Community Health Project Intern
Department of Preventive Medicine
University of Kansas School of Medicine
Jon Rolf, Ph.D.
Extension Community Health
Kansas State University
Community Mental Health
Kansas State University
Imagine taking your child to the doctor for a regular checkup. As the exam ends, the office nurse says that your child also needs an immunization.
An immunization shot does not need to be stressful for children. Many parents provide their children with information and support in order to make the immunizations as easy as possible. However, for some parents and children, needles become scary and immunizations are expected to hurt. Children can easily tell if their parents are afraid of needles and injections. When parents are anxious, children are likely to become anxious. If the parent acts extremely worried about the child's behavior during the immunization, then the child is also more likely to become upset. Parents can help decrease anxiety about immunizations in a number of ways.
The schedule for infant immunizations begins at a very early age (at birth for the first Hepatitis B vaccination). With preparation and support, children won't become anxious or afraid of the place where they receive immunizations.
One of the most important preparations is for the parent to remain calm and confident. If you find yourself becoming nervous, try anxiety-relieving techniques such as breathing and muscle relaxation to help you relax. Also, consider letting another calm mannered adult, such as a grandparent, go with the child.
Bring along a stuffed toy or blanket for your child to hold during the immunization, or use them yourself as a tool for distraction. Hold your child gently during the procedure, talking calmly and firmly stroking the child's arm or back.
After being pricked by the needle, your child will cry for a brief time. It is his or her way of coping. Your job is to comfort, hold, and talk supportively. Lastly, if the child is still upset after the injection, don't immediately leave the health department or doctor's office. The child will learn that this was a bad place that can be escaped by crying. It's important for the parent to let the child calm down before leaving. This will help the child remember health care providers in a positive way and see their office as a nice place.
Continue Through Early Childhood
The majority of immunizations are to be given to children aged 15 months and under. Another set of injections is to be given when they are 4-6 years old. As children become older, they are able to anticipate certain situations (such as immunizations). To help reduce your child's anxiety, consider the following suggestions:
- Tell your child why immunizations are necessary. Explain that they keep us from getting sick and that most immunizations only work if the “medicine” is put in the body through needles.
- Be honest about what the child may feel when getting an immunization. Never tell them that it won't hurt at all. Explain that the slight pain only lasts for a short while.
- Teach your child that health care providers are friendly people. Their jobs are to keep kids healthy and well.
- Explain to the child that you (or someone they trust) will be with them during the immunization.
Preparing for Immunization Day
Educate yourself about immunizations so that you can answer any questions your child may have. Giving too much information can cause misunderstandings and anxiety. Balance what your child wants to know with the child's ability to understand. When immunization appointments are near, recall your child's reactions to the last immunization. Was the child calm and able to cope well? Was it a stressful event for either of you? You are the best judge of how much preparation your child needs to deal with this potentially stressful situation. The following exercises are suggestions for reducing anxiety. Research has shown them to be helpful for pre-school aged and older children. Choose ones appropriate for your child and your abilities.
- Breathing exercises. Show your child how to breathe deeply and slowly: in through the nose and out through pursed lips. Explain that this will help them calm down if he or she starts to feel anxious about getting the injection. This may also help to decrease the pain of the actual injection by switching the child's attention from the needle to the controlled breathing.
- Muscle relaxation. Have your child lie down to practice relaxing – make it a game. First, begin with several deep breaths. Next, have the child tense up muscles in one part of the body (for example, tense the legs first, then the arms, and so forth). Keep the muscles tense for a few seconds and then leave them limp for a much longer time. Explain to your child that learning to relax helps the injections not hurt as much. Injections into tense muscles hurt a little more.
- Block negative thoughts. Have your child think about pleasant memories from a similar event. For example, recall previous visits when the nurse gave him or her a book or stuffed animal to play with. Your child can also practice saying phrases like, “This will only hurt a little while,” or “It will help keep me from getting sick.” Each time that your child begins to feel fearful, he or she should “block that negative thought” by saying those rehearsed sentences or remembering pleasant memories.
If you teach some of these coping skills, begin several weeks prior to the scheduled immunization. Keep it positive and practice regularly with your child. (Note the resources provided at the end of the document if you want more ideas.)
For children under the age of 7, tell them about the immunization appointment about one hour beforehand. A longer “countdown” may cause extra anxiety. Remind your child of the exercises you have been practicing together. If necessary, try these last minute techniques:
- Use distraction to focus on something positive while in the waiting room. This can be quiet singing, humor, talk not related to immunizations, listening to music, watching TV, reading a children's book, blowing bubbles, etc. Similar distraction techniques may also be used during the procedure.
- Tell your child to “blow away the pain” by blowing out really hard just before the injection. This can prevent concentrating on the anticipated pain. Children can even be given a party blower which will also add the distraction of fun and noise.
- Get down to the child's eye level and be honest in telling the child that the injection will hurt a little. However, also explain that the pain won't last long. If the child desires, sit next to or hold your child gently during the procedure.
- Using whichever arm is not being injected, have the child squeeze your hand as hard as what the pain of the needle is. This will provide an alternative to crying or yelling as the child concentrates on how hard to squeeze.
- Most importantly, make sure that you, the parent, remains calmly in control in the examining room where the injections will occur. For example, don't give children the control to postpone or avoid the inevitable by saying that they need to go to the bathroom – have them go beforehand. As much as possible, communicate with your child at their eye level.
- Children should be allowed to watch the needle piercing the skin if they want to. You can be there as a focal point if the child decides to look away. You can also become “the eyes” to report on the progress of the procedure, when it will be over, etc.
- Remember to gently coach your child on using the immunization-coping exercises that you've been practicing together. They will forget to use them if you don't remind them during the procedure.
- Set reasonable and firm limits. Children of any age should be allowed to cry and not feel embarrassed about it. However, behaviors such as kicking and screaming are not acceptable.
- Reward your child when he or she behaves well during the procedure. Praise him or her, and take your child somewhere special to spend “fun time” together.
Calm Parents are Best
The best way to prevent your child from becoming stressed or frightened by immunizations is for you to remain calm. Overcome your own anxieties, if you have them, and avoid appearing outwardly anxious. Your child will always pick up on your feelings and behaviors. This may cause your child to act or become afraid every time he or she goes to the doctor's office or health department. Above all, remember that the short discomfort of an immunization is a small price to pay for a lifetime of protection against deadly diseases.
Training Children to Cope and Parents to Coach Them During Routine Immunizations: Effects on Child, Parent, and Staff Behaviors. (1992). Behavior Therapy, Vol. 23, pp. 689-705.
Preparation of Children for Painful Procedures. (1990). Pediatric Nursing, 16 (6), pp. 537-541.
The Needle is Like an Animal: How Children View Injections. (1978). Child Today, Jan/Feb, pp. 18-21.
Coping Skills for Children Undergoing Painful Medical Procedures. (1988). Issues in Comprehensive Pediatric Nursing, Vol. 11, pp. 113-143.
Thought Stopping: A Strategy for Impending Feared Events. (1984). Issues in Comprehensive Pediatric Nursing, Vol. 7 pp. 83-89.
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Ruttman,C., J. Rolf, E. Johannes. (1997). *Making immunizations easier: A guide for reducing your child's fear.* [Extension Publication MF-2278]. Manhattan, KS: Kansas State University Cooperative Extension Service.
Any additions or changes to these materials must be preapproved by the author .
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Dr. Charles A. Smith
Kansas State University
Cooperative Extension Service
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