Reducing Pain during Childhood Immunization
I was invited to participate in a workshop yesterday in Toronto. I was sitting beside a woman who I will call Anna. She was there to tell the group her story:
When Anna was a child, she had a rare condition which took years to diagnose. Through the process of diagnosis, she had many needles. She remembers being physically restrained for the shots and tests. Eventually her condition was diagnosed and she was able to go on with her life. Around the age of 16, when she could refuse, she stopped having any sort of medical intervention which required a needle, no immunizations, no blood tests, no IVs. Even if she was sick, she would suffer through it.
At the age of 31, in an ironic twist of fate, Anna discovered that to have children she would have to undergo in vitro fertilization which would need daily injections, as well as a battery of blood tests. Anna wanted to have children more than she feared needles. At the first blood test, she fell on the floor in a panic and the hospital’s crisis team was called in. She was restrained and they took her blood (with her consent).
There is a happy ending. Anna has two fully immunized children, ages 8 and 6, and now she goes first at influenza shot time.
So, here are a few questions for you to ponder:
Did you know that there are about 1 billion injections given to children annually worldwide (CDC, 2001)?
Did you know that the most commonly asked question by children in a doctor’s office is “Am I getting a needle today?”
Did you know that health professionals and parents, to this point, have done very little to manage the pain of children getting immunized? (Taddio et al., Pediatrics 2007)
We’ve always considered pain a necessary evil in childhood immunization. We say “it will just hurt for a minute”.
But what if it doesn’t have to hurt, or at least not as much?
Research has shown that rubbing the arm or leg before injection, holding a child, injecting really quickly (without aspirating), using the less painful brand of a vaccine, and doing the shot that hurts least first, work to reduce pain(Taddio et al, 2009).
Research has shown that topical anesthetics (Emla patches), feeding sweetened water a couple of minutes beforehand, and breastfeeding during the immunization, work (Shah et al, 2009).
Research has shown that breathing exercises (in kids that could be blowing a windmill or blowing bubbles), distraction by the nurse or parent(same methods as previous suggestion), child-led distraction (video on an iPod or video game) work (Chambers et al. 2009).
At the workshop, we got to see videos of infants and children who had their shots with and without using these techniques. The results were striking (and hard to watch for a parent).
So why do all immunizers not use these techniques? There could be less pain, less fear, more satisfaction and perhaps even more willingness to stay on schedule with vaccines.
One energetic young family practice nurse told us about how she has implemented these strategies in her clinic and the great success she is having. Her enthusiasm was infectious.
The group who hosted the workshop are about to publish what is known as an Evidence-based Clinical Practice Guideline so that immunizers will have this information and will hopefully be able to incorporate it into their busy practices. But in the meantime, we, as parents, can take this info to our doctor’s and public health nurses, and use some of the strategies ourselves.
The next time my boys are due for vaccines, I will:
1) Bring juice for them to drink a couple of minutes before (this would be sugar in water for babies).
2) Bring bubbles.
3) Buy Emla patches at my local pharmacy and apply them 45 minutes before their appointment.
4) Bring Derek’s iPhone cause the kids love playing with it.
5) Hold them during the shot (I usually do this anyway).
6) Ask the nurse to do it quickly and ask her not to aspirate first (if she does; I kinda remember that she doesn’t but I just want to be sure).
7) If they are having multiple injections, I’ll make sure she uses the more painless one first (I’m pretty sure she already does this).
8) Distract them with discussion about something unrelated to the moment.
9) Rub the injection site for a couple of seconds before the shot.
A couple of interesting points about techniques that DO NOT work to reduce pain:
1) Analgesics prior to immunization (Tylenol or ibuprofen).
2) Reassurance from the parent. It does not help to tell your child it will be over or they’ll be okay. Apparently research has shown that this makes them more anxious. I am definitely guilty of this.
These techniques also work for blood tests and IVs.
Do you have any other great tricks that work to distract your kids or reduce their pain during immunization, blood tests or other injections?