Category: Children’s Health

Overcoming Needle Fear: Strategies to Minimize Vaccination Pain

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

Student Submission: Ocular Trauma and Nonpowder Firearms

August 11, 2023 | Ayaka Fujihashi, Medical Student

 

Amidst the political climate on gun control and gun safety, there is another aspect of public safety that is often overlooked: nonpowder guns. Firearms such as BB guns, airsoft guns, and paintball guns. These guns differ from their powdered counterparts in their mechanisms. Nonpowder firearms use plastic or pellet bullets, and, instead of relying on the high pressures created from chemical reactions using powder, nonpowder guns utilize springs, compressed air, or CO2 to send their projectiles flying. Nonpowder firearms are often seen as toys, with marketing campaigns specifically targeting male children. Yet, these devices are deceptively dangerous.

Between 1990 and 2016, roughly 360,000 cases of nonpowder firearm related injuries were treated in emergency departments, which equates to about 13,500 cases annually.1 Most injuries occur in children between 6 and 12 years old, and 87% occur in boys. The majority of the injuries occur in the head and neck region, and many injuries specifically involve the eye. Of the total, 16% suffered an open injury to the eye. 3.5% were left with legal blindness—defined as visual acuity of 20/200 or less in the better eye with correction—and 11.1% were left with visual defects.2

While accidents do happen, 98% of these ocular injuries occur without eye protection and could have been prevented.1  Currently, there are no federal law regulations on the use, possession, or transfer of nonpowder firearms. Because these forms of firearms are considered a consumer product, the regulating body would be the Consumer Product Safety Commission (CPSC), but it has not adopted any specific regulations. Some states have laws limiting the possession, use, or sales to minors, but there are no laws at any government level mandating the use of eyewear protection.

The American Academy of Pediatrics and American Academy of Ophthalmology issued a joint statement recommending the use of protective eyewear for all participants in sports in which there is a risk of eye injury. Nonpowder firearms were categorized in the “high risk” category, meaning an increased risk of the eye being impacted with sufficient energy to cause injury.3

However, statements of recommendation with no actionable authority can only go so far. In order to help reduce needless injuries, legislation on the state/federal level is necessary. While these laws may be difficult to enforce, especially considering that many of these injuries occur in private homes, laws could provide a motivator for proper safety. The implementation of such a change can bring about awareness on the importance of eye protection, be the instigator of changes in social norms, and create a culture of social responsibility.

Ocular trauma is the leading cause of monocular blindness in the United States. But it doesn’t have to be. Well written legislation addressing this could be the difference between full, binocular vision or a life of permanent disability.

 

References:

  1. Lee R, Fredrick D. Pediatric eye injuries due to nonpowder guns in the United States, 2002-2012. J Am Assoc Pediatr Ophthalmol Strabismus. 2015;19(2):163-168.e1. doi:10.1016/j.jaapos.2015.01.010
  2. Jones M, Kistamgari S, Smith GA. Nonpowder Firearm Injuries to Children Treated in Emergency Departments. Pediatrics. 2019;144(6):e20192739. doi:10.1542/peds.2019-2739
  3. Protective eye wear for young athletes. A joint statement of the American Academy of Pediatrics and the American Academy of Ophthalmology. Ophthalmology. 1996;103(8):1325-1328.