No FluMist? Now what?
If your child is afraid of needles (and 68% now are1)), you may be aware that the CDC determined FluMist hasn’t protected against flu the last few years. What to do, what to do?
To start with, the right instinct is NOT to ditch protection. The injected vaccine reduced the incidence of flu 68%, and huge public health benefit and great for over 2/3 of those who got the vaccine. But with a kid who has demanded FluMist or negotiated for it for the past 5 years, it could be a tough conversation this year.
Fortunately, as needle phobia has kept pace with the addition of new vaccines, there is also new research on techniques to decrease the drama. A Canadian group published the updated guidelines to reduce needle anxiety at various ages last summer.2 Here are a few of the best studied suggestions:
- Be authoritative: in psychology speak, this means warm but firm. Treat the injections as not a big deal, but support your child lovingly. Research shows apologizing, syrupy empathy (“I’m sorry, I’m sorry!”) actually makes the experience worse. Go for more of a “we do this to keep us healthy, and you’re really brave” vibe.
- Hold your child in your lap during immunizations, not held down flat. Breastfeed infants.
- Show your child that paying attention to something else can make the experience more comfortable. Use visual counting and finding tasks, like “Where’s Waldo” around the room. Ideally counting wallpaper patterns with 5-8 objects (“How many fish? How many spots on the leopard?) is the right amount of time and difficulty to finish up an injection. For multiple injections, have a few backup visual finding things, a book, or DistrACTION cards with clinically proven questions on the back to reduce needle pain.
- Leave the room as soon as possible after the injections to change the scenery and distract with praise and treats.
- Using Buzzy® vibration and cold for 30 seconds for 7 year old children decreased TDaP pain 73%.3 Either bring your own Buzzy, or make sure your child gets a chance to play with the vibration and cold sensations before using. Tactile things like pokey prongs or stimulating the area with your fingers were not found effective, so were removed from the guidelines this year, while cold and vibration was added.2
For more tips at different ages, download evidence-based suggestions for different ages here: https://buzzyhelps.com/for/children
- Taddio, Ipp, Thivakaren et al. Survey of the prevalence of immunization non-compliance due to needle fears in children and adults. Vaccine. 2012 Jul 6;30(32):4807-12.
- Taddio, McMurtry, et al. Reducing pain during vaccine injections: clinical practice guideline. CMAJ. 2015 Sep 22;187(13):975-82.
- Sahiner, Inal, Akbay. J Perianesth Nurs. 2015 Jun;30(3):228-35. The effect of combined stimulation of external cold and vibration during immunization on pain and anxiety levels in children.
Amy Baxter MD is a pediatric emergency physician and inventor of Buzzy Pain Relief. She lectures nationally and internationally on needle phobia, pain management, sedation, and child abuse.