I cannot remember a time when I was not terrified of needles. And to my great dismay, it seems I’ve passed this phobia onto my daughter. The implications are extremely troubling for all of us.
Logically, I know how crucial needles are to proper healthcare. They transport immunizations, pain relief, and life-saving medications. They are essential components of diagnosis, treatment, and repair. But despite having all this practical information, there is an irrational part of my mind that remains completely terrified of any procedure involving a puncture. The sound of the elastic tourniquet, the crunch of a new paper sheet, smell of an alcohol swab, and slow search for a vein is more than enough to make the world go dim and the floor rise to meet me.
I try to use cheerful self-talk to remind myself of how much time I will have left over for errands if I don't have to lie clammy and half-conscious in a recovery room for 20 minutes. But it never works. My tendency towards fainting has become so expected that when I passed out cold after receiving an epidural, my loving spouse was quoted as stating calmly, “And, there she goes…”
Unfortunately, it appears that my eldest daughter may have inherited this fear. She once screamed so loudly prior to receiving a routine shot that the gastroenterologist next door walked over to offer medical assistance. She tried to make a run for it seven hours into a line-up for the once-limited H1N1 vaccine. Choosing to restrain my writhing toddler and hissing “Just stick her!” to the clinic nurse likely didn't improve matters.
Strangely, my son – who had open-heart surgery last summer and which required umpteen needle procedures – is the least afraid. He is even comfortable watching his injections and own blood being drawn.
I have been meaning to educate myself on “needle phobia” in order to make needles less traumatic for my entire family. Thanks to It Doesn't Have to Hurt, an initiative led by the Centre for Pediatric Pain Research to get research evidence about children’s pain directly into the hands of parents who can use it, I received the opportunity to have a lengthy chat with Dr. Meghan McMurtry. She is a Clinical and Health Psychologist, expert on needle phobia, and member of the It Doesn’t Have to Hurt research team.
It turns out that a fear of needles is extremely common. Children have long reported that receiving a needle is one of their most feared and painful experiences – over 90% of pre-school age children and 50% of primary school age children experience severe distress.
The onset is thought to occur in early to middle childhood (five to 10 years-old); younger children are thought to be more at risk of experiencing distress and pain than older individuals undergoing the same procedure. Interestingly, needle phobia is more common in girls, and temperament likely plays a role as well.
Luckily, pain researchers have identified many simple ways to help reduce the fear and sting of getting a needle:
1. Implement proper pain reduction procedures starting at babyhood. Breastfeed babies during injections.
2. Be honest with your kids, and don't surprise them with an injection at the last minute. Walk them through what is ahead and let them know that it might pinch for a second.
3. Let the nurse or doctor know about existing fears in advance. Ask if needle aspiration (the process of pulling back the plunger to check for blood) is necessary, as it might cause extra pain and make the injection last longer. If multiple injections are necessary, ask to have the most painful one given last.
4. Distraction is very helpful. My eldest at thirteen is now able to handle injections at school, and she claims that it really helps when the nurse talks to her about other things while giving a shot. It could also be helpful that I am no longer standing above her with skin the colour of mushroom soup and wild eyes offering “reassurance.” Blowing bubbles or watching a show are other examples of ways to distract a fearful child.
5. Topical treatments to numb the area, such as a patch or cream, can help to reduce the pain of a needle procedure. My son reported really liking a freezing spray used at the Children’s Hospital of Eastern Ontario prior to blood work. These topical treatments are available for purchase over-the-counter at a pharmacy, so you can buy and apply the product before your appointment.
6. It is not always a good idea to have other siblings in the room during appointments involving needles.
7. If fainting is not a worry, have kids sit up for needle procedures. Lying flat can create a feeling of greater vulnerability, especially for tiny children experiencing a giant person looming above. Restraining your child might work once, but it is guaranteed to cause more trouble the next time.
8. Take the time to work on your own needle-related fears. According to the experts, kids look to their parents to determine whether they should be afraid.
9. Pain management techniques will not work on their own if a true phobia exists. Phobias should be targeted with exposure-based therapy (which falls under cognitive behavior therapy) by specially trained mental health professionals such as psychologists. It can be very effective for adults and kids over seven even after as little as one treatment. After the severe fear is managed, then pain management techniques can be used for future procedures.
10. Patients like myself who experience a vasovagal response to needles (dizziness, clamminess, seeing spots) may benefit from a physical technique called muscle tension. Squeezing a rubber ball or other hard object when feeling faint would be one example of how to use this technique.
It is extremely important to prevent and manage needle pain and fear at an early age since repeated negative experiences can make needles even more distressful. Severe fear can prevent individuals from receiving necessary treatments needed to keep all of us safer and healthier.
Preparing our children and ourselves to receive needles will undoubtedly help the entire health care system to be more efficient and effective!
This is proudly sponsored by our friends at the Centre for Pediatric Pain Research.
www.itdoesnthavetohurt.ca
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