As winter approaches, many children and families are setting out for their yearly flu shot. For some youngsters, a pending shot conjures up lots of fear and dread. In line with all forms of anxiety, fear of needles has a cognitive component (e.g., thinking the worst, like “this will hurt so much!”); an emotional component (e.g., physiological reactions such as racing heart, feeling faint, dry mouth) and a behavior component (e.g., trying to avoid the appointment). Of course, avoidance only works to stave off anxiety in the short-term, and doesn’t help up to achieve the bigger goal – to get the immunization.

Below are some guidelines that parents can use to support their children prior to taking them in for any shot.

1. Increase Calm/Coping Talk to Target the Cognitive Component

Parents are naturally driven to reduce child’s worries or stress through reassurance. While this is an understandable response to youngsters experiencing anticipatory worry, telling a child that “It will be OK” or “Don’t worry” might inadvertently give them the message that there is something to worry about. Apologizing for the pain is also discouraged, as this tact might also indirectly increase the child’s fear. Indeed, reassurance does not engage or build on kid’s skills to manage the stress in a way that building their coping self-talk might.

In order to encourage coping talk, I coach parents to focus on past successes their children have experienced, e.g., “You’ve handled a pinch like this before” and “What would you say to a friend who was feeling nervous about the doctor’s office?”. I also suggest that parents use phrases to minimize children’s sense of danger, while remaining honest, e.g., “The pinch feeling will pass quickly”; and “Everyone feels a little nervous before a shot”.  Finally, I also encourage parents to replace any pain-related words with more tolerable words. For example, using the word “discomfort” rather than “pain” can help kids to feel greater sense of safety and soothing.

2. Body calming to Target the Emotional Component

Teach children that they can be “the boss” of their body’s stress system by taking calm, deep breaths when feeling panicky or worried. Active props such as bubbles, or a pinwheel, can help children to stay focused on their breathing.  Visualization of their belly as a balloon, filling with air when they take big breaths, can also help in the absence of physical props. Square breathing (find more information on this technique here) can be coached in older children by teaching them to breathe in on counts of 4, hold for 4, out for 4, pause for 4, as their eyes track a square share in the room, or your draw a square with your finger to guide the exercise. Some children like to breathe in the mantra “peace” or “calm” and breathe out “tension” to further deepen their relaxation.

3. Use Distraction and Encourage Coping to Target the Behavior Component

When children try and delay or avoid their shots, helping them to employ distraction strategies as a means of coping can be very helpful. For younger children, singing, or holding a small toy, can be sufficient distraction during the brief procedure. Whereas, older kids can utilize counting, eye-spy, or parents’ mobile phones to look at photos, listen to music, or to watch videos during the procedure. Consider incentivizing children’s coping efforts by rewarding their bravery with a small treat or special activity after the appointment.

The research literature on needle phobia estimates that approximately 10% of adults have an extreme fear, or phobia, of needles due to negative experiences with needles in the past. If your child has extreme fear regarding vaccinations, working together with a child behavior specialist or psychologist can treat this fear in childhood. Contact us for more information if you’d like to further discuss the treatment of needle phobia in children or adolescents.