For some children, going to the doctor isn’t cause for alarm. For others, a doctor’s appointment can be nerve-wracking, and their anxiety can increase even more if that visit involves shots. And with the Pfizer vaccine now available for kids over the age of five, a lot of kids are begging their parents to skip the shot out of anxiety. “The degree of anxiety varies widely, but virtually all children have some amount of hesitation or worry about shots,” says Dr. Nicole Beurkens, child psychologist, best-selling author, and nutritionist. Dr. Amy Lee, PhD, a pediatric psychologist at Cleveland Clinic Children’s, agrees that being nervous about new or stressful situations is a completely normal reaction for all children. She says, “During the infant and preschool years, children receive a lot of vaccines, and even young children develop memories of aspects of the experience that may have been surprising or frightening. The injection experience requires a child to be still, adults may need to restrain them, and there is a brief episode of pain that very young children may be surprised by. Everything about these experiences is remembered, even if children do not have words for the experience.” In addition, a child’s “flight, fight, or freeze” behaviors may kick in when faced with an injection, according to Dr. Lee. And as Dr. Aude Henin, Founding Co-Director of the Child Cognitive-Behavioral Program at Massachusetts General Hospital, notes, it’s something that can easily continue into adolescence and even adulthood. So, what can you do to soothe your child’s nerves? And decrease shot anxiety in the future? Read on for our experts’ top tips and tricks that can help younger and older children.
For young children
No matter what age your child is, if they are very fearful, it can be helpful to talk with their pediatrician ahead of time to book a longer appointment, Dr. Henin recommends, adding, “This will allow the child time to settle in without needing to rush through the injection. You may also want to book more than one appointment to prepare for the injection so that the child can face their fear gradually.” Also, from little ones to older kids, Dr. Henin says that unless absolutely necessary, avoid forcing or coercing the child. She says, “Needle-related fears often get worse because the child’s anxiety is met with negative reactions from adults and may even result in being physically restrained. These experiences lead the child to associate getting a shot with increased fear and distress and can lead to a negative spiral of anxiety and avoidance.” If your child is four or younger, Dr. Lee advises waiting to tell your child about the shot until right before the nurse enters the exam room. This can lessen anticipatory anxiety. And while it’s understandably tough to see your child so upset, Dr. Henin emphasizes that it’s important for you to stay calm. She adds, “Children can be especially sensitive to their parents’ anxiety or distress when they are stressed themselves.” Here, Dr. Lee says that it’s helpful to use your normal voice so your child will feel that everything is okay. There are some creative things you can do to keep your child calm during the appointment. Lee suggests bringing a toy along or another comfort item. To provide a distraction, Lee says that toys, bubbles, and singing work especially well for babies; toddlers will also enjoy those things along with pop-up books and noisemakers. Role-playing before the appointment can also be an effective tool to keep kiddos calm. Dr. Beurkens says, “Children, especially young ones, benefit from acting things out in play so they can know what to expect and work through their feelings. Do some pretend play or role-playing with puppets or dolls where you go through the steps of the appointment, how they might feel, and what they can look forward to after it’s done.”
For older children
For children five and older, Lee recommends telling your child about the shots on the day of the appointment or one day before. Lee goes on to note that older kids tend to ask more questions than little ones, so when they ask, “What will happen?” be straightforward and explain that they will get a vaccine in their arm or leg with a needle. If they follow that up with, “Why?” simply say that it’s to keep them healthy. And if they ask about pain, matter-of-factly say that there will be a small pinch for a few seconds. Talking with your older kids about what to expect is key, and it can be helpful to go through the steps. Dr. Beurkens says, “Let them know when you’re going, what will be happening, who will do what, and what will happen at the end. Preparation helps kids feel more secure and in control, which reduces anxiety.” Also, if your child is struggling with substantial anxiety before the appointment, it can be beneficial to reflect on past experiences and how they came through them successfully. Dr. Beurkens says, “If the child has had other experiences with shots that they recall, it can be helpful to revisit those experiences to help reduce their anticipatory anxiety. Talk about how their last appointment with shots went, how they felt before, and how they felt after. It can be helpful for them and you to have a reminder that they’ve gotten through this before.” Another way to prep for a vaccine appointment is to look at cartoon images of needles online or play “doctor” so that they can practice giving pretend injections to you, and vice versa, as Dr. Henin suggests. Additionally, plan something to look forward to. Dr. Beurkens explains, “When a child is anxious about an upcoming event, it helps to have something positive to look forward to when it’s done. This allows them to temper their anxiety about the discomfort of a shot with the happiness they will feel at getting a treat, playing at the park, or doing something special when they leave the office.” During the visit, Lee recommends distracting school-age children with videos, stories, counting, jokes, or talking about an activity. Effective distractions for teens include games, videos, and music. One tried-and-true anxiety buster for anyone, from 9 to 99, is deep breathing. While receiving the shot, Lee says that you can encourage your child to take three relaxed belly breaths. And when it’s all over, no matter what age your child is, lay on the praise, using phrases like, “You were so brave,” and “You really helped yourself stay calm.” Also, this is an excellent opportunity to reward and provide comfort. “Reward the child for any attempt to tolerate their anxiety, even if it didn’t go perfectly,” Dr. Henin says. “Rewards can include praise or special time with a parent. Comfort the child if they experience any pain or distress. Hugs and snuggles can go a long way.” Lastly, Dr. Henin says that if your child’s fear is severe, it’s important to seek help. She says, “Cognitive-behavioral therapy that emphasizes a technique called progressive exposure is highly effective to treat phobias in children and teens, including needle phobia.” Next up, learn why it’s important to stay up-to-date with your children’s vaccines.
Sources
Dr. Nicole Beurkens, a child psychologist, best-selling author, and nutritionist.Amy Lee, PhD, a pediatric psychologist at Cleveland Clinic Children’s in Cleveland, Ohio.Dr. Aude Henin, Founding Co-Director of the Child Cognitive-Behavioral Program at Massachusetts General Hospital in Boston, Massachusetts.Centers for Disease Control and Prevention (CDC): “Recommended Child and Adolescent Immunization Schedule for ages 18 years or younger, United States, 2021”
