Afraid of Shots? – Colin Blenis, RN, FAWM

Jake’s mom and I joked about her son’s future fear of noodles (zymarikaphobia is a mouthful), but the fear and pain children experience is a real problem needing serious solutions. Historically, no one cared much about the pain and fear children experience. Experts once believed young children do not experience or remember pain. Yet, views have evolved with studies showing traumatic experiences in early childhood have long-lasting physical and psychological health consequences.

Consider how repeated experiences of fear and pain in a healthcare setting may deter a person from seeking care later in life. Associative learning is powerful, difficult to unlearn, and often occurs without a person’s awareness. I, for one, remember being held down by a team of doctors and nurses to receive routine vaccinations at the pediatrician. Even now, as a nurse, I would be lying if I didn’t admit to mild anxiety when faced with routine physical exams. Setting aside the long-term consequences of painful medical procedures, I am sure we agree that parents and clinicians prefer for children not to be afraid of safe medical procedures: less time, less energy, and less stress for all involved.

1. Stay Calm

Pain is a physiologic process profoundly affected by psychosocial context: the same stimulus viewed as painful in one context may be ignored in another. Consider the wise parental wisdom stating that when a child falls, it’s best to let the child’s reaction determine your response. The child is likely to look to you to see how they should react: if you cry, they will cry; If you laugh, they will laugh. This wisdom is consistent with research showing that when a child receives an injection, the parent’s physiologic response predicts the child’s perception of pain.

Stay calm. Even if you need to pretend. Photo by Ksenia Makagonova on Unsplash

2. Use Your Imagination

Medical and nursing scientists are working to create better ways of preventing and managing children’s pain. For example, Dr. Amy Baxter, a pediatric emergency physician and pain researcher, developed a product called Buzzy. Buzzy is essentially a vibrating icepack disguised as a bumblebee. The idea is that buzzy will land on your child’s arm or leg and the combination of cold and vibration inhibits the nerve pathways that transmit pain. Introducing Buzzy through imaginative play, parents, and clinicians can help reduce the fear of receiving an injection. Buzzy and other similar devices were recently tested through a randomized control trial presented in the Journal of Emergency Nursing. Engaging children in imaginative play and inhibiting pain pathways with Buzzy reduced fear and pain associated with injection in children.

Clearly, children are not the only ones who benefit from a little distraction and imagination. Why not have these available in adult health settings?

3. Get Distracted

This strategy is one that most parents and clinicians use intuitively. Distracting kids is an effective way to reduce pain. By focusing on something other than the procedure, kids are likely to experience and remember less pain. One study compared distraction methods: some kids blew up balloons before and during a painful procedure, some kids listened to music, some looked at cards. Overall, the three ways were equally effective and better than no distraction. Although the balloon method was just as effective as other distraction methods, I suspect it has other benefits the study did not measure. Blowing up balloons could double as a deep breathing exercise, increasing vagus nerve stimulation, and promoting relaxation.

4. Stay positive but be honest.

“Will it hurt?” Adults and kids often ask me this question. It does no one any favors to lie. While proper technique and other strategies in this article can help reduce pain, there is no way to eliminate the pain of injections completely. Parents and clinicians should never lie to the patient and tell them it won’t hurt. Instead, be honest and emphasize the positive. It will hurt, not for very long, and it will help us make you feel better.

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