Child vaccination. Family doctor vaccines or injection to baby gDid you know that about 10-15% of the world’s population has a significant degree of needle phobia? Conditioning negative experiences, mostly pain, can lead to the postponement or avoidance of medical and dental visits and, for some, job applications or even marital licenses where blood tests are required.

Even though many of the fears and reservations about childhood immunization have been addressed and refuted, the role of repeated painful pokes, as well as the impact of recurring pain and anxiety, has been under emphasized. Yet most parents know only too well the degree to which children learn to fear going to the pediatrician because of shots. The need for ever-increasing and more frequent immunizations, sometimes three or more at a single visit, further compounds the problem.

By now, there are many well-rehearsed and published strategies available to blunt the impact of pediatric injection pain. Some involve technical matters such as needle length and the best positioning of the child, while others teach parents approaches that have been shown to work.

The two most effective research-validated psychological techniques to reduce pain are distraction and its first cousin, hypnosis. While some children may be distracted by stories or handheld video games, others benefit from a more active role, one that allows them to achieve curiosity and mastery as an antidote to fear.

Several years ago, we developed a distraction method we termed “multi-modal,” because it involves several senses by means of a sequence of carefully chosen steps accompanied by verbal suggestions of reduced sensation. In addition, we thought it best to involve the child in a game we called “beat the buzzer.”

A few short scripted and spoken sentences illustrate the method as the child experiences the effect of a cold numbing spray and a multi-ponged rubber gripper (or thumb rubbing), both of which suggest less skin sensation. There then follows the beat the buzzer game by which the child is engaged to follow a meandering massage wand from the shoulder to the elbow of the arm not receiving the injection and shout “elbow!” exactly when it touches. By varying the route and speed of the wand, the amusement surrounding the “game” distracts the child from the injection.

The method, which is based on the “gate theory” reduction of pain and suggestion language, has proven highly effective for children over the age of four years in two studies published in the pediatric literature. It seems the confusion created by the different stimuli cause children not to “notice” or be “bothered” even when they feel the injection. Most importantly, a child can feel an active part of the process and proud of agreeing to it, rather than a passive recipient of what is being done to him or her.

So why is this method not used more widely? Sadly, time and money now determine what is practical, even when the benefits of expending just a bit more of both are clear. As originally formulated, two medical assistants and about 2-3 minutes were required to complete the sequence. Given the constraints of the times, we more recently have sought to involve parents by having them in charge of the buzzer game wand. In a study recently published in Clinical Pediatrics, we showed that this adjustment is as effective as having two medical assistants and with roughly the same dramatic impact on the reduction of pain and anxiety, It has already been shown that parents are eager to play a more active role in their child’s medical treatment and procedures and welcome the opportunity to contribute to their child’s comfort and security. Further, more recent literature documents the “dos” and “don’ts” of parental behavior, including some counterintuitive findings that may change what parents do and say.

Medical personnel sometimes tend to adopt change slowly. Despite all the available evidence, injections often still are given as they were 40 years ago, using outdated practices such as needle aspiration, securing children on an exam table, slow injection, and short needles. The menace of injections is augmented by repeated stating of “no shots,” a high-pitched voice of reassurance, jokes about pokes, and even worse, threatening language that links shots to undesirable behavior as though they were a form of discipline. Parents are in the best position to urge their pediatricians to get with the times and attend to the best evidence-based interventions for immunizations and other painful procedures.

The immunization technique described above can be viewed at www.vimeo.com/81836551. The verbal suggestion script can be made available to health care professionals by the author.

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From issue: 30/03-04