Docassist

Helping Children with Fear of Needles and Immunizations

February 16, 2021 Written by Rhapsody Mason
A fear of needles and injections are common among young people and can be a contributing factor to noncompliance with vaccine recommendations. One study found that 63% of children ages 6-17 reported a fear of needles and a second study noted that 40% of children ages 4-16 with Type I Diabetes feared needles. This fear emerges around age five and usually lessens with age and development. However, fear of needles can last into adulthood, impacting up to 10% of adults (Orenius, et al, 2018). Administering multiple injections in one visit has also been linked to increasing the likelihood of developing a fear of phobia of needles and injections (Baxter et al, 2017). Decreasing distress and trauma associated with receiving injections in younger children can help to prevent development of a lasting phobia. Evidence based strategies to reduce distress include:
  • Avoid holding children down for immunizations and injections. Have a parent hold the child on their lap or breastfeeding for infants.
  • Coach parents in the waiting room on using distractions such as bubbles, videos, or toys. Involving the parent can reduce their anxiety which in effect can greatly reduce their child’s anxiety.
  • Remind parents that receiving a shot at the child’s doctors visit should never be used as a threat for poor behavior.
  • Administer fewer shots in one visit when possible with the most painful injections occurring last.
  • Use a topical product to numb the injection site.
  • Move the child out of the area where the shot occurred as soon as possible.
  • Provide rewards or incentives immediately after the injection.
Treating Trypanophobia (Needle Phobia)
Trypanophobia is in a class of anxiety disorders known as specific phobias. It is characterized by a lasting and unreasonable fear caused by the presence or thought of needles or medical procedures associated with needles. Specific phobias such as Trypanophobia do not respond to psychopharmacologic treatments but respond to exposure therapy. Exposure therapy involves helping a child to confront the fear gradually and systematically in a safe environment to reduce anxiety and avoidance. Even when a child is seeing a therapist, the bulk of exposure therapy is done outside of the office, with parents guiding exposures and rewarding children for success.
Below is an example of an exposure hierarchy used to address a needle phobia. The child starts with exposures to situations causing less anxiety and after multiple repetitions moves to situations which are more anxiety provoking.
  1. Look at pictures online of syringes with needles for 5-10 minutes/day.
  2. Look at pictures of medical professionals holding syringes with needles for 10 minutes/day.
  3. Look at pictures of people getting shots.
  4. Watch videos of people getting shots.
  5. Imagining themselves getting a shot.
Visit the  llinois DocAssist website for  more information and resources related to screening, diagnosing, and treating anxiety and phobias.

HELPinKids&Adults provides evidence-based information and tools for health care providers and the public on making vaccine injections less painful and less fear inducing for adults and children.

Healthy children (AAP) provides tips for managing children’s pain during vaccinations.

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Orenius T, LicPsych, Säilä H, Mikola K, Ristolainen L. Fear of Injections and Needle Phobia Among Children and Adolescents: An Overview of Psychological, Behavioral, and Contextual Factors. SAGE Open Nurs. 2018 Mar 14;4:2377960818759442. doi: 10.1177/2377960818759442. PMID: 33415191; PMCID: PMC7774419.

Taddio A, Ipp M, Thivakaran S, et al. Survey of the prevalence of immunization noncompliance due to needle fears in children and adults. Vaccine. 2012;30(32):4807-4812.

Baxter AL Cohen LL, Burton M, Mohammed A, Lawson ML. The number of injected same-day preschool vaccines relates to preadolescent needle fear and HPV uptake. Vaccine. 2017; 35(33);4213-4219.
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