Taking kids to get their vaccinations can be a traumatic process for everyone involved.
There can be tears, tantrums, begging, shaking, screaming and panic — not to mention the accompanying parental guilt.
It's common to think there's not much you can do except hold on tight and get through it until the next time. But Liz Bishop's experience suggests there's a better way.
Liz's two boys Alex and Hamish have both had countless needles in the course of lifelong haemophilia treatments, as well as the usual battery of childhood vaccinations.
One thing that separates them, though, is their differing emotional responses to needles.
Alex endured plenty of bad needle experiences, including being restrained to a bed with sheets and forced to have gas as a method of relaxation. These exacerbated his phobia and caused the family a lot of distress — and later in life he still harbours a reluctance to see medical professionals.
However, about four years later when Hamish came along, the family met paediatrician and childhood pain management specialist Angela Mackenzie.
She helped Hamish and his family develop coping mechanisms that have seen needles not play a negative role in his life.
Each child is different but the experience of child psychologists, paediatricians and the Bishop family indicates that as a parent or carer, keeping kids calm at needle time and sending relaxing messages to your child can help your child avoid debilitating trauma around jabs.
Why it matters to help your child through a fear of needles
Anxiety around getting jabs and blood tests is very common — especially in kids.
A 2012 Canadian study (there are no Australian figures available) reported 63 per cent of children aged 6-12 had a fear of needles.
Almost of quarter (24 per cent) of parents reported they did, too.
Distress aside, a fear of needles presents a wider societal health problem, with the study finding for up to 8 per cent of families it was the reason for them not getting routine immunisations.
Why do some children get more anxious about needles than others?
The short answer is: it's complicated.
As with many fear and phobia-related issues, they can develop from our brains building up a negative association with needles after a few bad experiences — even ones we can't remember.
There is evidence that even things that happened to us as newborn babies can impact the way we react to pain.
So you may never get to the bottom of your child's fear but that doesn't mean you are powerless to help them.
Strategies for helping kids keep calm at needle time
ABC Life spoke to Queensland Children's Hospital senior psychologist Dr Moana Harlen, the head of Sydney Children's Hospital's Paediatric Pain and Palliative care research team Dr Tiina Jaanist and Dr Mackenzie — who has written a book about helping children cope with medical procedures — about how parents can help children play it cool at needle time.
Here is some of their key advice. But if you suspect your child's fear is more of a phobia, that may require some professional treatment of its own.
Be prepared (that includes everyone)
Dr Harlen says the ultimate preparation is working with your child regularly at times of high stress to practice relaxation and emotional regulation techniques.
"It's really important that parents provide a consistent message, consistent modelling and really help practice emotion regulation skills themselves, and that they model them for their child," she says.
"Every now and then just saying that you're taking deep breathing exercise when a little bit worried about something or feeling overwhelmed.
"The idea is to keep them as calm for as long as you possible can prior to and during the needle."
She also says trust in your relationship with your child is paramount so, especially if a shot is likely to be an unpleasant surprise, give the kid a heads up without making a big deal of it.
If you don't, you risk making the situation worse and having them afraid of going to the doctor altogether — even for things that will not involve a jab.
If you think it's worth your while, let the clinic or doctor know in advance your little one is apprehensive, but don't do this in front of your child, lest you reinforce their anxiety.
This will allow the doctor or nurse to approach needle time gently.
But remember, you know your child better than anyone, so don't rely on the doctors and nurses doing everything to ensure a stress-free experience. This is firmly up to you.
Dr Jaaniste said while numbing cream is often recommended as a method of easing the sensation of getting a needle, it does need to be applied to where the needle will actually go, so you need to talk to the physician about this in advance for advice and their OK.
What will take the focus off the needle?
It's not always as easy as the doctor in the above video makes it look (especially as kids get older and catch on to what's up) but distraction can be powerful when the moment arrives.
If you have a baby, breast or bottle feeding through the procedure can both distract and keep them restrained.
Try to keep an older child still with a calming cuddle or, if possible, ask them where they would be most comfortable. Seated on you lap? Lying on the bed looking out the window? Liz says from her experience and talking to others, giving the child a sense of control can take some tension out of the situation.
Depending on their age and what's the flavour of the month (or let's face it, week/day/hour), take something likely to capture their attention and distract from what the doctor is up to? A song. A pinwheel (helps slow breathing and therefore relaxation). A book. Streaming videos of rubbish trucks. A teddy.
Dr Mackenzie and Liz also strongly recommend listening to music as both a relaxation and distraction technique.
It's worth remember that sometimes not knowing what is going on can cause some of us more concern. Dr Mackenzie said if your child is keen to see what's going on, let them watch — remember it's a totally normal part of life, so treat it as such.
How to send a relaxing message to kids anxious about needles
When trying to separate what's a threat from what's cool, children instinctively look to the adults in their lives and follow their cues.
So if you speak negatively about needles, exhibit signs of distress or impart words of empathy — you're subtly sending the signal that there's a reason to alarmed.
That's not helpful in the short or long term, so here are some approaches that may help:
- Model the behaviour you want: Practise what you preach and if you can keep calm when having a needle, maybe take the kids with you next time you get a shot and demonstrate how you breathe and keep relaxed, showing how normal and natural the procedure is.
- Avoid talking about the "pain" associated with needles: Don't tell your child they hurt, but don't say it won't either. Dr Mackenzie says: "If you say, 'This is going to hurt', 'This will sting you' or 'This will feel like this' you're telling the child how it will feel… it's about using words for what you want, not what you don't want."
- Talk up and reinforce the positives of the experience: Get creative if required and enthusiastically focus on the lollipop, ice-cream (even if they're a sometimes treat), the trip to the park afterwards, how quick these appointments are or the fun toys in the waiting room.
- Don't expose them to negative needle experiences: If you know one of your children is likely to have a panicked response it might be an idea to take the kids for needles separately, if possible, because seeing distress in others can cause anxiety and negative associations.
- Treat the visit as a normal trip to the doctor: It's a trip to the doctors that will help keep us healthy and strong, so speak about it in those terms.
- Try and keep yourself calm and measured: It shows there's no threat and, again, model the response you're wanting to encourage. If needles distress you, don't feel ashamed to ask another trusted adult in your child's life to take them.
- There's no need to apologise for the needle: It's to protect your child after all! Be sure to praise positives in each needle-related experience and let them know through your demeanour and words they're in a safe and secure environment. As Dr Mackenzie says, "Children know as soon as parents say, 'Don't worry' — there's something to worry about."
This is general information only. For detailed personal advice, you should see a qualified medical practitioner who knows your medical history.