When your young child whimpers at the mention of the word "shot," you probably have mixed feelings. You want your son to be protected by his vaccinations; you just wish that the procedure was pain-free.
"Vaccines protect the health and well-being of children, but children don't understand that," says Deborah Wexler, MD, executive director of the Immunization Action Coalition, a national organization based in St. Paul, Minn. "It can be really hard for them to come in for their shots."
Fortunately, you can have an active role in changing your child's attitude. What a parent says and does before, during, and after the doctor's appointment can help to calm a child, reduce her fears, and ensure that she develops a healthy attitude toward seeing the pediatrician.
If you struggle with what to say or have trouble putting on a brave face, read on for expert advice.
Stay on schedule.
The American Academy of Pediatrics' immunization schedule recommends that children get the bulk of their vaccines before age 2.
"Don't delay those infant vaccines until they're over 1," Wexler says. "The older they are, the harder they are to vaccinate, because they remember the last appointment."
Your attitude and appearance is more important than you may realize, because young children take cues from their parents. If you grimace or tense up, your child may become anxious, too.
"Parental behavior during vaccinations has been shown repeatedly to be a key factor in determining the amount of pain and anxiety a child will experience," says pediatric needle pain researcher Lindsay Uman, PhD, a clinical psychologist at IWK Health Centre in Canada's Halifax, Nova Scotia.
"Interestingly, many studies show that parental reassurance (saying "It's OK' or 'Don't worry') is likely to increase a child's distress, [possibly because] it tells the child there's something to worry about," Uman says.
Have you ever fibbed and said there would be no jab at a flu shot appointment or promised that the needle prick wouldn't hurt a bit? The truth may cause some worry, but lying means that your child can't trust what you say, which sets a bad precedent.
"Saying that shots don't hurt is not a good idea, because shots do hurt, although the amount of pain varies from child to child," says Howard Bennett, MD, author of Lions Aren't Scared of Shots, a picture book to help children feel less anxious about getting vaccinated and a professor of pediatrics at George Washington University School of Medicine. "A better response is something like, 'It may hurt, but I'll be here with you, and if it does hurt, the pain will only last a little while.'"
Practicing at home helps remind Kira Storch's 3- and 5-year-old sons that shots aren't pain-free. "I say that getting a shot is like getting a pinch on the arm, then I give a light pinch and ask how it felt," says San Francisco resident Storch, whose boys don't cry at the doctor's office. "Five minutes later, I ask how their arm feels, reminding them about the pinch and saying that a shot will be the same."
Eliminate the element of surprise by teaching your child what to expect at his appointment.
"At home, parents can read books to their kids about visiting the doctor and encourage them to play doctor," Bennett says. "Sometimes kids who bring stuffed animals to appointments like giving them pretend shots before the doctor gives one to them."
Having a doctor kit on hand helps ease anxiety for the 2- and 4-year-old sons of Sara Sutton Fell of Boulder, Colo. "We play with doctor equipment at home, including a routine of what happens when we go to the doctor's," she says. "And we talk about how everyone has to get shots sometimes, even Mommy and Daddy, because even though they hurt for a quick minute, they can help make us healthier."
Call attention to something else.
When a shot is imminent, distraction may be your best ally. It's been shown to reduce pain and anxiety associated with needles, Uman's research shows.
How you distract your child should depend on her age.
"Babies and toddlers can be distracted with singing, stories, or playing with a small toy," Bennett says. "Older children respond well to watching videos or listening to stories or music. Parents can also use cell phones to show movies or photographs to their kids during painful procedures."
If one shot per doctor's visit is all that your anxious child can endure, consider the following options.
- Most children aged 2 and older can get FluMist, a safe, effective, painless nasal spray given annually that's an alternative to an annual flu shot. (One less pinch per year.)
- Some doctor's offices offer synchronized vaccinations. "If a child needs two shots at the same visit, two nurses give the shots simultaneously, which reduces the anxiety of waiting for the second shot," Bennett says. "There's no reason why parents can't ask for this, if the doctor has enough staff on hand to accommodate the technique."
- For some children, making an additional trip to the doctor for a second vaccination helps. "We only do one at a time," says Michael Owens of Falls Church, Va., whose 3-year-old daughter rarely cries from shots. "When it's necessary to schedule an extra appointment to get in a required shot, her comfort was well worth the extra $20 copay."
Dull the pain.
Numbing the skin may help to lessen pain. Try placing ice on the skin for a minute immediately beforehand, or Buzzy, a new product that uses a combination of cold and vibrations to confuse the nerves at the shot site.
"Topical creams in combination with distraction are effective for reducing pain and distress associated with needles," Uman says. "Many parents aren't aware that these creams can be purchased over the counter."
Numbing isn't right for every child: The cold from ice may hurt and with the topical treatments, the additional waiting can sometimes add to a child's anxiety, Bennett says.
Enlist your child's help.
Older kids who outgrow the tendency to cry may still worry about pain and won't remember that last year's vaccination only stung for a few seconds.
Minimize next year's worries with a brief letter-writing campaign.
"I occasionally encourage a child to go home and write himself a note," Bennett says. "It should say something like: 'Dear Timmy, This is to remind you that you were really worried about your shot today, but it surprisingly didn't hurt much. Remember this the next time you have to get a shot. Love, Timmy.'"
Many pediatricians' offices give stickers or lollipops to patients afterward. "It's a way that the doctor says, 'Thanks for being cooperative,' and, 'I'm sorry for doing something unpleasant,'" Bennett says.
You don't need to rely on the doctor for rewards; praise for being brave is often sufficient. Bringing a favorite book or snack from home, or taking your child to the playground on the way home, can also be effective.
Carly Kuper of Bala Cynwyd, Pa., always has supplies to ensure that her 2-year-old daughter stays calm. "We always bring a snack and a drink for after the shot," she says, "and if she seems really upset, we offer the pacifier, even though it's usually only for sleep."