Tips for Reducing Needle Anxiety to Increase Vaccination Rates Among Children

Routine vaccine coverage in the United States (US) declined during the COVID-19 pandemic and has not rebounded to prepandemic levels. Vaccine hesitancy may in part be due to the uncomfortable process of vaccination. This article discusses strategies to help combat needle anxiety among children.

The rate of routine vaccination in the US has dropped below the 95% needed to protect the general population, putting large groups of children at risk for potentially life-threatening illnesses. Adding to the number of unvaccinated children has been an increase in the vaccine exception rate. During the 2022-23 school year, the exemption rate increased 0.4 percentage points to 3.0%. Exemptions increased in 41 states, exceeding 5% in 10 states.¹

The US Centers for Disease Control and Prevention (CDC) reported that among kindergarten-aged children in the 2022 to 2023 school year, vaccination rates for measles, mumps, and rubella (MMR); diphtheria, tetanus, and acellular pertussis (DTaP); poliovirus; and varicella were below the target level, ranging between 92.7% for DTaP to 93.1% for MMR and poliovirus.¹

Addressing pediatric needle pain has been repeatedly identified as a priority in pediatric medicine, however, it remains undermanaged in the clinical setting. In addition, recommended approaches to managing pediatric procedural pain do not address anxiety about needle pain, which is a key driver for noncooperation.

Evelyn Chan, MBBS, MSc, DCH of Monash Children’s Hospital and Royal Children’s Hospital in Australia has investigated strategies for reducing anxiety among children during painful procedures.

To prepare children for vaccination, they should be aware of what to expect, according to Dr Chan. Children should be encouraged to ask any questions or to voice concerns and their perspectives should be validated and listened to actively. During vaccination, the goal should be to distract and to relax. This could mean bringing a stuffed animal, looking at a tablet, or breathing deeply. Throughout the process, vaccination should be encouraged through positive reinforcement, by informing the child about the health benefits and that with vaccination they are protected from illness.

To minimize the pain of vaccination, Dr Chan recommends employing the 3 ‘P’s: physical numbing, positioning, and psychological techniques.²

• Some patients may benefit from using a numbing cream or cold pack to reduce procedural pain.
• Certain positions during the procedure may facilitate a more relaxed vaccination process, for example, sitting on their parent’s lap, facing the parent, etc.
• Patients may engage in conversation, play with a stress-relieving toy, practice deep breathing, or use medical virtual reality to distract them during the procedure.

To combat needle phobia, some children may benefit from role-playing, in which the child and guardian take turns playing doctor and patient, thereby familiarizing themselves with the procedure through play.

Adults should avoid minimizing or dismissing a child’s fears over vaccines, pretending that the child won’t be receiving a vaccine during an appointment, sharing negative experiences related to vaccines with the child, and using bribery or threats to try and force the child into compliance as these strategies can exacerbate anxiety and/or make the experience more distressing.

This article originally appeared on Clinical Advisor