Nobody enjoys a shot. But with vaccinations against COVID-19 ramping up, eventually including children in the mix, it’s time to address the fear. According to a survey published in the 2012 Vaccine scientific journal, 63 percent of kids fear needles, as do nearly 25 percent of adults.
“We often see hospitalized patients do have a fear of needles,” says Kristan Denning, Child Life Specialist at Rocky Mountain Hospital for Children. “A fear of needles is common and normal, but with preparation, education, and coping, we see children overcome this fear, making them feel more empowered and confident.”
Helping parents soothe their children when it’s time for vaccinations, the Colorado-based Meg Foundation provides resources for pain and anxiety reduction.
Founder Jody Thomas, a pain psychologist and adjunct faculty at the Stanford University School of Medicine, knows the psychological trauma parents go through watching their children suffer during medical procedures. When her daughter was being treated with needlework in the NICU, Thomas had to fight for simple interventions that she says are proven to prevent lasting medical issues related to the nervous system, such as increased risk for chronic pain, depression, and anxiety.
“I’m sitting there having to fight for a glucose pacifier or to be allowed to take her out of her isolette [enclosed crib] to hold her to my breast, this is insane,” says Thomas. “And I’m standing in a NICU with other parents who obviously care as much about their babies as I do, but they don’t know what they should be fighting for, how to fight for it, or what they should be doing. That was part of the foundation.”
Changing the pain story
The Meg Foundation, established three years ago, is Thomas’ way of making her expertise widely available. She wants parents and kids to know: pain is in your brain, and there are skills and tools available for building comfort into your doctor visits.
For example, an option to mitigate needle pain is topical anesthetic, which Thomas calls one of the most underutilized and most empirically validated interventions. The World Health Organization and several studies find topical anesthetics effective when applied 20 to 60 minutes before needle insertion. Parents can find numbing creams over the counter and apply ahead of time. This information is included in the resources at megfoundationforpain.org.
Super Meg, the foundation’s latest technology, is an interactive chatbot that guides kids through the science of pain and helps them build their personalized Comfort Plan. The superhero character sympathizes with the child’s potential anxieties about their upcoming “poke” and offers them choices: Would you like your parent/caregiver to rub your back or hold your hand? Would you like the doctor to tell you when the poke is coming, and how? Would you like to watch a video or do an imagination exercise as a distraction?
All of these options are methods to take turn down the warning signal (pain) the brain is receiving from the nervous system. Whatever the child decides goes into a plan that’s sent to their caregiver via email.
While parents might instinctively avoid talking about the appointment until they’re in the clinic’s parking lot, Thomas strongly advises against the ambush method. “We know that having an actual plan and preparing is one of the strongest tools that we can give [kids],” says Thomas.
Denning agrees: “Tell them the truth about when and where they are going and what procedure they are getting done,” she says. “Once you have arrived, talk to medical staff about the patient’s fears or concerns and make a collaborative plan to help decrease those fears.”
Putting knowledge and power in the families’ hands is key so they can make sure the kid’s needs are met in the appointment without feeling like a pushy or coddling parent, according to Thomas. “When someone comes in with scrubs or the white coat, we defer,” she says. Which is why the Meg Foundation will release a chatbot similar to SuperMeg for parents in May. This version walks caregivers through the pain management strategies and also includes “speak up scripts” they can use in the office for better collaboration with the healthcare team.
It’s not “no big deal”
“People ask me, ‘Why are you doing this? It’s just five minutes of hard in the doctor’s office,’” says Thomas. “If it were just five minutes of hard in the doctor’s office, believe me, I wouldn’t be doing this. It’s really about what happens next.”
Thomas refers to medical care avoidance that can occur after trauma experienced in that setting. She speaks from personal experience, having watched her brother-in-law die from stage four cancer after he waited six months to get blood test, evidently because of trauma that happened when he was four. “I wish I could tell you that was an unusual circumstance, but it’s not,” says Thomas.
Even parents can consciously or unconsciously make medical decisions in an attempt to avoid their child’s freak out, according to Thomas. The thought of dragging a kid out of the car or having to restrain or bribe them in a medical office may be a powerful deterrent to seeking care.
The “no big deal” response goes back into medical practice history, notes Thomas. It wasn’t until 1987 that the American Academy of Pediatrics declared it unethical to operate on newborns without anesthetics. This is because the predominant wisdom in medical offices assumed babies hadn’t yet developed the neurological capability for pain. Thomas argues proper child pain management practices, what she’s fighting for, are still catching up in part because of these past assumptions and expectations.
The journey to comfort
Using interventions for anxiety and pain management will take time and vigilance. Thomas acknowledges that even with the plans and conversations ahead of time, kids are still likely to be stressed.
When you see your child’s anxiety rise, remind them of the strategies for coping they’ve already decided on, and always point out the small victories along the way, advises Thomas. “Especially for kids who’ve had it really traumatic and bad, anything that gets us further down the line is true progress.”
Progress might be getting through the door, sitting in the waiting room, not hitting a nurse, or actually getting through the poke or whatever brought you into the doctor’s office.
“Whatever we did well, we want to build on,” says Thomas.
Find more age-specific tips for pain management, including resources for adults with needle anxiety, plus chronic pain resources and links to research at megfoundationforpain.org.
