future injections and other medical procedures. How well would you respond to a random and painful procedure?
Similarly, children told too far in advance may experience excessive anticipatory anxiety—or increased fear and dread in anticipation of the event. The timing you choose will likely depend in part on your child’s developmental level and in part on your knowledge of how your child has responded in similar situations. Dr. Keith Slifer, director of the Pediatric Psychology Consultation Program at the Kennedy Krieger Institute/Johns Hopkins University School of Medicine in Baltimore, Maryland, recommends, for example, telling pre-school age children about a “shot” a few minutes before the procedure (2014). For older children, the timeframe may be extended. Importantly though, if your child asks about a vaccination that’s been scheduled, refer to Tip No. 1: Be honest. A simple, “Yes, you are scheduled to get your vaccine next week” may suffice. It may also provide an opportunity for you to talk to your child about the benefits of the vaccine, helping to set the stage for a positive experience.
Tip #3: Give them a choice about something that can be a choice.
While getting the vaccine is a choice caregivers need to make, there are many things about immunizations that kids can make choices about. Do you want to sit on my lap or on the exam table? Do you want the vaccine in your right arm or your left arm? Do you want to hold a stuffy or my hand? Or, do you want to go after school or on the weekend? Giving children a choice allows them to feel a sense of control, which can be important in reducing their distress. So, even if they can’t be in control of whether they receive the vaccine, they can experience a sense of control over other things that matter to them (but that may not make much of a difference to you or the medical professional administering the vaccine).
Tip #4: Be prepared with a strategy.
It can be helpful to come up with some strategies to help your child cope in the moment when getting their vaccination. Distraction can be a powerful tool in reducing pain, discomfort, and anxiety (Birnie et al., 2018). So, bring along some favorite toys or activities, or better yet talk to your child about what they might like to use as a distraction strategy. Perhaps a few minutes of screen time, a game of I Spy, listening to a favorite song, playing a video game, or telling silly jokes, like my son did when he received his vaccination, may be good strategies in helping your child cope and cooperate. Who knows, your child may even give the nurse administering the vaccine a joke to pass along to the next child.
Tip #5: Stay calm yourself.
Have you ever noticed how observant children are? They notice the smallest details, whether the shape of a cloud, a furry caterpillar, or the look on our faces. Children certainly have a way of noticing the small things and picking up on our emotions, especially fear. The COVID-19 pandemic and vaccine have raised anxiety for many, and a parent’s expressions and behavior can influence their child’s response to many situations, including vaccination. So, avoid being critical or sharing your hesitation. Even things like apologizing or overly reassuring your child (e.g., “It’ll be OK, I promise.”) can lead to increased distress, whereas distraction or humor can help a child cope and cooperate (Cohen et al., 2017). So, tell your child a new joke or a story or bring their attention back to the activity of their choosing and remember to take a few deep breaths yourself. You may just be able to guide your child’s coping with a little bit of your own.
Tip #6: Celebrate with a reward.
Praise and even a small reward like a small prize or a treat can go a long way in reinforcing your child’s cooperation and reducing their distress after the vaccination. So, be sure to tell them what a great job they did, plan to stop for an ice cream after, have a special movie night, or let them choose the music on the ride home. Remember that children should be rewarded even if they cried or screamed (or even accidentally kicked the nurse, like our 4-year-old did). Bravery is doing something in the face of fear, so reward your child for their bravery. Give yourself a pat on the back or an ice cream cone too for supporting them through it.
Tip #7: Get help if you need it.
If your child is experiencing excessive fear and distress about injections or other medical procedures, there’s good news. There is substantial support for the effectiveness of evidence-based interventions, like cognitive behavioral therapy (CBT), in treating phobias and anxiety in children (Oar, Farrell, & Ollendick, 2019). You and your child don’t have to suffer, and they certainly don’t have to miss their shot.
To find a therapist, please visit the Psychology Today Therapy Directory.
References
Cohen, L.L., Blount, R.L., Chorney, J., Zempsky, W., Rodrgues, N., & Cousins, L.A. (2017). Management of pediatric pain distress due to medical procedures. In M.C. Roberts & R.G. Steele (Eds.), Handbook of pediatric psychology (5th ed.). Springer.
Birnie KA, Noel M, Chambers CT, Uman LS, & Parker JA. (2018) Psychological interventions for needle-related procedural pain and distress in children and adolescents. Cochrane Database of Systematic Reviews, 10. DOI: 10.1002/14651858.CD005179.pub4.
Oar, E. L., Farrell, L. J., & Ollendick, T. H. (2019). Specific phobia. In Compton, S.N., Villabro, M.A., & Kristensen, H. (Eds.) Pediatric Anxiety Disorders. Academic Press.
Slifer, K.J. (2014). A clinician’s guide to helping children cope and cooperate with medical care. The Johns Hopkins University Press.
