Helping kids overcome a fear of shots

The CDC has authorized Pfizer's COVID-19 vaccine for children under 12. Here’s how to get them ready.

Gretchen Cureton’s nine-year-old daughter Evie has been afraid of needles for as long as either of them can remember. She has cried through every single shot since her newborn immunizations—and she’s had to be held still during doctor’s appointments and routine vaccinations since she was a toddler. But Evie’s needle anxiety rose to new levels this summer.

During a family conversation about when kids her age would be eligible for the COVID-19 vaccine, Evie burst into tears. Although she understood her mother’s explanation that the vaccine will protect her from disease, the thought of facing a needle still filled her with angst.

Cureton’s daughter is one of many kids under 12 who are nervously waiting for their COVID-19 vaccines, after the Centers for Disease Control and Prevention recently authorized the Pfizer-BioNTech shot for emergency use in their age group. Although children 12 and older have been eligible for the vaccines since May, the agency had not yet done so for the younger set until November 2. (Get the latest on vaccines for kids as well as booster shots for adults here.)

But it’s this same young age group that seems to have particularly prevalent fears and phobias of needles, with two-thirds reporting anxiety compared to about half of older children.

While these fears are common, pediatricians and child psychologists say that it’s critical to take them seriously—not just because the fear is valid for the child’s developmental stage, but because kids who don’t learn how to cope with needles become adults who avoid medical care. Fortunately, new research is shedding light on the ways that parents, caregivers, and medical practitioners can help make vaccination a little easier for everyone.

Why younger kids are particularly afraid of shots

There’s nothing particularly shocking about the fact that kids are afraid of needles. After all, says Anna Taddio, a pharmacy professor at the University of Toronto who specializes in pain management, needles are “pointy, sharp, and they hurt.”

But for most of human history, science has dismissed that pain. Up until the 1980s, the scientific consensus held that newborn babies don’t perceive pain, and doctors routinely performed surgeries on infants without anesthesia. It wasn’t until 1987 that the New England Journal of Medicine published a study showing that, in fact, infant pain is real.

In the years since, research has yielded new insights showing that younger kids are particularly afraid of pain. In 2012, Taddio surveyed children and their parents to determine the prevalence of needle fears in kids. In the survey, 68 percent of kids ages six to eight and 65 percent of kids ages nine to 12 reported a fear of needles. That number dropped to 51 percent among 13- to 17-year-olds.

That disparity is caused by several reasons, says Rebecca Pillai Riddell, a clinical psychologist at York University who researches children and pain. For one, younger children are still in the age of magical thinking.

“What enables us to believe that Santa and the Tooth Fairy are real also leads us to think that monsters are real and allows us to imprint fears,” she says, explaining that needle phobias tend to develop between ages five and 10 because by that point, kids have figured out that they get poked every time they go to a doctor’s office—but they don’t yet understand that it’s just a routine procedure that will keep them healthy and, more importantly, be over soon. “We don’t have the rational abstract reasoning that tends to happen around 12,” she says.

Studies of children’s brains have shown that their frontal lobes, which control cognitive abilities like problem solving, memory, and emotional expression, undergo significant developmental changes as they approach puberty. Pillai Riddell says this cognitive development allows older children to reason and put vaccination in perspective as just a quick prick—not total agony.

Young kids also simply don’t have as much exposure to needles and vaccinations as older children and adults. Much like checking under the bed reassures kids that no monsters are hiding there, Pillai Riddell says that children learn there’s nothing to fear about needles the more that they’re exposed to them.

But though many children may grow out of their fears as they move through adolescence and gain more experience with vaccinations, it’s not a given. A bad experience with a needle can stick with a child into adulthood—and that can have serious implications. Taddio’s 2012 survey, for example, showed that five percent of parents avoided or delayed immunization in one or more of their children due to the child’s fear of needles. Those unaddressed needle fears may also help explain some of the vaccine hesitancy we see among adults today, Taddio says.

Fortunately, she adds, “This is something we can solve.”

How to get your kid through getting a shot

Sure, kids might get used to the idea of vaccines over time, but whether their fear abates depends on whether their experiences are positive. A growing body of research shows that teaching your children certain coping techniques can set them up for a positive experience even before you step into the doctor’s office.

“Parents are probably the most powerful, preventable strategy for pain-related distress,” Pillai Riddell says.

Here’s how she and other experts recommend helping your child deal with their fear of needles.

Check yourself first. Pillai Riddell suggests that parents and caregivers first reflect on their own anxieties surrounding vaccination before they start teaching their kids how to cope. Parents shape the way their children approach new experiences—particularly young children. When kids see that their parent is anxious about getting a shot, they can be vicariously conditioned to fear it, too. Kids can actually feel their parents’ anxiety: If you’re holding your child during the shot and your heart is racing, Pillai Riddell says your kid’s heart rate is likely to elevate as well.

“It just keeps getting modeled over and over again as a scary, distress-provoking experience,” she says.

For parents with a true needle phobia, Pillai Riddell suggests seeking treatment so that you don’t pass it on to your child. Otherwise, she says, parents should assess their own anxiety before their child undergoes any kind of medical procedure. If you’re feeling nervous and your heart is racing, take deep breaths or do whatever else you need to help yourself relax.

Get them ready. Prepare kids for an immunization ahead of time. For the under-12 set, Pillai Riddell doesn’t recommend preparing a child too far in advance. Instead, she says, on the day of the appointment, talk to your child about what’s going to happen—a pinch that’ll be over by the time they count to five—and remind them of when they’ve gotten through it before. Katie Creager, a nurse practitioner with the Cleveland Clinic, says that children can even practice administering shots to their stuffed animals. (This article explains how parents can talk to kids about why we need vaccines and how they work.)

Whatever you do, Creager says, don’t lie. She has seen children whose parents have told them that they’re going out for cupcakes—only to arrive at the doctor’s office for a shot. “That never goes over well,” she says. “Most kids do a lot better if it’s not a giant surprise.”

Find out what’s really scaring them. Taddio adds that parents should ask their kids what bothers them about the prospect of getting a shot—and encourage them to ask questions in return. For a child who’s worried the needle will hit their bone or take their blood, answering those questions can be a huge source of relief.

“Empower kids to ask about what bothers them,” she says. Even if their concerns seem minor or silly, Taddio points out that they simply don’t have the life experience that adults do—and that their worries are perfectly valid for their developmental stage. “It’s for them to tell us how big a deal it is for them, and for us to help them through,” she says.

Put them in control. Both Pillai Riddell and Taddio suggest letting older kids decide what shirt to wear, what arm to get the jab in, what kind of bandage to get, or whether to go out for ice cream or cupcakes afterward. That, they say, gives them a sense of control that can make them more relaxed with the whole situation.

Parents can also prepare their kids in advance with coping strategies that they can use to help themselves through the procedure. Taddio recommends kids take deep breaths or repeat affirmations to themselves such as “I can get through this” or “This is hard but I can do it.”

“These things can relax us,” she says.

Comfort—then distract. When it comes time for the main event, encourage your children to stay calm. Comfort kids by holding their hands or letting them sit on your lap—and then distract them during the shot itself. Depending on their age, Taddio suggests packing a video game or bubbles or talking to your child about something else.

Enlist some help. Healthcare providers also have a role to play in helping a child overcome a needle fear, so parents should let them know when a child is particularly afraid. For example, Taddio says practitioners can arrange to administer shots in private if a child is nervous that others might be watching them.

They can also help out parents when it comes to comforting and distracting children. Nurses have seen it all, Creager says—and they have all kinds of strategies, from blowing out imaginary birthday candles to pretending to do magic tricks.

“We can accommodate you,” Creager says. “Pediatric nurses are so good and everybody is so happy to be able to help.”

Give them the gold. After the shot, psychologists encourage parents to use “coping-promoting” language with their kids, such as complimenting their strength or deep breathing technique. Taddio says this reinforces the experience as a positive one—whereas teasing or criticizing a child by saying, for example, that big kids don’t cry will only reinforce their negative feelings.

That said, wait a minute—literally—before saying anything. In July, Pillai Riddell and her colleagues at York University published a study of four- to five-year-olds showing that they’re in peak distress during the first minute after receiving a shot—and that encouraging statements actually increase their distress during that minute.

“It surprised us but when you think it through, it absolutely makes sense,” Pillai Riddell says. “Imagine you’re in pain and someone tries to make coping-promoting statements. You’re not ready.”

Get ready to do it again! Taddio acknowledges that, in the moment, parents won’t always be able to say the exact perfect thing at the exact right moment for their needle-phobic child. But that’s OK—they’ll have more chances to do better in the future. And ultimately, it’s about taking your child’s pain and fears seriously and thinking about it from their perspective.

“Adults might think it doesn’t matter because we know these needles aren’t going to cause physical harm,” she says. “But because it matters so much to them, it should matter to us.”

Editor’s note: This article was originally published October 25 and has been updated to include information about the Centers for Disease Control and Prevention's authorization of Pfizer's COVID-19 vaccine for children under 12.

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