As parents, you will likely agree that taking your kids for their vaccinations can be a very stressful experience. For me, despite my stress, my guys did okay but the anticipation of shrieking cries made me sweat with fear! I own a medical clinic and have seen many babies and toddlers do just fine through their vaccinations—I had to learn how to stop psyching myself out.
Thankfully, there are several things now being done to help reduce immunization pain and make the experience more tolerable. Vaccinations are critical for child health, so properly managing pain and calming the fear and avoidance of needles is very important. The Centre for Pediatric Pain Research and the Canadian Institutes of Health Research are making sure we have evidence-based information to know how to reduce our kid's pain during immunizations.
An independent, cross-Canada team, called “Help Eliminate Pain in Kids & Adults” (HelpinKids&Adults)," led by Dr. Anna Taddio, has created guidelines for doctors and nurses on how to reduce pain during vaccinations. An updated and expanded Clinical Practice Guideline (CPG) on reducing pain during vaccinations was published this summer in the Canadian Medical Association Journal and many of these recommendations were recently also adopted by the World Health Organization.
It is important for parents to know these guidelines so they can better support their children through the vaccination appointment. The HelpinKids&Adults team put their recommendations into an easy-to-remember format for parents and healthcare professionals:The Five P’s.
1. Procedural
Here is the low-down on how doctors and nurses will make help your child experience less fear and pain:
Doctors will stop “aspirating” the needle: that means they won’t put the needle into the skin, then draw the plunger back out a bit. This recommendation will lessen the time the needle needs to be in the body.
Doctors will inject the most painful needle last. For example, when your one-year-old gets their shots, the MMR (measles/ mumps/ rubella) one should go last.
If there are more than one shot to be given at once for a baby under the age of one, they will be done at the same time. Likely a nurse and a doctor would give a needle in each leg at the same time. However, children between one and ten-years-old will get their needles one after the other.
It is recommended that vaccine practitioners give needles in the leg rather than the arm when babies are between 0-11 months of age.
2. Physical
Parents should follow these guidelines before and during their child's immunizations to make things go smooth:
This one is for breast-feeding moms: feed your baby before, during, and after the needle. I did this with my boys and it really did help. If you aren’t going to be there or can’t feed before and while the injection is happening, feed just before the shots.
Hold your child upright rather than have them lying down during and after the vaccine. I call this the “hug hold” – I hugged my upright children, singing into their ear while the doctors and nurses quickly did their thing. I like this position because the child doesn’t see the needle coming towards him/ her, you can sooth with kisses/ rocking, and you can get a firm hold on a potentially squirmy little one without actually restraining them.
If your child likes to suck on his or her finger or a pacifier, or your thumb (but not food), offer that during and after the vaccination.
3. Pharmacological
If you aren't sure about some of these suggestions, talk with your doctor or nurse in advance of the immunizations.
Topical anesthetics should be applied before injections (EMLA cream, for example).
If you are breastfeeding, it is recommended to both feed and use a topical anesthetic.
Do not give your child acetaminophen (Tylenol) or Ibuprofen (Advil) before your vaccination appointment.
Try giving your child two and under a sucrose (1 teaspoon of sugar with 2 teaspoons of water) or glucose (sugar) solution right before their vaccination. You’d need to prepare this and bring it with you, as most medical offices don’t have this on hand. The recommendation was for 2 mL of a “saturated” sugar in water solution.
Use a sugar solution and finger/ thumb/ pacifier sucking together but NOT sugar solution and breastfeeding together.
Do not use a vapocoolant spray just before the vaccination.
4. Psychological
A bad experience with an immunization can cause fear for future vaccinations. Here are some things you can do in advance and during the appointment:
If your little one doesn’t remember his or her last vaccination experience, warn your little one that (s)he is about to get a vaccination. Try saying something like this: (smile) “It is time to visit our doctor. (S)he is going to give us some medicine—it’s called a ‘vaccination’—that will help us to be really strong.”
“The use of language that is falsely reassuring or dishonest is not beneficial and may harm by decreasing trust.” Please don’t tell your young child that “this won’t hurt at all.”
The authors also recommended against using “repeated reassurance.” I found the best thing was to book an appointment time where I knew there wouldn’t be only a short or no wait in the waiting room. I’d distract my child with fun music in the car ride, nice books to read in the waiting area, and speak very little about the appointment ahead of time.
This is one of the only times it would be okay to distract your child who is three years of age and under with a mobile device. Use your smartphone, if needed, to keep your child’s attention away from getting themselves worked up before or during the vaccination. The authors words are, “we suggest directed video distraction.”
For older children (over age three), use verbal distraction, because they likely remember their last vaccination experience. Our nurse asks the children to count as loud as they can.
Music distraction is great, too! We’d rather hear a child and parenting singing loudly than a loudly screaming one. Also, you could offer headphones to the child to listen to music of their choice.
Breathing with a toy is a great way to distract a child over three-years-old! Bring some bubbles or a pinwheel to your vaccination appointment.
Have you seen this video? This doctor is AMAZING at administering vaccinations.
5. Process-Education
This point refers to educating parents, older children and adults about what to expect with a vaccination: how it might feel and what they can do to manage any pain.
The authors of the guidelines also recommend that school vaccinations campaigns can focus on how to make this program a more positive health care experience for children.
The 5 P's listed above are recommend to educate parents, older children and adults about what to expect with a vaccination, how it might feel and what they can do to manage any pain to help with the entire process from beginning to end. I like that this list provides many different types of suggestions so we can find ones that suit the personality of our children the best. It’s time to stock my clinic up with goofy Band-Aids, tissue, and bubbles! It doesn't have to hurt!
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