Tuesday, September 13, 2016

Vaccines don't have to hurt as much as some fear

Many kids are scared of shots. Some even fight parents and nurses when it's time to get shots. The more they fight and worry, the worse it gets. But it doesn't have to be that way.

vaccines, fear



In general there are some things that increase anxiety about shots or just make them seem bad. Lying about shots or threatening them as a punishment are never a healthy approach to the situation.
  • Never tell kids they won't get a shot at the doctor's office. They might be due for one (or more) and if they were specifically told they won't get one, they are usually more upset.
  • Do not threaten kids with shots if they misbehave. This makes kids see shots as a negative.
  • Siblings can increase anxiety with their teasing. Don't share the need for shots with siblings and if it's possible to leave siblings at home when one child will need shots, that might work best. 
  • Some kids worry more because parents are worried or presume the child will be worried. When the parent starts talking about shots in a worrisome manner it feeds into the fear. Try to be factual. Don't start telling them it's okay and not to worry. That tells them there's something to worry about.
Oh, no!

Some kids do best if they don't know shots are coming. If they ask if they'll get shots at an upcoming visit, you can say you don't know. If you think your child will lose sleep for days worrying about the shots, this is often the best way to handle it. Then the doctor and nurse at the office can deliver the news and it isn't your fault.
Just kidding. It's not bad getting my flu shot!

Some kids do better with advance warning. If you want to prepare your kids before bringing them in for shots or if you just need some help when you're at the office, follow these tips:

  • Do not tell kids it won't hurt. Shots can hurt. Lying doesn't help. It just minimizes their fear and makes things worse. It might hurt, but how much is variable. Pain is a very individualized feeling. You can describe it as a pinch. 
  • I often ask kids if they've ever gotten hurt playing outside. They usually say yes. Then I ask if they still wanted to play outside again. They usually say yes. I might sound surprised that even though they know that they can get hurt, they still want to play, but then I "realize" that it was because the benefit (playing) outweighs the risk (getting hurt). Then we talk about the benefits of the shot are so much more than the quick poke and a little pinch feeling. This works really well for the middle school shots because they're old enough to get the connection.
  • Don't pre-treat with an oral pain reliever. Studies have shown that acetaminophen and ibuprofen decrease the immune response, which might make the vaccines less effective.
  • Don't tell kids to not cry. It's okay to be scared and to feel pain. Let them know what is and is not okay. If they cry it's okay. It is not okay to kick, hit, run, or do anything that can harm others or themselves.
  • Educate kids about how vaccines help us. There are many resources available. When they understand why the shots are good for them, it helps them to accept them.
  • Practice what happens when we get shots. Have them practice sitting still and making their arms loose. Wipe the arm with a tissue as you explain the person giving the shot will clean the area with a very cold wet tissue to clean the area. (I avoid the term alcohol swab because the term alcohol confuses younger kids who learn about drug prevention in school.) Pinch the arm to show them there will be a small pinching feeling. Put a bandaid on the area if they like or just explain that they can get a bandaid when it's over. (If your child hates bandaids, tell the person giving shots that they prefer to not have them.) Let them practice giving you a "shot" too. 
  • Let kids know that the poke will be fast and they can move their arms up and down afterwards to make the sting go away. 
  • Bring a comfort item from home, such as a stuffed animal or blankie.
  • There is evidence that blowing out or coughing during the injection helps decrease the pain. We often recommend this for kids old enough to blow or cough. Sometimes we'll entice preschoolers with bubbles or pinwheels. It really helps!
  • Other forms of distraction can help too. Telling stories, reading books, or watching a video on a smart phone or tablet are great distractions. 
  • Studies have shown that allowing kids to sit (rather than force laying down) during shots is perceived as less painful. The less restraining the child needs, the better. It makes sense that if they need to be held down they will be more scared and it will be perceived as more painful.
  • Ask the person giving the vaccines to save the most painful vaccine for last, if applicable. (Our nurses do this routinely.)
  • Our office sometimes uses Buzzy when kids are especially afraid of shot pain. As long as the child isn't overly worked up and they aren't opposed to the coldness of the ice, Buzzy works fantastically! If kids have worked themselves into a frenzy it isn't sufficient to distract in this way.  
  • I used to think bribery was not a good parenting technique... until I had kids. It can be very effective. If you can promise a reward for being brave, such as stopping for a smoothie or getting a favorite treat, that can work wonders. 

Help with anxieties in general (great for life worries, not just shots!):

  • After kids do things that they were afraid of, congratulate them for the attempt. Remind them that even though they were scared they did it. This helps set the pattern that they can be brave when faced with any fear. They can even keep a list of things that they did despite being scared to try. They can use the list whenever a new fear pops up to see how many things they've already done and how brave they really are. I've started recommending that parents take a video of kids to show their future self if they can say it didn't hurt as much as they worried it would. They tend to remember the anxious phase of excessive worry, but forget that it wasn't that bad. Show the video the next time shots are due. Their own self stating it wasn't bad can be reassuring!
  • Use a meditation app, such as Stop, Breathe & Think. It's free and helps with general anxieties as well as mindfulness. Download it and use it at home several times to let them get comfortable using it. 
  • Some great articles: 


Resources

Reducing the pain of childhood vaccination: an evidence-based clinical practice guideline

Vaccines are a pain: What to do about it (This includes a link to this parent tip sheet.)

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