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Posted by Dr. Claire McCarthy April 16, 2012 09:20 AM
It's often the first question a child asks me when I enter the exam room: "Am I going to get a shot today?"
Shots: it's what kids -- and parents -- dread most about trips to the doctor. I don't blame them, because shots hurt. Immunizations have made a huge impact when it comes to preventing and even eliminating some diseases. Because they are so effective, we tend to dismiss the pain they cause. We see the pain as inevitable, a necessary evil.
But maybe that pain doesn't have to be inevitable or necessary.
There are a few things that doctors can do to help minimize the pain of immunizations. Using anesthetics would seem to be obvious, but we don't have effective ones that can work quickly -- pain creams can take 30-60 minutes to work, and that's not practical (unless you have a child with real shot phobia -- if that's the case, talk to your doctor about putting the medication on your child before you leave home). We can, though, help by using longer needles, putting pressure on the site, and holding the skin a certain way. Giving sugar water can help some babies, too. But the people with the real power to make a difference aren't the doctors.
The people with the real power are the parents.
A study out this week in the journal Pediatrics showed that using the 5 S's (swaddling, side or stomach position, shushing, swaying, and sucking) was effective in soothing babies after immunization. Check out the YouTube video to see how it's done (while you're there, watch one of the many videos on how to swaddle your baby -- there is a certain way of folding the blanket that makes it tighter). It's our natural instinct to pick up our babies and soothe them when they cry, and a few little adjustments in how we do it can make us more effective.
Obviously, though, we can't swaddle our toddlers and preschoolers. So the approach needs to be different for them. In a great article published a few years ago, Dr. Neil Schecter (now on staff at Boston Children's Hospital) describes the proven ways parents can help. They include:
Preparation. As tempting as it can be, it's not a great idea to spring it on your kid at the last minute that they are getting shots. It's also not a great idea to tell them so far ahead of time that they have time to fester about it. According to Dr. Schecter, it's best to talk with kids close to the time of the visit, and tell them:
- What will happen (e.g. they will get two shots, they will be in the arm)
- How it will feel (don't say it won't hurt -- they will know you are lying)
- What they can do to cope. Which leads to the second thing parents can do ...
Coping strategies. Involve the child in figuring out what might help. Squeezing Mom's hand? Looking away? Thinking about ice cream? Talking about it ahead of time can make your child feel more in control, and more hopeful.
Helpful behavior. I mean parents here, not kids. It turns out that what lots of parents do at shot time, i.e. apologizing and being overly reassuring ("I'm so sorry we have to do this, it's going to be okay, really") or scolding ("It's just a little prick. Buck up and take it like a man") makes kids more anxious. You know what helps?
- Humor. Indeed, a joke, or at least not taking the whole thing too seriously, is good.
- Talking about something else besides the shot. Like what to have for lunch after the appointment, or the interesting thing that happened yesterday.
- Telling the child to use the coping strategy you planned.
Distraction. This is something doctors and parents can do together. There's real science behind this: the parts of the brain that process pain are less active during distraction tasks. And there's only so much attention you can pay to pain if you are paying attention to something else. You can be creative here; it could be anything from blowing bubbles or a party blower to telling a story or making noises together. It works best if the kid is involved --e.g. it's better if they blow the party blower than if they watch you blow it.
We can't take all the pain out of medicine. But when it comes to shots, sometimes all it takes is some creativity, some snuggling, a good partnership with your doctor -- and maybe a funny joke.
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