Clinical Challenges: Vaccinating Kids With Needle Phobia

With the school year well underway, holiday travel just around the corner, and the spread of respiratory pathogens already in full swing, pediatricians are trying to shield as many kids as possible from the possibility of severe outcomes from preventable illnesses.

One hurdle that’s often overlooked is needle phobia, which can leave many kids (and adults) downright terrified of getting a shot that can provide them with protection over the course of a season, or even a lifetime.

Indeed, estimates have indicated that as many as two in three children and one in four adults have “strong fears around needles,” according to the CDC.

Needle phobia “can be learned from a past experience of pain, but there is also a biological component that makes some people react very strongly to the idea of procedures involving a needle,” the CDC noted. “These phobias can make procedures feel more painful, lead to severe panic, and in some cases to a physical response that causes fainting.”

Furthermore, needle phobia may lead to the avoidance of vaccines altogether, with the CDC reporting that as many as one in 10 people might delay the COVID-19 vaccine due to fears of needles.

In the case of young patients, needle phobia may stress both the child and parent.

“It’s an art and a science to practice pediatrics,” Ashlesha Kaushik, MD, a pediatric infectious diseases specialist at UnityPoint Health in Sioux City, Iowa, and a national spokesperson for the American Academy of Pediatrics (AAP), told MedPage Today.

Parental Involvement Is Key

Kaushik suggested that a pediatrician’s office is an ideal spot for kids to receive vaccines because this type of setting is “uniquely positioned for giving the greatest comfort,” and providers in this setting are “uniquely trained” to interact with and care for infants and toddlers.

It’s essential to start with parents when it comes to addressing needle phobia in kids, she said. “A lot of it is communication with the parents — especially for the new parents.”

Explaining everything in detail “goes a long way,” she noted, and this is especially true in regards to the benefits of vaccination.

As for the need for needles, the big picture is that they are simply the “modality for getting the best protection for life,” Kaushik said.

However, there are techniques to help soothe anxious children.

Healthcare providers can use techniques aimed at distracting the child while they receive a shot, or they can give a vaccine while the child sits in their parent’s lap, Kaushik suggested, noting that it’s important to have the parent present.

Indeed, a systematic review published in Pediatrics and highlighted by the AAP in a recent blog post indicated that non-digital distraction strategies, such as singing or blowing bubbles, were as effective as digital distraction strategies, such as virtual reality, or listening to a book or music.

In addition, a separate blog post from the AAP emphasized the importance of parental involvement in helping to achieve a “positive, calm — and even pain-free poke.”

“Some parents don’t speak up because they feel intimidated, or the doctor or nurse doesn’t ask,” the authors of the post wrote. “They may worry that they will upset someone. It’s okay to speak up when you know what works for your child. Your pediatrician needs and wants your input!”

Moving the Needle — on Needle Phobia

Often, the potential fear of needles among young (and older) patients is simply “accepted as part of the process,” Lori Handy, MD, MSCE, associate director of the Vaccine Education Center at Children’s Hospital of Philadelphia, told MedPage Today.

However, this issue can negatively affect the receipt of important vaccines and other healthcare services, such as routine blood draws, she said, noting that there are ongoing efforts to help address needle phobia in young patients.

For example, she pointed to the Comfort, Ask, Relax, Distract, or CARD, framework developed in Canada. Benefits of the framework include reducing “stress-related reactions, including fear, pain, dizziness, and fainting during vaccination,” according to Immunize Canada.

It is also said to improve the vaccination experience not only for the person receiving a vaccine, but also the educators, parents, and healthcare providers who support them.

Recent research related to CARD included the evaluation of a web-based game that uses the framework to teach kids how to cope with needles, according to a study published in Vaccine. School-age children and their parents “liked the CARD game and learned coping strategies they would use during future needles,” researchers reported.

Overall, when it comes to vaccination in young patients, “actually planning it out is much more effective,” Handy said.

Children may be able to make decisions on matters like whether they want to be on their parent’s lap while receiving the vaccine, as well as what tools they would like to have present for distraction, such as the ability to watch a YouTube video or play their favorite game, she explained. These preferences can be communicated with healthcare staff to partner on the process.

“I think there is more of a movement now to actually recognize that we can make this process better and less fearful,” Handy said.

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