Friday, December 26, 2014

Five Ways to Help Your Child Overcome Needle Fears

American children receive over 30 shots for vaccinations during the course of their lives. That doesn't include Novocain shots at the dentist's office and injections to draw blood for tests. Yet In a recent study, 63% of children reported mild-moderate fears of receiving shots (as did about 24% of adults).

Five Ways to Help Your Child Overcome Needle Fears

Edwin Garcia, 5, reacts as he gets a flu vaccination at Carlin Springs Elementary School in Arlington, Va., Thursday, Jan. 7, 2010. H1N1 flu-shot drives for all ages are scheduled around the country for what´s officially dubbed National Influenza Vaccination Week, in hopes of preventing a possible third wave of the epidemic later this winter. (AP Photo/Alex Brandon)
Edwin Garcia, 5, reacts as he gets a flu vaccination at Carlin Springs Elementary School in Arlington, Va., Thursday, Jan. 7, 2010. H1N1 flu-shot drives for all ages are scheduled around the country for what's officially dubbed National Influenza Vaccination Week, in hopes of preventing a possible third wave of the epidemic later this winter. (AP Photo/Alex Brandon)

By Katherine K. Dahlsgaard, Ph.D.

American children receive over 30 shots for vaccinations during the course of their lives.  That doesn’t include Novocain shots at the dentist’s office and injections to draw blood for tests. Yet In a recent study, 63% of children reported mild-moderate fears of receiving shots (as did about 24% of adults). Estimates vary, but studies have suggested 2-8%of children have injection phobias (i.e., extremely intense fears combined with high anticipatory anxiety that results in impairment in everyday living).

While intense fears may need counseling, parents can help kids overcome mild to moderate fears with these steps: 

Educate your child about shots, the more explicitly the better. Much of the fear surrounding injections is due to misconceptions; visual education will correct these.  For instance, many children imagine that a needle is HUGE and that shots take forever.  It isn’t and they don’t – but nothing will make your child believe that until he sees it for himself, repeatedly. There are lots of great YouTube videos that feature instruction and education about shots – here is a good one for younger children and here is a good one for tweens and teens.

Provide him some visual role models. Have your child watch YouTube videos of other children receiving shots who show brave behavior. Remember, being brave doesn’t mean not being scared. Brave means scared, but I do it anyway.  It’s fine – great, even! – to have your child watch these videos over and over until he has seen children his age or younger model brave behavior so many times, he believes it is possible for him. Here are some really great ones.

Watching the videos repeatedly will also habituate your child to the sight of needles and injections, such that he will be far less distressed when he actually encounters them at the doctor’s office.  [Note: please avoid any videos that depict adults or children receiving injections where they aren’t acting brave.]

Have your child practice the “Brave Body” pose --sit up straight, head up, arms and face relaxed-- while he is watching the videos. When it comes time for the actual shot, he’ll be reminded to adopt the same attitude.

Several days before, help your child develop an explicit, written coping plan for the shot.  Generally, helping your child plan what he will DO (“I will sit up straight”) will work much better than telling your child what NOT to do (i.e., “don’t be scared” or “don’t cry”). 

Things he can do:

  1. Develop a playlist of “Power Songs” or “Songs of Triumph” that he can listen to on the ride to the doctor’s office and in the waiting room (bring headphones). These should be songs that make him feel confident and like he can take on the world.
  2. Write a ”Coping Card.” This should be a message to himself on a notecard or his iPad that he can read out loud to you while receiving the shot. Reciting it will keep him from looking at the injection site and distract him from the overall process.
    Here, for instance, is the text of an actual coping card written by an 11 year old patient of mine who, indeed, now takes shots like a Rock Star: It will hurt for a second but then it will be over. Millions of people have gotten shots before me, this is no different, I can do it.
    Younger children or those who cannot read can plan to sing a verse from a Brave Power Song during the shot.

Offer a reward, to be provided immediately after your child shows SPECIFIC brave behaviors.  Write out the agreement like a contract, which both of you can sign.  For example:

“To earn my reward, I must:
a)       Listen to my Power Playlist on the way to doctor’s office.
b)       Do “Brave Body” while getting the shot
c)       Read my Coping Card to Mom during the shot

When I do those three things, then we will go out for lunch at my favorite restaurant immediately afterwards(tween or teen) / I will receive the sheet of Star Wars stickers that mom will be dangling right in front of my eyes during the shot (younger child).”

Note: it doesn’t matter how scared your child actually is DURING the shot; you will be rewarding him for following the plan and showing brave behaviors!

Katherine K. Dahlsgaard, Ph.D., is lead psychologist at the Anxiety Behaviors Clinic in the Department of Child and Adolescent Psychiatry and Behavioral Sciences at the Children's Hospital of Philadelphia.

About this blog
Anna Nguyen Healthy Kids blog Editor
Sarah Levin Allen, Ph.D., CBIS Assistant Professor of Psychology at Philadelphia College of Osteopathic Medicine
Stephen Aronoff, M.D., M.B.A. Chair of the Department of Pediatrics at Temple University Hospital
Peter Bidey, D.O. Medical Director of Family Medicine at Philadelphia College of Osteopathic Medicine
Christopher C. Chang, MD, PhD, MBA, FAAAAI, FACAAI Associate Professor of Medicine in division of Rheumatology, Allergy and Clinical Immunology at UC Davis
Katherine K. Dahlsgaard, Ph.D. Lead Psychologist of The Anxiety Behaviors Clinic at Children's Hospital of Philadelphia
Gary A. Emmett, M.D., F.A.A.P Director of Hospital Pediatrics at TJU Hospital & Pediatrics Professor at Thomas Jefferson Univ.
Mario Cruz, M.D. Pediatrician, Associate Director of Pediatric Residency Program at St. Christopher’s Hospital for Children
Magee DeFelice, M.D. Division Chief of Allergy and Immunology at Nemours/Alfred I. duPont Hospital for Children
Hazel Guinto-Ocampo, M.D. Chief of Pediatric Emergency Services at Nemours duPont Pediatrics/Bryn Mawr Hospital
Rima Himelstein, M.D. Adolescent Medicine Specialist at Crozer-Keystone Health System
Jessica Kendorski, PhD, NCSP, BCBA-D Associate Professor in School Psychology/Applied Behavior Analysis at Philadelphia College of Osteopathic Medicine
Anita Kulick President & CEO, Educating Communities for Parenting
Janet Rosenzweig, MS, PhD, MPA VP for Programs & Research for Prevent Child Abuse America
Beth Wallace Smith, R.D. Registered Dietitian at Children's Hospital of Philadelphia
Jeanette Trella, Pharm.D Managing Director at The Poison Control Center at CHOP
W. Douglas Tynan, Ph.D., ABPP Director of Integrated Health Care for American Psychological Association
Flaura Koplin Winston, M.D., Ph.D. Scientific Director of the Children’s Hospital of Philadelphia’s Center for Injury Research and Prevention
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