Taking the sting out of vaccines
No child looks forward to a vaccine, but for some the prospect of facing down the needle is more terrifying than others. While this understandably worries parents, their anxious reaction to their child’s fear can sometimes make it worse.
A new study that has come out of the O.U.C.H. Lab (Opportunities to Understand Childhood Hurt) at York University links parent behavior to children’s fear of needles. Parents who acted fearful or anxious before vaccinations transferred that fear to their children.
Pediatrician Emily O’Connell, MD, of Falmouth Pediatric Associates has had plenty of first-hand experience with this phenomenon.
In light of the O.U.C.H. study, which found parents’ response to their child’s fears have implications when they are preschoolers, Dr. O’ Connell said she tells parents that’s it’s best to remain calm even when the child is very young.
“Honestly, the children of parents who are the calmest and the firmest have the easiest time,” she said. “The parents need to give the message that there is no negotiating.”
Dr. O’Connell said the nurses who give shots at her office are excellent at assuaging children’s fears and have several different strategies to help. The strategies are different depending on the age of the child.
Babies get vaccines at 2, 4 and 6 months and are thought to be too young to be frightened.
Older children are much trickier. Some kids come into the office asking repeatedly if they are going to get a shot. For those children, the best strategy is to get the vaccines out of the way first thing so the child can relax for the rest of the visit, she said.
“We’ll do them right away and we always ask, ‘Was the thinking about it worse or the doing it worse?’” she said. “Uniformly, the thinking about it was worse.”
For this age group, Dr. O’Connell uses the word “vaccine” or “immunization” instead of the word shot because the more time a child has to think about it, the worse it’s going to be.
“Emotional anxiety actually makes things hurt more,” she said.
There Are Many Strategies
Another strategy is to spin vaccines as something positive and fun. Nurses at Falmouth Pediatrics tell 5-year-olds who need three vaccines in one visit that each one imparts different strengths, like making them jump higher or run faster. The kids also get a prize afterwards.
“Instead of saying, ‘Don’t be scared,’ or even offering that as an option, we say, ‘Guess what we’re going to do today?’” said Dr. O’Connell.
Children also need vaccines at the ages of 11 and 15. For those ages, Falmouth Pediatrics offers different strategies.
“We have one nurse who is really good at doing some calm meditation before vaccines,” Dr. O’Connell said. “She has special magic rocks that make a soothing noise so she can work on some relaxation techniques. We often will talk to parents about having kids do visualization or do deep breathing to help them because the emotional anxiety will often lead to a physical response which then exasperates the emotional anxiety.
“Most kids have normal anxiety, and that’s usually pretty easy to talk through. But then there are actually people who have a true phobia and that is a psychiatric diagnosis just like any other phobia or specific anxiety. Those are a much harder group of kids to help.”
In the most extreme cases, she refers patients to the Cape & Islands Cognitive Behavior Institute in Falmouth to work with a counselor there doing Exposure and Response Prevention, which is a type of Cognitive Behavior Therapy. With ERP therapy, the child slowly builds up his or her level of exposure while using relaxation techniques like deep breathing.
An example of this therapy would be that the child would think about getting a shot on the first visit. Then on subsequent visits, the child would progress to looking at a needle, watching a video of someone getting a vaccine and finally watching a friend get a vaccine.
“I had a child do it very successfully recently,” Dr. O’Connell said. “She was a little behind in the timing, but she did fine and got the vaccines she needed.”
Children today get a lot more vaccines than they have in years past. The Centers for Disease Control and Prevention recommends that children get 69 doses of 16 different vaccines between birth and the age of 18. That number includes yearly flu shots. Dr. O’Connell views this as a positive turn of events.
“We now have more vaccine-preventable diseases, so yes, it makes more shots, but in our eyes it’s such a good thing,” she said. “It’s a sign of scientific advancement where we are learning to prevent this multitude of illnesses.”