How You Can Help Reduce Your Kids' Vaccination Pain

As parents, you will likely agree that taking your kids for their vaccinations can be a very stressful experience. Add in wearing masks and all the pandemic related stress we've all been living with, getting your kids vaccinated for COVID requires a lot from emotionally exhausted parents. 

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 so important. Solutions for Kids In Pain (SKIP) and Children's Healthcare Canada are making sure we have evidence-based information to know how to reduce our kids' pain during immunizations. 

An independent, cross-Canada team, called “Help Eliminate Pain in Kids & Adults” (HelpinKids&Adults)," led by Dr. Anna Taddio, created guidelines for health care workers on how to reduce pain during vaccinations. A Clinical Practice Guideline (CPG) on reducing pain during vaccinations was published in the Canadian Medical Association Journal and many of these recommendations were adopted by the World Health Organization.

These Five P’s are an easy way to remember the key takeways for parents and healthcare professionals to better support kids when getting vaccinated. By the way, these tips aren't just for the COVID vaccine, but all kid-related immunizations.

1. Procedural

Here is the low-down on how health care professionals will help your child experience less fear and pain:

• Health care professionals 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 lessens the time the needle needs to be in the body.
• Health care professionals 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 smoothly:

• 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. 
• 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 health care professional in advance of the immunizations.

• Topical anesthetics could be applied before injections (EMLA cream, for example). These creams numb the skin and are available from most pharmacies.
• 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. There is some evidence it can interfere with the efficacy of the vaccine. But it’s okay to give it to your children after the needle.
• 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 negative 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 them 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.”
• Be honest with your kids. Don’t tell your young child that “this won’t hurt at all.” It can break your kids' trust.
• The authors also recommended against using “repeated reassurance” like saying “don’t worry” and “It’ll be okay” on repeat. I found the best thing was to book an appointment time where I knew there'd be a short or no wait in the waiting room. I’d distract my child with fun music in the car ride, cute books to read in the waiting area, and speak very little about the appointment ahead of time.
• Use your smartphone to keep your child happily distracted before and during the vaccination. 
• Music distraction is great, too! We’d rather hear a child and parent 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.

5. Process-Education

Educate yourself about what to expect with a vaccination: how it might feel and what you can do to manage any pain or anxiety.

When schools run vaccinations clinics, they can integrate these tips, which will make the experience easier for everyone involved. 

Put the 5 P's Into Practice Now!

You might want to check out the the CARD (Comfort Ask Relax Distract) system [www.cardsystem.ca] which brings together everything we know about making vaccinations a more positive experience in a step-by-step process for healthcare providers and patients to follow.  Each letter category represents a different group of activities people can play to have a better vaccination experience and reduce negative stress-related reactions like pain, fear and fainting.  

Parents across Canada are part of one the biggest vaccine rollout in recent history thanks to COVID. When it's your family's time to get the COVID vaccine, remember these 5 P's. It will make the process less stressful and less painful. Vaccines can be a positive experience when you know what to do. I know these tips will help, because it doesn't have to hurt.

Photo courtesy of Monica Roddey