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Health

Pain and trauma from childhood injections can lead to lifelong needle phobia: Shots

Julia Cramer sits with her two children, Maya, 3, and Lily, 6 months, at their home in Petaluma, Calif., on Dec. 19. Maya uses a toy medical syringe on an Elmo doll that she often takes to the doctor. desk.

Beth LaBerge/KQED


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Julia Cramer sits with her two children, Maya, 3, and Lily, 6 months, at their home in Petaluma, Calif., on Dec. 19. Maya uses a toy medical syringe on an Elmo doll that she often takes to the doctor. desk.

Beth LaBerge/KQED

Almost every new parent goes through this: the distress of hearing their child scream at the doctor and the emotional torture of having to hold them down while the clinician administers one vaccine after another.

“The first injections he got, I probably cried more than him,” says Rémy Anthes, while pushing his 6-month-old son, Dorian, back and forth in his stroller in Oakland, California.

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“The look in his eyes is hard to bear,” says Jill Lovitt, recalling her granddaughter, Jenna’s, reaction to some recent vaccines. “Like, ‘What are you letting them do to me? Why?'”

Some children remember the pain caused by the needle and quickly begin to internalize their fear. That’s what Julia Cramer described with her 3-year-old daughter Maya. Maya had to have her blood drawn for an allergy test when she was 2 and a half years old.

“After that, she was afraid of blue gloves,” Cramer says. “I went to the grocery store and she saw someone wearing blue gloves stocking vegetables, and she started freaking out and crying.”

Research on pain management suggests that needlesticks may be the largest source of pain among children in the health care system.

The problem is not limited to childhood vaccination either. Studies investigating sources of pediatric pain have focused on children treated for serious illness, who have undergone heart surgery or bone marrow transplants, or who have ended up in the emergency room.

“It’s so serious that many children and many parents decide not to continue treatment,” says Dr. Stefan Friedrichsdorf, a specialist at the Stad Center for Pediatric Pain, Palliative and Integrative Medicine at the University of California, San Francisco. , during the End Well conference. conference in Los Angeles last November.

Distress from needle pain can follow children as they grow and can interfere with important preventive care: an estimated 25% of adults have a fear of needles that began in childhood.

Sixteen percent of adults refuse to get the flu vaccine because of it.

According to Friedrichsdorf, it doesn’t have to be that bad. “It’s not rocket science,” he said.

It outlines a series of simple steps that clinicians and parents can follow:

  1. Apply a numbing cream, an over-the-counter lidocaine, 30 minutes before an injection.
  2. Breastfeed babies or give them a pacifier dipped in sugar water to comfort them while they are vaccinated.
  3. Use distractions, like teddy bears, pinwheels, or bubbles, to take the focus away from the needle.
  4. No more trapping children on an examination table. Parents should instead hold their children on their laps.

Friedrichsdorf worked on a similar effort when he practiced at Children’s Minnesota. He is now leading the rollout of these new protocols to all children at UCSF Benioff Children’s Hospitals in San Francisco and Oakland.

He calls it the “Ouchless Jab Challenge.”


Dr. Stefan Friedrichsdorf demonstrates one of the distraction techniques he uses for children receiving injections at UCSF Benioff Children’s Hospital in San Francisco on Dec. 18.

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Dr. Stefan Friedrichsdorf demonstrates one of the distraction techniques he uses for children receiving injections at UCSF Benioff Children’s Hospital in San Francisco on Dec. 18.

Beth LaBerge/KQED

If a child at UCSF needs to get a shot — for a blood test, a vaccine or an IV treatment — Friedrichsdorf promises that his clinicians will do everything possible to follow these pain management steps.

“Every child, every time,” he says.

It seems unlikely that these foolish efforts will dent the vaccine hesitancy and refusal driven by the anti-vaccine movement, since the beliefs that motivate it are often conspiracy-oriented and deeply held.

But that’s not necessarily Friedrichsdorf’s goal.

He hopes that making routine health care less painful for children could help convince some parents who may be hesitant to vaccinate their children because of the difficulty of watching them suffer.

In turn, children who grow into adults without needle phobia may be more likely to benefit from preventative care, including an annual flu vaccine.

In general, it will likely fall to parents to take a leadership role in requiring these measures in their own local medical centers, Friedrichsdorf says, because tolerance and acceptance of children’s pain is so ingrained among clinicians.

Dr. Diane Meier, a palliative care specialist at Mount Sinai, agrees. She believes this tolerance is a major problem, stemming from the way doctors are usually trained.

“We are taught to view pain as an unfortunate but inevitable side effect of good treatment,” says Meier.

“We learn to suppress this feeling of distress about the pain we cause, because otherwise we can’t do our job.”

During her medical training, Meier had to hold children down for procedures that she described as torture – for them and for her. This drove her out of pediatrics.

She shifted her focus to geriatrics instead and later helped lead the modern movement to promote palliative care in medicine, which did not become an accredited specialty in the United States until 2006.

Meier believes the campaign to reduce needle-related pain and anxiety should apply to everyone, not just children.

“People with dementia have no idea why human beings come up to them and stick needles in them,” she says. And the experience can be painful and distressing.

Friedrichsdorf’s techniques would likely work in this population as well, she says. Numbing cream, distraction, something sweet in the mouth, and perhaps some music from the patient’s youth that he remembers and can sing along to.

“This is worth studying and deserves serious attention,” says Meier.

This story comes from NPR’s health reporting partnership with KQED And KFF Health News.

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