Taking the Pain Out of Vaccinating Children | Opinion

Children ages 5 to 11 will soon be getting vaccinated against COVID-19. As we celebrate that milestone, we must also acknowledge our collective blindness to the problem of needle pain. Our health care system does not prioritize simple accommodations that research shows are effective in reducing needle pain and fear. This produces needle phobic adults, some of whom avoid important medical care throughout their lifespan as a consequence. An estimated quarter of the adult population has needle fear, and while there are many reasons for current vaccine hesitancy, needle phobia is an important, misunderstood factor.

At first glance, the status quo seems to work well enough for children. The majority of kids are fearful of shots, but most of them end up getting their required vaccinations because adults don't give them a choice. As a clinician working with adults with needle phobia, I see how this approach ultimately backfires. Most of my patients trace their symptoms of panic and avoidance at the sight of a hypodermic needle to negative injection experiences they had as children. My patients report stories of being strapped to a chair to get Novocain shots at the dentist, passing out during a particularly painful blood draw and crying and hyperventilating before a vaccination while being told dismissively, "It's just a poke, there's no reason to be scared."

Research suggests that fear of needles is primarily established when children are 4 to 6 years old and often persists, leading to decreased compliance with medical care over the lifespan. While we can force needle phobic kids to grin and bear the needle when they are young, how many of them might avoid driving themselves to the vaccination clinic as adults? The number appears to be significant. A recent meta-analysis found that 16 percent of the adult population reports avoidance of flu shots due to needle fear.

Symptoms of needle phobia, also known as trypanophobia, include feelings of dread and panic, physical symptoms of heart racing, trembling and nausea, and for some, a sudden drop in blood pressure (called vasovagal syncope) that leads to lightheadedness and fainting. Children, who are often in environments in which they are not in charge, are particularly susceptible to the panic-inducing sense of loss of control that vaccine injections can trigger.

A person receives a bandage
A person receives a bandage after their first dose of the Pfizer COVID-19 vaccine. PATRICK T. FALLON/AFP via Getty Images

Pediatric pain specialists recommend simple, evidence-based changes that can have profound effects on reducing needle pain and fear. At Children's Minnesota, the entire hospital has committed to reducing or eliminating needle pain. Strategies like blocking the pain signal using lidocaine cream or ice and vibration, promoting diaphragmatic breathing by having the child blow bubbles and harnessing distraction by watching videos on a smartphone are standard evidence-based practices made available to children. Pediatric and primary care settings could teach applied tension, a simple technique in which you squeeze your knees together to increase blood pressure back to normal levels so you don't faint.

Recently, I taught several of these comfort strategies to a man in his 30s seeking to overcome needle phobia so he could get vaccinated against COVID. As we practiced applied tension together, he asked with a crestfallen look, "Why hasn't anyone told me about this before?" He had a traumatic childhood vaccination experience when he was rushed to the emergency room after fainting, waking up to a room of strangers hovering over him. His experience was preventable.

As kids under 12 start getting vaccinated against COVID, we have a choice to make: We can continue to ignore needle pain and fear and raise a new generation who avoids medical care as adults, or we can change how we are doing things. Research shows these strategies work, yet there continues to be a mismatch with what is standard practice in how we vaccinate kids. Some, like pediatric pain researcher Amy Baxter, hypothesized that there is an empathy gap. Before the 1980s, there were far fewer vaccines, and only one per visit was ever administered, all before the age of 2. Now kids can get over 30 vaccine injections by the age of 6, as many as five injections in one visit and are old enough to recall what happened. For adults born before the '80s, it's hard to have empathy for this rigorous vaccine schedule because they never experienced it themselves.

As we begin to vaccinate children, who also have the highest rates of needle phobia, we must adopt a more inclusive approach to health care that considers different peoples' needs and acknowledges the problems of pain and fear involved in vaccine injections. Implementing accommodations for those with needle fear is not only about effective public health policy; it's about empathy for other humans, young and old.

Dr. Jocelyn A. Sze, PhD, is a clinical psychologist who founded the Free Needle Phobia Pilot, which harnesses a national collective of volunteer therapists to help people with needle phobia get vaccinated. She serves on the Society for a Science of Clinical Psychology to help clinicians access findings in basic science to guide their clinical work.

The views expressed in this article are the writer's own.