April 1, 2024 | Miriam Calleja, LHC Staff
Needle phobia is more than just a minor concern; it’s a legitimate issue that can lead to avoidance of essential medical care, including vaccination. For parents and healthcare professionals, understanding how to alleviate this fear is pivotal to ensuring that children and adults receive necessary immunizations and other interventions that involve the poke of a needle. Industry experts can help decrease the pain and anxiety associated with vaccinations.
The Painful Truth Behind Needle Phobia
Needle phobia can strike at any age, but it often takes root in childhood. The sheer sight of a needle can trigger fear, escalating into an aversion that persists into adulthood. This dread isn’t just psychological; the anticipation of pain plays a significant role. The snowball effect distresses the individual and complicates the job of healthcare providers. The fear can be associated with the pain of the needle piercing the skin, but it can be more complex, such as associating the pain of a needle with an operation that occurred soon after.
It is estimated that around 25% of adults have a fear of needles, known as trypanophobia, with most fears developing during childhood. The implications are widespread, as needle fear has been known to lead to the postponement or outright refusal of vaccinations. This can have dire consequences on public health, herd immunity, and individual well-being.
The problem isn’t confined to immunization either. Children who require surgery such as a bone marrow transplant or heart surgery due to serious illness can become highly distressed and agitated due to their fear of needles. “This is so bad that many children and many parents decide not to continue the treatment,” says Dr. Stefan Friedrichsdorf, a specialist at the University of California San Francisco’s Stad Center for Pediatric Pain, Palliative and Integrative Medicine, speaking at the End Well conference in Los Angeles last November.
The distress experienced by those with needle phobia is not just psychological. Physical effects such as difficulty breathing, increased heart rate and blood pressure, trembling, and chest tightness have been reported. Patients have been known to faint at the sight of a needle.
Although several studies have investigated the issue, the avoidance of pain in children remains underrecognized. Of the top pain-causing procedures in hospitalized children, needle pokes remain the top quoted one, coming in at approximately 40% of pain experienced. Addressing the problem requires a compassionate, multi-faceted approach.
A Case Study in Comfort
Physicians used to be taught almost to ignore vaccination pain and see it as a necessary evil. The approach is different nowadays, and this new philosophy could be a game-changer in avoiding needle phobia. Now, pain and fear associated with needles were deemed to be significant enough barriers to vaccination in children to warrant attention.
Reducing the stress around vaccination is particularly important with neurodiverse patients who tend to have lower childhood immunization rates than their peers, leaving them vulnerable to vaccine-preventable diseases.
Friedrichsdorf spoke to NPR about what he is calling “Ouchless Jab Challenge.” He has worked with these practices at Children’s Minnesota and is now leading the rollout of new protocols for all children at UCSF Benioff Children’s Hospitals in San Francisco and Oakland. The Children’s Hospital of Philadelphia has also led similar campaigns, highlighting various methods to alleviate the anxiety and discomfort associated with shots. These approaches aim to provide a less daunting experience for both patients and caregivers.
Distraction Techniques – One of the simplest but most effective tactics is distraction. Engaging children in conversation, playing music or videos, or allowing them to play with toys during the injection can significantly defuse tension. For teenagers and adults, deep breathing or focusing on a picture or an object in the room might serve the same purpose.
Topical Anesthetics – A more direct way to minimize vaccine discomfort is by applying topical anesthetics to numb the skin before injection. Products like lidocaine creams or patches can be placed on the injection site about 30 to 60 minutes before the vaccination, reducing the pain sensation.
Cognitive Behavioral Strategies – Cognitive behavioral techniques also play a role in managing needle fears. By educating patients on what to expect using vocabulary they understand and teaching them coping strategies, healthcare providers can help transform a scary experience into a manageable one.
The Role of Technology – The advancement of technology paves the way for innovative solutions such as the Buzzy Bee device, which employs a combination of cold and vibration to confuse the body’s pain nerves, making the injection less painful. These types of solutions can be valuable tools in a healthcare provider’s repertoire.
Adapt the position – No child should be pinned down by the healthcare professional. Instead, the caregiver should hold the child in a comfortable position. Patients known to feel faint or experience a drop in blood pressure should be vaccinated lying down.
Guidance for Parents and Caregivers
Parents can prepare their children by talking to them honestly about vaccinations calmly and reassuringly. Practicing with a toy doctor’s kit can demystify the process for young children. It’s also helpful to plan a fun activity after the appointment, giving the child a positive event to look forward to.
For older children and teenagers, involving them in the discussion about their health and the importance of vaccines can make them feel more in control of the situation. Validating their feelings while offering encouragement and support can also ease apprehension.
Adaptation and Empathy
A study conducted on 194 children and their parents in 2018, after initiating the new pain-reducing protocol, showed its effectiveness compared to the same survey conducted two years earlier. Both meaurements resulted from a single-day, hospital-wide survey of children’s pain and its treatment. A higher percentage of children reported no pain (33% vs 24%), and fewer children experienced severe pain (a score of ≥ 7 out of 10) after the protocol was put into effect. While needles remained the highest reported cause of pain of the experience overall, fewer children identified needle pain as the cause of the worst pain (21% vs 30%).
Acknowledging and understanding the individual’s fear can help with decision-making. Does the patient prefer to look at the injection site to know that the needle didn’t get stuck inside the arm? Do they prefer to look away and avoid the sight of blood?
Healthcare professionals can tailor their approach based on age groups and individual needs. For instance, adolescents might appreciate a quick, matter-of-fact process, while younger children may need more time to be comforted. Maintaining a gentle, empathetic bedside manner is crucial throughout.
Overcoming the fear of needles to ensure timely vaccinations is a collaborative effort. It combines clinical interventions with psychological support from healthcare professionals and parents. By incorporating these research-backed methods, we can transform the narrative around vaccinations from fear to empowerment. Through understanding, innovation, and empathy, everyone plays a role in making the vaccination process more comfortable—and therefore more effective—for those with needle phobia.
Sources:
Free Program for Needle Anxiety. “Symptoms of Needle Phobia.” Accessed February 29, 2024. https://www.idontlikeneedles.com/symptoms-of-needle-phobia.
Taddio, Anna, Christine T. Chambers, Scott A. Halperin, Moshe Ipp, Donna Lockett, Michael J. Rieder, and Vibhuti Shah. “Inadequate Pain Management during Routine Childhood Immunizations: The Nerve of It.” Clinical Therapeutics 31 Suppl 2 (2009): S152-167. https://doi.org/10.1016/j.clinthera.2009.07.022.
Friedrichsdorf, Stefan J., Andrea Postier, Donna Eull, Christian Weidner, Laurie Foster, Michele Gilbert, and Fiona Campbell. “Pain Outcomes in a US Children’s Hospital: A Prospective Cross-Sectional Survey.” Hospital Pediatrics 5, no. 1 (January 2015): 18–26. https://doi.org/10.1542/hpeds.2014-0084.
Hamilton, J. G. “Needle Phobia: A Neglected Diagnosis.” The Journal of Family Practice 41, no. 2 (August 1995): 169–75.
Postier, A. C., Eull, D., Schulz, C., Fitzgerald, M., Symalla, B., Watson, D., Goertzen, L., & Friedrichsdorf, S. J. (2018). Pain Experience in a US Children’s Hospital: A Point Prevalence Survey Undertaken After the Implementation of a System-Wide Protocol to Eliminate or Decrease Pain Caused by Needles. Hospital Pediatrics, 8(9), 515–523. https://doi.org/10.1542/hpeds.2018-0039
