Getting shots, or the pain and fear associated with them, is one frustrating association children have with seeing their doctor. There are some ways to make this better. Diminishing shot anxiety is a huge goal for parents and pediatricians. If expectations are clear, everyone can leave a visit after shots feeling more successful.
- Prepare: Do your best to prepare yourself for a visit where there will be shots. Bring your husband/wife/partner, friend, or relative with you for support. If you act or feel nervous, your child may pick up on this. Even infants pick up on nervous cues. It is well known that parental behavior influences the amount of pain and distress from shots. In one 1995 study, 53% of the variance in child distress during immunizations was accounted for by maternal behavior. Geesh! So, if you’re freaking out, your child may be influenced. A Pediatrics review article in 2007 found that excessive parental reassurance, criticism, or apology seems to increase distress, whereas humor and distraction tend to decrease distress. First shots for new parents are often nerve-wracking. Layer your support and tell your pediatrician you’re nervous so they can provide reassurance and support. Bring a new toy for your child, plan a joke ahead of time. Scripting may truly help.
- Distraction: Use distraction whenever possible. Squeeze your child’s hand during shots, sing songs together, blow on your baby’s face, or talk about plans you have later in the day during the injection. Discuss your favorite spots or places you’ve been together. Also, consider the “cough trick.” A study in Pediatrics out earlier this year found that children (age 4-6 and age 11-13) who were coached to cough during the injection experienced less pain from the shot. Consider coaching your kindergartner, 11 year-old, or even 16 year old (!) to use this skill. Adolescents are often very nervous about the expected pain of immunizations. Coughing to decrease discomfort may be a great “trick.” In my experience, the waiting and anticipation of shots is far worse for kids than the actual injection. Like so many things in parenting, knowing what to expect is essential for your child. Transfer control (when you can) to your child; it can dramatically change the visit and the experience of getting shots.
- No Promises: Never make promises that your child won’t have a shot at a doctor visit. Plain and simple, it’s a lose-lose most of the time. Each visit is a chance to “catch-up” on missed doses or recommended doses due to current recommendations (they change frequently). My recommendation is to avoid making a promise you can’t keep. Focus on rewards after visits, instead. Promise things like a trip to the park or a stop at your favorite coffee shop, a sticker, or allow your child to choose what’s for dinner after the visit.
- Medications: I recommend you don’t give acetaminophen (Tylenol) before shots. New research in infants finds that pre-medication may dampen the (desired) immune response after shots. Up to about ½ of infants will have an elevated temperature after immunizations. This is a normal inflammatory response to the shot, proving the vaccine is working to protect your baby against future infection. The elevated temperature (usually around 99 or 100 degrees) subsides within a day or 2. If your baby is otherwise comfortable, soothe them without the use of medications. However, some injections are more likely to cause higher temperature elevation. MMR vaccine, given at 12 to 15 months and and again to complete the series between age 4 and 6 years, can cause fever (lowgrade) between 5-15% of children, and rarely cause high fever (over 103) 5 to 12 days after the shot. If temperature is elevated over 101 degrees, I would suggest using Tylenol to relieve discomfort for your child.
- Never Punish: Don’t ever use shots as a form of punishment. Never say, “You’re going to get a shot if you’re not good.” Pediatricians hear things like, “Sit down or the doctor will give you a shot,” and squirm. I usually clarify directly with a child when I hear similar things, explaining that shots are never something I would do to cause them pain. Shots clearly aren’t punishment; viewing them as such can confuse the experience at the office for children and adolescents.
- Control: Let your child be in charge whenever possible. Older children should tell the MA or nurse which arm to start with, or on what count to give the injection. Be honest and tell your child the shot will likely hurt and may leave them sore. Reassure them that the injection is quick.
Another idea for pain relief during shots includes using prescriptions for numbing medications like EMLA cream or vapocollent spray that can be applied to the skin prior to a shot. Research and some children feel this can be very helpful! One deterrent for me in recommending EMLA routinely is that although EMLA or numbing sprays affect the surface of the skin, they doesn’t numb the area where the needle goes into and the area where the medicine is injected. Therefore, it may not relieve much of the pain associated with injections. For some children, I worry EMLA be instructive, teaching children shots are something to fear. However, I have given prescriptions for EMLA to some families and have received good feedback. Others didn’t see to notice much of a difference. Part of me thinks it is about a child feeling in control. If you think your child will really benefit from EMLA or Vapocollent, talk with your doctor ahead of the visit to request a prescription and instructions on use.
Pain research also finds that young infants can acquire pain relief from concentrated sugar (Sweet-ease) in their mouth. If interested in using sugar to ease an infants discomfort, consider dipping the pacifier in sugar water (your pediatrician may have this on hand) just prior to to giving shots. It’s possible that the experience of that sugary dip may distract and relieve pain associated with vaccinations.
Lastly, some offices allow breastfeeding during the time of immunization. Many mothers report that this skin-to-skin contact, reassurance, and cuddling helps both of them during the shots. Ask your pediatrician to breastfeed during shots if you think it will help calm you down, too!
What have I missed; what have you done that worked?
“Ask your pediatrician to breastfeed during shots if you think it will help you, too!”
I’m not sure that’s exactly the phrasing you wanted. 🙂 My pediatrician is not equipped to breastfeed me even if he wanted to.
Wendy Sue Swanson, MD says
Well, of course, I meant breast feeding may calm a nervous mother down, as well. BFing may allow her to feel she is actively soothing a baby during immunizations and decrease her anxiety, thus her baby’s. But yes, will consider a revision 🙂
I haven’t breastfed during immunizations, but I was allowed to breastfeed by the home health nurse that did the heel sticks for Emma’s jaundice care. She paused very briefly in her suck for the actual stick, and then sucked furiously for the rest of the draw, BUT not one cry. It was a wonderful tool and I would love to breastfeed during her vaccinations. What is the protocol for that? Is it up to the individual MA administering the shot? Pediatrician? Clinic? I do use a nursing cover when nursing outside of the home and would do the same in the clinic so would that help, too?
Wendy Sue Swanson, MD says
I think it varies wildly between clinics and doctors. I always defer to the medical assistant who is giving the immunizations. To provide a safe, efficient round of shots, the staff member administering shots needs to be in a comfortable spot with a place to sit or stand where they can control equipment easily to avoid errors or needle sticks. I never want an MA giving shots in an akward, uncontrolled manner. However, I’m certain we could figure out a way to position an infant in a way that is safe while nursing. If they doesn’t feel they can safely give shots with a breastfeeding infant, I defer to them. We get requests here and there to do so, and some moms have BF in my office during shots. In my heart of hearts, I feel like we should do everything we can to increase immunization rates (since I believe children without any contraindication should be immunized) so I should possibly revisit this in my clinic. I would never want a mother not to immunize because she couldn’t breastfeed during the injections. I don’t want families to feel any additional barriers.
Did you want to BF your babies during immunizations and didn’t get the chance because of the clinic?
I always breastfed immediately after shots and it seemed to calm down both of my kids fairly quickly if not instantly. Although, one MA said that they did not allow breastfeeding DURING shots or blood draws because of the chance of aspirating milk. It might not be terribly likely but it made sense to me at the time and I stuck with doing it as soon as they were done.
I have BF both before and directly after shots with good results for all my babies. For my daughter who is 7 she brings her favorite bear and then when she gets upset I grab her hand she looks me in the eye and I tell her to blow out just as they give the shot. She still tears up but it allows her to relax her arm so the shot hurts less. My niece went through a bone marrow transplant for Aplastic anemia and was a mess every time someone came near her with a needle. They had great success using the numbing cream with her.
I asked about breastfeeding at Emma’s two month vaccinations (simply because we had such a positive experience breastfeeding her through the needle sticks for her jaundice draws at home) and the response made me feel as if it wasn’t really the “done” thing. That could have just been my impression, however. I tend to be modest, even when it comes to breastfeeding, and I never want to affront others. That being said, it would not (and did not) keep me from having Emma or Will vaccinated, as I believe that it is the right thing to do. I just want to make it as easy on my kiddos as possible.
In any case, I just stuck Emma on The Boob immediately afterward, and she seemed fine. I just like to minimize the crying whenever possible. Since nursing is such a natural comfort, I do think it would be great if breastfeeding during vaccinations was supported if not encouraged at any pediatrician’s office if it’s safe and practical to do so.
Oh, and I want to add that we’ve had LOTS of success with our two year old if WE get a shot first. Last year, I got MY flu and swine flu shots before he did and this year, his dad got his pertussis shot before he got his shot. Watching his parent get a shot seemed to intrigue him and we had no tears either time. SO, if a parent is due for some sort of vaccination, it can’t hurt.
I must chime in that I think that parental anxiety (or lack thereof) does greatly affect the child. My mom was a nurse and gave me weekly allergy shots as a child and as an adult I have an autoimmune disorder that requires me to give myself shots two or three times a week. So, shots are a non-event for me and I think because of that they are a non-event for my young daughter.
I think the biggest challenge is for the needle-phobic parent. I have a couple mom friends who they themselves can barely get a shot without fainting from the fear. I wonder if it would be better in that case to have a different care-giver take the child for their shot? Having my own phobias of other things I know that you can’t just “pretend you don’t have the phobia” when presented with it. For instance, if someone insisted that every year my young daughter go to the doctor and have a tarantula sit on her for a few minutes I wouldn’t be able to feign calmness!
I wish there was a way I could pass on my calmness and my daughter’s calmness about shots to everyone! I haven’t figured out a way to do that though.
My 11 year old son has a severe needle phobia. The last time i took him to the doctor he bolted out of the exam room when he found out he was getting a needle (a new dose was added to the recommended shots that we didn’t know about). My other 2 kids got their shots that day without any problems, but his pediatrician, a very well regarded an busy doctor in our city, refused to vaccinnate him b/c it would mean restraining him. I had called and emailed various docs, home care agencies, public health, etc. and have gotten nowhere. It’s unbelievable that in a large city of over 4 million people, i can’t seem to find a clinic/agency that has experience injecting needle phobics. He is now in grade 7 and i had to refuse to consent that he received 2 important immunizations. I’m not sure what to do. I have thought of emla patch, anxiety meds, cbt, etc. He reluctantly agrees but then gets so scared that he resists. Any help, advice would be really appreciated.
Wendy Sue Swanson, MD, MBE says
Did you see the recent post I wrote about this (link below)? Although you may have already tried all this, I would recommend you see a pediatric psychiatrist to discuss options for your son.
Further, if he ever has general anesthesia for another procedure (dental work, surgery, etc), WORK HARD to make sure you get his immunizations during that time. Hopefully his pediatrician could/can help coordinate that.
Biofeedback, hypnosis and other by adolescent specialists are techniques that may help him with phobias. I agree with your son’s pediatrician — I’m so glad he didn’t hold your son down, and I believe this is the time to build trust with him in the medical system, but I certainly think helping him learn to find a way to get recommended care will really help him as he ages. And thankfully the far majority of his community is likely immunized and protecting him from vaccine-preventable illnesses…
Hope this helps!
I know I’m a little late to this party. I have 5 kids, 14, 11, 10, 5, and 2. Some of them have handled shots much better than others. My 5 year old has his kindergarten physical tomorrow, which includes shots. 4 of them to be exact. He’s already rather fearful of the doctor in general. I’ve tried being very open and honest with him about the shots and that they will hurt but won’t last long. And none of that has seemed to help. His anxiety is through the roof over it.
So I purchased an over the counter topical numbing cream and, at the advice of some friends and family, I decided to call and ask the doc if it was ok for us to use it ahead of time. I was expecting them to say yes, whatever helps. Instead, they called back and said absolutely NOT. I asked if there was a medical reason not to and they said no, but said he needs to learn that this is a fact of life and that it doesn’t hurt for long. They also said I need to just comfort him and asked if my husband could also come to the appointment, which were both already in the plans.
I completely understand what they are saying but I’m totally heartbroken that that was their answer. I’m tempted to lube him up anyway, but am afraid we’ll get turned away or “in trouble.” I’m more venting than anything, but I’m also scrambling for other ideas of what to do to make my son more comfortable with the situation. I’m so frustrated!
Wendy Sue Swanson, MD, MBE says
Maybe find a physician partner who understands why you want this, how you want to support your child’s anxiety and build trust with the system, and that shots are about prevention, not lessons in tolerance of pain? I feel strongly that you should feel you have a partner in your child’s physician.
I’m so sorry it feels like you would have to “sneak” something. You shouldn’t have to feel that way, in my opinion. Hope it all went okay. Perhaps talk with friends about how they have handled vaccinations and anxiety with their doc — or make a visit to talk directly with the doc?
Roger Middleton says
My six year old needs his shots before he starts school and I’ve been worried about how he’s going to take them. I liked that you had mentioned that it can be very important to distract a child while receiving shots and even consider having them cough while they put the needle in to distract the child fully. I think I’ll be trying some of these tricks, even the hand squeezing one to make sure that he can handle the immunizations once I can find a company to do them.
Marcus Coons says
I loved when you mentioned how you can distract your child by talking about plans after they get their immunizations so the visit goes smoothly. It is important to remember that taking the time to understand how you can help your little ones get their vaccinations can help them stay as healthy as possible. Personally, I would want to take the time to consult with the doctor that will help me with this and ask what I can do to prepare my son for his shots.
Marcus Coons says
Thank you so much for mentioning how you should not use immunizations or shots to punish your kids or make them fear them. I can understand that doing this can help you find the best way to protect the health of your kids. It is important to remember that taking the time to consult with a doctor can help you make sure your family gets their immunizations on time.
Kyle Wayne says
I thought it was interesting that you mentioned never making shots seem like a punishment for your kids. My sister is looking to get child immunizations but needs tips. I’ll be sure to talk to her about making sure shots aren’t a punishment.
Dino Violante says
Thank you for mentioning that instead of promising the kids that they won’t receive shots, it is better if we just promise a reward after the event. My brother’s idea was right when I told him that I need to take the kids for an interventional injection. You were right that it isn’t a good idea to make promises I can’t keep. That is why I will just secure a bar of chocolate for them as a way to convince the little ones. Thanks!
Vikram Swami says
Getting shots can be tough on you and your child, but the benefits are worth the effort. Fortunately, you can do a few things to make the experience less painful and stressful. These are :
– Swaddling immediately after the shot. You also can swaddle before the shot, but
leave your baby’s legs exposed for the vaccination.
– Placing her on her side or stomach
– Making shushing sounds in her ear
– Swinging her in your arms or an infant swing
– Giving her the opportunity to suck.