Tame Vaccination Fear and Pain

Many parents consider their children’s fear of vaccinations a necessary evil – a short-lived, if traumatic, event for the greater good, both for their children’s health and that of the community.
 But shots actually don’t have to be painful – and that pain and the fear of it can have long-term consequences of avoiding vaccinations and other healthcare, says clinical psychologist Jody Thomas, Ph.D. The problem is of particular concern now, when large-scale vaccination will be required to end the COVID-19 pandemic. 
“One in 10 parents in North America will not vaccinate their kids, not based on an anti-vax stance but based on needle fear and anxiety. That is millions of kids who don’t get vaccinated because of something preventable,” Thomas says. “We all know adults who ‘don’t do doctors,’ and they don’t do doctors because of trauma they had as kids around needle pain. And it is utterly preventable.”
Thomas, the founder and former clinical director of the Packard Pediatric Pain Rehabilitation Center at Stanford, created the Oakland-based Meg Foundation to educate families on steps they can take to prevent needle pain themselves and advocate for their children with healthcare providers.
While the advice is particularly helpful for children with chronic medical conditions requiring procedures such as regular blood draws and IVs, it is also relevant for a surprising number of people: 63 percent of kids, half of adolescents and a quarter of adults have a fear of needles that makes it hard to get vaccinated, according to the foundation.
While COVID vaccines are not yet available for anyone under 16, vaccinating children is considered critical to reaching herd immunity. Clinical trials in children are underway and vaccines may be available for kids 12 and over by early fall, though approvals for younger children aren’t expected until next year.
And while we wait for approval of child-safe vaccine doses, there are plenty of adults who are hesitant to get vaccinated, at least in part due to needle fears. That’s why the Meg Foundation just launched HacktheVax.org, giving adults advice on many of the same strategies that work for kids to reduce needle pain and anxiety.
“We’re very likely going into a period of time where we need people routinely vaccinated,” says Thomas, an adjunct lecturer at Stanford’s School of Medicine who now lives in Denver. “This is going to become a more and more significant issue.”
While healthcare providers, and especially pediatricians, certainly don’t want to hurt their patients, the field of pediatric pain management is relatively new, Thomas says. Most doctors get very little training in it and simply rely on giving vaccinations the way it has always been done.
“The interventions we’re talking about are unbelievably uncomplicated and straightforward,” she says. “Every major pediatric association agrees on what should happen. It just doesn’t happen.”
Because medical professionals often don’t offer these interventions, Thomas says parents can and should step in to lessen their children’s needle pain and the anxiety around it. She offers the following tips:
1. Use a topical anesthetic or numbing cream in the area where the shot will be given. Available over-the-counter and by prescription, products such as Lidocaine take time to work, so often need to be applied at home beforehand but will last a while, Thomas says. Alternatively, vibration can also work to block the “pain signal” from the shot. “Pain happens in our brain. It doesn’t happen where the needle goes in,” Thomas explains. She recommends Pain Care Labs’ Buzzy, a small device that uses cold and vibration to “create a traffic jam of signals” to lessen or eliminate the sharp pain of an injection.
2. Provide comfort and touch. For babies, skin-to-skin contact with a parent or a glucose-dipped pacifier, or “sweetie,” are useful. Parents can hold a younger child on their lap during the shot, or hold the hand or rub the back of an older child.
3. Create distraction. “Hand them the phone or the iPad. Do that in the waiting room to not let that anxiety rise” and during the shot, Thomas says. “Give as much choice as you can give: ‘Do you want to read a book or watch a video? Which video do you want? Which arm or leg (do you want the shot in)?’ … So much of this feels stressful because it feels out of control. Any moment of choice is a moment where they get to have power or control.”
4. Help your child to breathe. Taking deep breaths is a well-known stress reducer, but it can be hard for children to do on their own. Breathe along with your child, or offer a pinwheel or bubbles to get them to take deep breaths, Thomas suggests.
5. Remain calm, and don’t apologize. “The number one predictor of a child’s distress is the parent’s distress,” she says. While no parent wants to see their child in discomfort, apologizing for a shot sends the wrong message. “How we frame it is incredibly important. … ‘We get (a vaccine) because it helps protect you and our family and keep everyone safe.’”
6. Plan a reward. “We’re not bribing them. We’re rewarding them for hard effort,” Thomas says. “It is amazingly helpful. In the moment you can say, ‘What flavor of ice cream do you want to get today?’ It helps with distraction. All of a sudden, we’re thinking about that and the shot is over.”
7. Prepare your child ahead of time. While it might seem that not telling your child about a shot until you arrive in the parking lot would tamp down anxiety, Thomas says that approach is likely to backfire and can create unnecessary worry about non-vaccine doctor’s visits. “It deprives them and you of the opportunity to come up with ways to cope,” she says. “It starts a little bit of the anxiety in advance, but it gives us a chance to manage the anxiety. … Action is the enemy of anxiety.”
The Meg Foundation’s website (megfoundationforpain.org) offers a “superhero chatbot” called Super Meg that walks kids through questions to prepare them for a needle appointment and give them comfort choices, then emails parents a “customized poke plan” that they can follow and share with healthcare providers. It also has a similar chatbot and other resources to help kids with COVID nasal swabs. 
“Paying attention to pain is one of our most primal instincts. We’re giving (kids) a reason and a way to ignore their most primal instincts. That’s a tall order,” Thomas says.
“This is about a lot more than a few difficult moments at the doctor’s office,” she adds. “We end up making massive life-changing and life-ending decisions because of this.”