Parental Comfort Helps Children Cope With Shots

From the WebMD Archives

July 25, 2000 (Atlanta) -- It's true that a little sugar can make the medicine go down, and so can parents' cooing, cuddling, and other efforts to soothe a child who is getting an immunization shot, a new study has found.

Researchers at the University of Michigan wanted to find out whether parents' behavioral interventions could ease children's fears and make the immunization experience more pleasant for everyone, including others in the waiting room.

"As in other studies, we found parental involvement before the procedure begins appears to be of importance in relaxing the child," researcher Barbara T. Felt, MD, tells WebMD. The study is unusual, she says, in that it also assessed parents' responses to their child's immunization. Felt is an assistant professor in the department of pediatrics and communicable diseases and an assistant research scientist at the Center for Human Growth and Development at the University of Michigan.

The study, which was published in the Archives of Pediatrics and Adolescent Medicine, involved approximately 100 babies, 2 to 24 months old, and their parents who visited an urban pediatric office during the summers of 1997 and 1998. A little more than half of the parents were given suggestions for comforting their children, including using pacifiers, holding the children in their laps, and giving them verbal reassurances.

The immunizations were then videotaped to allow the researchers to observe the infants' and parents' behavior. Using a visual scale, parents were asked to rate their babies' comfort -- as well as their own -- at three points during the visit. Saliva samples were also collected from the infants and parents at different points in the process to check for concentrations of cortisol, a substance in the body that increases under stress.

While the parents who were given instructions on comforting the children did not indicate afterward that they felt any different than the other parents about the experience, their cortisol levels after the immunizations suggested they had less stress. "We suggest this might be due to a continued sense of active engagement in the visit for their child," Felt writes.

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Cortisol levels were also lower in the infants whose parents had received the instructions. After getting the shots, these infants got over being upset more quickly than the other babies, and their parents rated them as more comfortable.

Having a parent or other loved one present may be the best psychological treatment when a child is anticipating a painful event, says Patrick John McGrath, MD. "Children feel more secure with their parents there," says McGrath, who is with the psychology department at Dalhousie University in Halifax, Nova Scotia, and has written journal articles on helping children and parents cope with pain.

The Michigan researchers found that the parents who had received instructions were more likely to use comforting techniques and made positive or neutral comments before immunization, resulting in less distress for their infants. The researchers did not tell parents to use any single method, Felt says, but instead provided a list of suggestions and observed the parents' choices on videotape later. "Perhaps that allowed parents to individualize their intervention -- to use what they know about what might aid their children at the procedure," Felt says.

Overall, humorous comments and other statements not related to the immunization helped children cope, even those as young as 6 months. But comments that sounded like reassurance, as well as bargaining and explanations, seemed to increase distress. "One parent said, 'I know this is going to hurt.' That didn't help the child at all," Felt says.

Although many of the children in this study were very young, McGrath says he believes honesty is the best policy for those who are old enough to understand what's really going on. "Children need simple, accurate information about what is going to happen," he says. "Lies and threats teach children to distrust and be fearful."

McGrath says parents should tell the child what will happen and what it will feel like. "Explain things slowly, in small bits, and repeat as often as needed. Dolls, puppets, or drawings can be used to explain procedures. Children can also express how they feel using these methods."

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Another thing the Michigan researchers learned was that when a child was already crying, a behavioral intervention usually just brought more agitation. As a result, Felt says, she believes an infant's behavioral state may play a role in the effectiveness of methods to reduce distress.

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