Next up must be pediatric dentists. I had to work hard to find a dentist who would allow me to hold my child while she, age two, had four teeth removed under conscious sedation. The first person I spoke with about it at Boston Children's Hospital suggested we do the removal without sedation at all. That would have been a disaster. I held my child while an amazing chief resident performed the procedure. Not fun for any of us, but much, much better than the alternative, which can sometimes involve papoose boards and usually has no parent anywhere nearby.
1
The author is apparently unaware of the latest advances in pain management for infants and children such as Buzzy. It's a vibrating bee shaped appliance that temporarily desensitizes the skin before an injection, minimizing the pain and reducing the anxiety a child feels when getting a vaccination.
1
The more negative experiences people have with their medical doctors (both their own or their children's) the less they will seek out their opinions or help when it comes to anything health related. Children who are screaming and crying will remember how much they hate going to the doctor, and that will impact the rest of their lives. The resistance with getting a flu shot as an adult? Perhaps due to terrible experiences as a child. Children are treated often without the thought of what pain they may be experiencing. This is true for urology testing as well as other invasive treatments or testing.
2
@Izzy Exactly true! I was one of those children. I was held down for penicillin shots. I cried and screamed. I'm still mad at my pediatrician.
1
Sometimes the problem is the skill of the person doing the needle stick or the blood draw.
My pediatrition's office included a nurse named Max who gave all the shots. That was over 50 years ago so I don't remember her exact technique but basically it was over before you realized that she was there and there was never any after effect. In my teens I needed an inoculation before an overseas trip. Max was on vacation so the doctor gave it to me. He hit a muscle in my arm it hurt for several days. Luckily he was able to joke about his relative incompetence when I stopped in after school and showed it to him.
Fast forward to the aughts and Westchester County Medical Center. I had two minor procedures four years apart and blood draws before each. I frequently donated platelets so I knew what a competent blood draw should feel like. The first time the hospital phlebotomist had serious trouble finding the vein I had all plumped up for her thus causing me a lot of pain. Four years later, same doctor and you would have thought her technique would have improved by then but you would be wrong.
3
It is about time! One of my sons developed a fear of needles and blood draws in his mid-teens when he was ill for a while. He would turn white and faint. Scary. Several times, I found him sliding to the floor from a chair while getting blood drawn. He would even would faint sometimes lying down on an examining table. So when he left home for college, he did avoid medical appointments and vaccinations due to needle phobia-sometimes for years. I got him some numbing cream and had him apply it before a scheduled test or needle. Over the course of a few years, he gradually lost his fear of needles and now does not use the cream. I always thought it ridiculous not to use something for pain for little ones. After all, if someone without notice or preparation, stuck an adult suddenly with a needle, what do you think the reaction would be? I think it is OK for parents to help their children avoid a bit of pain in life.
4
@Marlene I. Shapiro Always warn the phlebotomist you have, or your child has, a history of passing out during procedures such as vaccination or blood drawing. A good facility will have a "cot" to lay on so there is no danger of "sliding to the floor." An experienced phlebotomist is watching for signs of potential fainting from the start and I've caught my fair share of patients who had never fainted prior to this particular phlebotomy. A doctor or nurse practitioner's office will have a table to lay on.
I can handle shots and blood draws but I (an adult) am terrified of strep tests and refuse them. I attribute it to many traumatic strep tests as s kid, plus a bad gag reflex and general anxiety. My kids can tolerate them but just barely (and have no idea I refuse them for myself!). I can’t wait til a substitute is found.
Circumcision is the removal of the most sensitive part of a male sex organs with little to no benefit. Considering the studies of pain and it’s ethical consideration. How is it that this is rarely addressed in medical discussion around pain and the life long effects. Consider watching American Circumcision on Netflix!
1
@Lowrey I graduated med school in 1968 and since then delivered many babies. At that time we did circumcisions with the old Gomco clamp or the Plastibell without any anesthesia. The baby was strapped in "Cirumstraint" sort of a plastic mold to hold him still. Needless to say this was probably unpleasant. Over the years I looked into this more. Done with topical Emla cream and a penile nerve block it is essentially painless for infants, older boys and adults too. The American Academy of Pediatrics has changed their recommendations about infant circumcisions. They are not as anti-circ as before. Many urologists and myself recommend infant circumcision because we have to deal with the older boys and men who come in with very tight foreskins and inflammations due to inability to retract it for proper hygiene. In Africa studies have tended to show lower risk of STD's and AIDS transmission in circumcised men. There is a lower risk of penile cancer but this is related to hygiene more than circumcision per se. Mom's and Dad's need to teach all boys about hygiene. Uncircumcised boys should be able to retract the prepuce by age 4 or so during bathing to remove the secretions (smegma) that can accumulate. Infant circumcision has been discussed and debated in the medical literature. A lot of persons get biased or incorrect information about it on the internet. They can get professional information provided by Mayo Clinic, WebMD, Medscape, etc. that discuss all the pro's and con's.
1
No mention of the important work of child life specialists ... really??!
8
my children's pediatrician, Jean Bennett in Clearwater, FL in the late 1960's did all of these right things to make injections easier on the children and me. I am surprised this is now news. She was a wonderful doctor and the kids were never afraid of her.
2
The best tool for needle pain relief, by far, is Buzzy. This device combines high frequency vibration with the benefits of ice. Through a physiological process, Gate Control, the central nervous system receives these two sensations before the sensation of pain and as a result of it, a decrease of up to 88% in the sensation of pain. In Brazil, Buzzy is widely used by hospitals, vaccination clinics and clinical analysis laboratories as well as patients with chronic diseases and other patients who use intramuscular or intravenous medication. There is no such tool on the market as Buzzy. There are around 28 clinical trials that corroborate the effectiveness of Buzzy in various medical procedures.
2
@Evandro I've worked in 2 pediatric clinics, one of which we used buzzy. While I think it is often effective, I also often found that even buzzy itself induced anxiety d/t knowing the shot was coming when buzzy was turned off. I often found the best way to approach the fear was to try to understand the fear. I felt that often coaching the child and letting them know every step you were taking was very helpful. Most of the fear I find comes from one bad experience, often like when you clip a dogs nail wrong once. They remember, and I think it is similar with children. it only takes one bad experience. I feel the one thing this article fails to mention is parent compliance. Often times parents are reluctant to be involved in the process as they do not want their child associating them with pain.
1
My daughter is an pediatric oncology pharmacist at Children's Hospital in Minneapolis. I'm very proud of her and good to hear of very simple common sense procedures being implemented at her work place. I know she works her buns off there. Mostly proud they keep options open for patients. Real life tough job. I am not a medical person and am mostly critical of that whole industry. Nevertheless, knowing people that are of the category of knowing the needs of their patients, and that does include my daughter, makes me less cynical.
2
I have researched needle pain for over 20 years (hence my inventing Buzzy). Needle fear has increased 252% since 1995 not because America is coddling youth, but because bad needle experiences in childhood can cause phobias. If you were born before 1983, you only got 6 scheduled injections and you got them before you could remember. We can't have empathy for routine needle fear! Boosters added in the early 80s extended the life-saving capacity of vaccines and community immunity. This means by 2000 US kids could get up to 36 scheduled pokes before age 6; Taddio found, as we did in our NIH Buzzy research, a 63% incidence of high needle fear for kids born in 2000. I published in Vaccine in 2017 that 50% of preschoolers who got 4 or 5 of the 4-6 year boosters clustered on one day were in the highest needle fear group 6 years later (at age 11-12). And they were 2.5x more likely to refuse the cancer-preventing HPV vaccine. Only 9% of the kids who got the same total number of injections staggered between age 4-6y with no more than 2 pokes on one day were afraid. We old folks think we were tougher or stronger, but we were just too young to get traumatized - the early vaccine schedule critical for immunity didn't cause needle fear. Just in the 4-6y window for boosters. 8% of parents who fear needles don't vaccinate their kids. 63% of kids born in 2000 fear needles. This math is terrifying for community immunity. Thanks to Dr. Klass for raising awareness of a problem.
26
@Amy Baxter MD
Thank you for your service to children and your community. Your device has the potential not only to alter pain perception, but also to save lives for the reasons you've outlined.
I'd have given anything for a Buzzy 65 years ago when five grown-ups were holding me down in the school cafeteria for my second polio shot. Made sure that my mother forgot (the silver lining of having neglectful, distracted parents) when the third and fourth were scheduled. Spent years dreading the possible consequence of getting the disease, but dreading the injection more. I followed the development of the Sabin oral vaccine and returned to my grammar school of my own volition at age 16 to swallow the sugar cube, with great relief. I never came down with typhoid, tetanus, or diphtheria, either, but not because I got vaccinated.
I still hate shots but have long been appropriately immunized because my phobia matured into mere loathing. But if it hadn't I'd be packing a Buzzy for all doctor's appointments, with utter disregard for my dignity.
7
@R Valentine it is my hope that kids who reach for a Buzzy will feel empowered for a physical rather than a pharmacologic solution during their lives. Because we study pharma so much in medical school, we don't have a bias against recommending drugs, but we do against devices. "You're up on what you're up on", I suppose. We have a responsibility to train kids for good health practices. Until we make it so grabbing a physical solution for a physical problem doesn't risk lacking dignity, we haven't done our jobs.
3
Thank you for this article. Reflecting on compassionate programs like these is a powerful antidote to despair.
6
Most shots are not very painful in the physical sense, as it is psychological. Distraction techniques could probably do wonders to alter the stressful environment in which a strong fear of needles develops in. The anticipation of the dreadful pinch is where most of the panic sets in. How shots are discussed and prepped in front of the children can be extremely problematic.
I developed paralysing arachnophobia as a child after I stumbled into a black widow’s web. But my fear of spiders began bubbling before that event only because I created this monstrous image of spiders in my head. Had I not heard horrible things about spiders from family members and other school children, that incident probably would not have set off the alarms and panic that it did.
It is so critical to minimise the fear of needles by reducing the trauma in children’s healthcare. I have adult friends who have skipped out on important travel vaccinations, or who cannot receive important healthcare procedures without their mother in the room. As anyone with a phobia knows, it doesn’t appear out of thin air..
6
It is terrific that these very humane common sense advances are being made. There is a general lack of understanding how traumatic experiences (and yes, a shot is traumatic when you're a baby or toddler) can set up a lifetime of anxiety, startle responses, and phobias. Think PTSD.
I take serious issue with one statement, though. That is the suggestion of using "nitrous gas". Without knowing a child's MTHFR status, that is a potentially deadly decision. A little too much nitrous oxide can be fatal for those with this mutation. MTHFR mutations are surprisingly common, and most doctors are surprising ignorant about MTHFR (and the SNPs that ride along with it). Among other things, MTHFR mutations impair the body's ability to clear toxins and drugs normally, such that people can be poisoned by standard doses. I myself had a near death experience in a dentist's chair when I was 16. It was beyond terrifying. Nobody knew about it in 1967, but now, there's no excuse. If you are a medical professional reading about MTHFR for the first time, go to PubMed and enter it into the search bar. Start reading; this is real and well-studied.
7
Thank you, Drs. Friedrichsdorf and Chambers!
Wonderful important work - I hope in a few years, all pediatricans will have learned your approach of minimizing pain and distracting from it, and the "hold 'em down" SOP will be history.
And as was pointed out: this empathetic approach to painful procedures is important for adult patients too!
2
They skipped the most obvious. When I take my 7 year old for a shot I tell him to even glance at the doc or the needle. I keep him looking at me and facing away. The shot takes a second and he usually only reacts to the bandaid being stuck on ... sorry son you missed it... it’s all done.
2
@Budley interestingly about 20% of kids get relief from the control of WATCHING the needle; it increases their distress to try to make them not watch. For the other 80%, not watching is great! Problem is with sentient children that after one poke, they're highly attuned to number 2/3/4+ so a pain and distraction strategy makes sense.
1
I never watch while they stick me and had my kids turn away as well. I also promised at stop at 7-11, Starbucks when they got older, for a Slurpy or special drink. It worked for us!
You can’t say it won’t sting or hurt, but you can focus on something else.
This article is ignoring the elephant in the room. Infant circumcision. babies pinned down? Yes. Inadequate pain management? Yes. most doctors or residents use none. They either are afraid of the risks, dont know how to administer, or just cant be bothered. Studies have shown babies subjected to circumcision have higher pain responses later on during vaccinations. The pain and trauma causes PTSD. and other brain related changes. By the way infant circumcision is entirely uncecessary and NOT recommended by over 22 pediatric associations around the world, and no medical association recomends it either.
6
I’m afraid of influenza, and measles, and meningitis, and diphtheria, and pertussis, and hepatitis, and polio. I have raised my children to be afraid of diseases and to be grateful for vaccinations. We need to be made of sterner stuff than to be anxious about a needle stick. Children need to learn to deal with some discomfort and they usually do manage to deal with getting shots by a fairly young age.
12
@Sherrod Shiveley. We don't raise "sterner stuff" by mistreating babies. I know the shots are necessary, and there are so many of them, it seems worth it to me to make them as easy (for the patient!) as possible.
1
I wish a difference had been made between pain management and pain suppression. It is one thing to breastfeed or use distractions, it is another to use lidocaine. Not only do drugs have side effects, they may induce the idea that no pain is endurable, which is very dangerous.
Besides, lidocaine will not make a situation in which the patient is not informed of what is going on right. Respecting the patient as a person is the first step in managing pain. A baby is a person and needs to be respected as such. If you do not know what vaccination is or which diseases it prevents, you are not receiving medical care, you are being tortured.
3
@Marie
I nursed my son through each one of his childhood vaccinations (born 2003, so he had many) and it really truly works. At most there was a whimper. But even if he had cried, I’d have still proceeded for his safety. It doesn’t have to be torture if the necessary medical care (even if uncomfortable) is followed by compassion, regardless of the child’s level of understanding. I’m very sorry for what you must have experienced or witnessed as a child regarding medical care.
1
These techniques have been used in my kids’s pediatricians offfice for many many years as well as other pediatrician offices. It seems common sense. Don’t see why this article is even written and why children’s hospital of Minnesota is acting like they had a major breakthrough discovery.
9
I thought the same thing
@jmax It's because these techniques certainly aren't being used by all, or probably even most, vaccine providers.
4
As Dr. Paul Offitt was recently quoted, vaccination is an act of violence. Injecting anyone, especially neonates with undeveloped immune systems, with neurotoxins such as mercury and aluminum (especially in combination), as well as emulsifiers, foreign proteins, formaldehyde, and others is no way to improve anyone's health. Vaccines are not safety tested (read the vaccine inserts), especially in combination. Why do we have the Vaccine Injury Compensation Program (VICP) if vaccines are safe. Take a look at the FDA's Vaccine Adverse Events Reporting System (VAERS) database and see how many adverse events are reported and know that only from one to 10 percent of events are actually reported. If that doesn't tell you that vaccines are unsafe, I don't know what is. Couple that with the CDC fraud on the MMR autism study. What is being done to children is akin to genocide--no informed consent.
@Dan
you are deeply misinformed. Since precise information is readily available on the number of lives saved, and blindness and deafness in children averted, through childhood vaccines - one can only conclude you don't want to know.
Withholding available, lifesaving vaccines from a child would be an act of violence.
20
Dr. Offit is also very, very, very clear that vaccinations have nothing to do with autism.
6
The shots are not as bad as drawing blood. The shots are over in a second and they get a sticker and candy. The blood draw, however, is terrible. You really have to hold the toddler tightly. And most of the technicians you encounter in Labcorp have no idea how to treat children and how to soothe them. They just stick that needle in and move it side to side while your kid shrieks from pain. They don’t take the time to be sure of the vein before poking and they don’t take a moment to talk with the child, distract them, or ease the parents’ concerns. Then, you have to come back another day and wait in the waiting room another hour only to further the child’s anxiety.
10
@R Sounds like a bad experience. Children's hospitals are sensitive to this and use very small needles, distractions and technicians and nurses who are well practiced in accessing tiny veins.
My pediatricians office draws the blood.
@R I know that most people have to go to a particular lab because of their insurance but you do have a choice as to which branch you visit and which phlebotomist draws your child's blood. Call the regional office and ask for the Field Operations Supervisor or local supervisor and get a recommendation. Unless it is an emergency, an elective blood drawing can be planned in advance with a nice, patient, and experienced phlebotomist who will behave in the opposite manner of those you have experienced. I'm very sorry your child has had such a terrible time with blood draws. I have a feeling future visits will go a lot more pleasantly for your and him/her. Try to make an affternoon appointment, at a non-busy lab time, so that the phlebotomist can give your child all the attention and care he or she, and you, deserve.
I'm one of those people with a crippling needle phobia that began early in childhood. I have so many memories of fear and pain from getting shots at the pediatrician's office. I was terrified of the doctor and the nurses, in particular, who gave the shots and always made comments about how ridiculous and babyish I was for being afraid. My parents never took my fears seriously, instead chose to shame and humiliate me over them. I have bolted from doctor's offices and phlebotomy chairs, avoided medical care, and generally been fearful of the doctor ever since. If I need a blood draw, I need anxiety medications and will still struggle with my fear and cry, even while loopy on Ativan. It's no fun. Please, parents, do better with your kids.
33
I am one of those terrified adults. I had a difficult surgery as a toddler which I remember too well. I’ve never trusted doctors or nurses since. I’ll do almost anything to avoid an injection, cannot tolerate surgery. Years of therapy have made no difference. If I’m not put completely out before anyone tries to move me around, I try to kill you. Should have never happened.
20
@Delawarewriter A person suffering from a phobia or PTSD is not a snowflake who needs to get over it. A phobia causes an irrepressible emotional reaction. I too started young, in intensive care as a post-term baby (early fifties) being stuck with everything they could come up with, far from my mother. I came out of it physically healthy. But my childhood still feels like it was an endless series of doctor visits and shots, one after another. I'd start forgetting, and then another round would come around. And that was when there were many fewer vaccines, compared to today. I can now control myself when necessary. I use EMLA myself. With every new doctor, I have to negotiate the number of sticks I will get, convince them that they have to be really necessary and not just routine in case anything comes up. I expect this to get more and more difficult as I get older, as so many more things can and will go wrong. If the doctor won't negotiate, I can change them, something children cannot do. And uh, thanks, I'm retired and can stay in bed, I'll take my chances with flu.
@Delawarewriter You can ask for the person who does the best blood drawing (phlebotomy) or gives shots the best and never NEVER feel embarrassed to refuse the assigned technician if you were comfortable with another person. As a former supervisor of new and experienced phlebotomists I knew who was good with children. Ask medical professionals who you know, or ask friends, relations, and neighbors, for the names of those lab personnel or doctors' office staff who treated them patiently and kindly. I would get frequent phone calls from anxious parents and direct them to the site and phlebotomists that would fit their particular situation or child. Adults are just as scared, if not more so, than children at times; demand good care and don't take no for an answer!
Topical anesthesia (like EMLA cream) is great for the inpatient pediatric unit, not so practical for a busy outpatient pediatric practice. Breastfeeding during vaccines works really well for infants. Using sugar water is also surprisingly effective for young infants to reduce the experience of pain. I am also surprised that Dr. Klass did not mention Buzzy that uses vibration and cold to block the pain receptors from experiencing pain related to shots (and blood draws), which has been shown to be more effective than EMLA cream in reducing pain sensation. Also, the Buzzy is supposed to be used with distraction cards because it is true that distraction alone can be effective in reducing pain. Places like Children’s Hospital of Philadelphia uses Buzzy in their pain control procedures as well. But, unlike EMLA, you can purchase it and use it for your kids. I don’t get anything from the company, I’m just a pediatrician mom who uses this for my kids (and have seen it work well firsthand), especially when my kids were older than 3 years old and started having signs of being scared of needles. (buzzyhelps.com)
14
I agree about the Buzzy! My eight year old was so terrified of the flu shot that last year, after 15 minutes of various distraction and breathing techniques failed to calm her, I had to hold her arm still so the nurse could give her the shot. This year, with the Buzzy, there was no problem whatsoever. Go Gate Control Theory!!
5
Breastfeeding before and during vaccination and blood draws is called Tetanagelsia, (teta=breast; anagelsia=numbing or absense of pain). I encourage mothers to start breastfeeding before the procedure. Several local vaccination clinics also encourage Tetanagelsia.
9
@Lizette. And there's no reason to stop using it at one year, if the child is still breastfeeding. "Mummy, I'm scared, it hurts, noo noo!" (my children's word for breastfeeding) "No dear, you're a year old now, get over it"
OK, so, according to this article these "strategies" will work for adults, too. So, where can I find someone to breast feed/hold me on their lap the next time I need a shot?
Super lame article. Zero interesting. Zero newsworthy. Belongs in Parents magazine. Or possibly USA Today.
Bottom line: people need shots and blood draws throughout their lives. The needle stick takes a nano-second. Take a deep breath and the whole thing is over. Get over it. This sort of nonsense is part of what is wrong with America. Good grief.
14
@Nadia
"Get over it" is what's wrong with America, i.e., the inability to have sympathy for or empathy with people who experience traumas you haven't (yet), or experience them differently from you. "Get over it" won't stop a panic attack, cure a phobia, ot reverse PTSD. "Get over it" contributed to women feeling impotent in the face of sexual harassment and assault. A surfeit of compassion won't be the downfall of this country but a dearth of it just might.
16
@Nadia my daughter has a chronic illness that requires her to have 26 shots and 4 blood draws a year, at minimum. I do not expect her to “get over it” nor do I expect this of a child who receives one shot a year. As an optimist, what I do expect is compassion from my fellow humans. I am grateful to anyone who discusses these techniques as best practices, as they are not commonplace (in some cases, they are disallowed) and some of them have mattered very much to my daughter. I’m sorry that you don’t possess the empathy to understand this. What Children’s Minnesota is working on is novel in the field of pediatric healthcare and thus newsworthy.
11
why is there no mention of nasal mist vaccines?
@Burt because there aren’t many. FluMist is the only I’m aware of, and it’s not as effective as a flu shot. As a needlephobe, I once got the FluMist vaccine, and I could not breathe out of my nose for 4 days. As much as I hate needles, a flu shot is less bad.
1
My dad, having grown up Tennessee in the 1920s when needles were not as sharp as today’s (and those needles were routinely sterilized and reused), described his own experience of receiving shots—
The family doctor, without fanfare, briskly slapped the skin before plunging in the needle. My dad swore that he never felt the shot.
We feisty kids often suggested that a solid punch in the arm might have worked well, too.
8
I have to disagree with those who say lidocaine will take too much time and be too bothersome.
After one of our daughters became terrified, our pediatrician gave us a prescription for lidocaine and before vaccinations, I applied the cream and covered with a waterproof bandaid, at the proper time before our appointment.
Except for the time it took the doctor to write the prescription, it didn’t impact the office staff at all.
6
I'm a physician and I can say lots of luck with the lidocaine, It's difficult to get this to be given to male children before circumcision, a one time deal. Busy pediatricians are not going to incorporate this in their vaccine administering regimen.
Distraction is most practical. However, the idea that there is anything new to this is ludicrous. I remember that when I was a child over 50 years ago, there is magazine for kids called "Highlights" that most pediatricians had in their office (I believe they were given them for free) and that on several occasions it had cartoons where kids (or animals portrayed as kids as many of the cartoons did) who were frightened of needles ended up getting their vaccines when they weren't aware and being surprised that they didn't hurt at all.
1
As a pediatric nurse practitioner in primary care, I often like I was working in a torture chamber. Shrieking toddlers at the entrance abandonned all hope, realizing what lay ahead. Topical anesthesia for small clinic procedures has been available for decades but typically medical and support staff consider its use unnecessary and time consuming from what I have seen over the years. Establishing an effective pain prevention program in primary care is a formidable undertaking. For a start, all staff have to be on board and well coordinated to avoid sabotage.Topical anesthesia has to be applied from the very first visit or a phobia will set in early on. Here are some other points on the subject of shots and children. Actually it's best not to say 'shots' and certainly not 'needle': try 'little stick' or 'sting' instead, and say it won't hurt too long which is true. Home preparation with instructions on what to expect is key. Too often parents just spring doctor visits for shots on a child. Consider a split visit: a four year old might manage two shots with dignity but four are just too much; the child loses control and feels humiliated. For the person doing the injecting, don't dart it, just put it in. About pinning down: obviously jumping on the child is to be avoided but adequate restraint must be achieved or there will be big problems. Finally in dealing with children, you must be honest.
12
The trouble with Dr. Klass is that she states the obvious so matter of factly.
I don't know where she went to medical school, or where she practices, but it is clearly not in the U.S.
But then again, when I was a kid, we went to my cousin who was an old fashioned GP. He delivered babies, took care of kids performed surgery, and took care of adults and their parents. This was in a medically well served upper middle class area of New York City.
1
The topical med has to be left on for a long time, in a large amount under occlusion, to get any effect.
Better to have the kid in the parent's arms and lap, and give the shot fast whilst pinching the skin, or using some counter irritant (scratching, vibration, diversion, etc).
And NEVER lie to any kid by saying that it's not going to hurt!
12
Topical anesthesia should be used only sparingly and should not be the standard of care for childhood vaccinations. They can have side effects and cause an adverse event in a very small number of children, some very serious.
3
@erik Our wonderful pediatrician in San Francisco in the 1960's would tell the child that he was going to give a shot. Then he said, "if it hurts, tell me to take it out and I will." The kids felt that they were in control and of course, by the time they said "Take it out," the action was completed. He also took phone calls at home in the morning during breakfast. We look back on our good fortune to have this lovely man as our doctor. And he never gave shots indiscriminately without a culture.
21
@sunset patty My pediatrician father in the 1960s said he preferred to do procedures without the parents in the room because the parents always got the kids worked up. The kids were much braver alone. I don’t remember what procedure/s he was talking about (probably shots) or the age of the kids (probably elementary school).
5
@erik
ludicrous
who are you? pediatricians know this sort if numbing is 100% safe.
4
I love how the 2 most vocal comments up to this one came from California. not surprised at all. when I was small my mom would lightly snack my other arm with a wooden spoon. then the doc would give me the shot. I never felt the shot and mom would ask, did the doctor shot hurt? and I would honestly reply that i didnt feel it at all. I'm sure the Californians are going into apoplectic shock right about now. oh and when we had a toothache, a little whiskey rubbed on the gum did the trick just fine.
12
@bored critic--I used a bit of tequila when my kids were cutting teeth. (They never had toothaches.)
4
Very interesting. I was always offered the chance to hold my babies while they got their shots. The only one who was held down was the one who was very needle phobic and that only happened after she was big enough to fight people off. She's much better now, but still likes to take her favorite stuffed animal with her, even as an adult.
2
@Jennie
My daughter was doctor phobic when she was young. (Probably an off shoot of needle phobia which she also developed). She asked (and I agreed) if she could take her blanky with her and she would cooperate. I was horrified when on doctor asked me how long I was going to allow such behavior. (Blanky only left the house to go to the doctor). I pointed out that she had behaved admirably so what was his point. I never went to him again. A child should be offered whatever comfort that works for them. If the doctor doesn't understand this, replace him/her.
49
My youngest daughter has a heart condition and is treated at Columbia, a world class hospital where they do a million things so smartly and sensitively. However, for routine appointments when they need to draw blood, it's all done in their phlebotomy lab, and and in the waiting room for the lab, kids await their turn while listening to other kids shriek from pain. It's just about the worst set up.
39
@Lizzie Simon Hopefully your comment will be read by enough folks at Columbia and they will evaluate this situation and consider how to improve it.
No one benefits from this current arrangement. Not the children, their parents/guardians nor the staff.
Your comment is an opportunity to inspire change.
9
pain is part of life. now you're gonna substitute that with opioids...
2
@Doug
There's no part of the article that recommends opioids.
23
@Doug
Topical lidocaine is not an opioid. A child does not need to be toughened up for life's problems by being subjected to pain before they even understand the concept. Have you ever had to undergo surgery with no pain meds afterwards? I have because I have bad reactions to pain meds. Even understanding that pain is part of life, that was a horrendous experience that I don't recommend even you to have to experience.
28
My dermatologist has a wonderful simple solution. She scratches your skin with one finger near where she’s putting the needle in. You do not feel the needle.
10
Something similar: I was scared to death of needles until a nurse was about to give me a shot but started slapping my arm to which I didn’t really get what she was doing. I then realized she had given me the shot—I was flabbergasted! I didn’t feel a thing, almost didn’t believe it! I’ve never been afraid of a needle ever since.
4
@Cheryl
My son's pediatrician did something similar. He used a plastic flower with a hole cut out of the center (like a 1960s-style daisy). There were nubs on the back side, which stimulated the area, so the nerve endings in that area didn't register the shot. The whole thing was soft, almost like one of those pink scalp massagers. It was good for 2 shots, then the sensory trick wore off. Thanks to this, my son never minded shots and never developed a dread of needles. He is 18 now and actually watches his blood fill the tube during a blood draw. (Ugh. I have to look away.) I use a similar trick when I get a flu shot or blood draw-I pinch a different part of the body. I don't even notice the shot. Although, I will say that needles are so much finer now than in the 1960s when I was growing up.
1
When my son was an infant and toddler, we put a topical numbing ointment on his thigh before going to the office. At the office, we would do the toy distraction thing. Once he was about 5, we started talking about how no one likes getting shots but they are very important. I would also often get a shot with him to demonstrate. Shots make me ill, not the pain but rather the idea that something is being injected into my body creeps me out. I don’t hide my revulsion. He has no problem getting them and gleefully watches me make all kinds of faces getting mine.
12
Oh it was so nice to see this story. My health communications team launched the topical lidocaine/xylocaine combination emulsion to prevent injection pain in children back in the mid 1990s. The efficacy and safety data were based on a study called "CHEER" that took place in a large number of US children's hospitals. The slogan? "The cream that stops the scream". On the one hand, this is just a small corner of the world of medicine and healthcare, but on the other hand reducing a young child's fear of the doctor can affect his or her lifelong attitude towards medical encounters.
26
Easy enough to use topical anesthesia or other numbing techniques for injections, or conscious sedation for other painful procedures on children or adults. But it takes more time and in some cases additional training and expertise, so it doesn’t get done by some medical providers. No one will be more proactive about their health care than the patient and their family. Don’t be afraid to speak up.
16
I too was surprised there wasn't a mention of Buzzy, a small bee-shaped device that uses cold and vibration to minimize the sensation of being poked. We have a child with type 1 diabetes who thankfully adjusted to shots and countless finger sticks quickly, but as a JDRF volunteer visiting new onset patients at our children's hospital, I see many kids and parents for whom it is an agonizing transition. I wish I could bring a Buzzy to each new family. It's a very simple thing, but extremely effective in mitigating the pain and fear of shots.
34
Shortly after midnight on what had just become September 17, 2014, I had an arrhythmia and went to get it checked out. The cardiac catheterization was painless because of the lidocaine topical anesthetic. My first thought was why don't pediatricians do this for vaccines? I was 49, and remember the pain of receiving shots as a toddler. For adults it is minor, but for young children it is traumatic. If the solution is that simple, it should be standard practice.
18
Great ideas, and overdue. I am of the belief that children’s experience of pain may be different, and more intense, than adults’. At least that’s my own experience. I went from one who would pass out from injections as a child, to a person who gave birth without pain meds as an adult.
19
makes total sense.
I have told my daughter since she was an infant that the vaccine might hurt a little bit but that it's for her own good, while on the way to the doctor, and held her on my lap for every single jab. Minimal cries, over in under a minute. Now that she can talk, she says bye bye to the doctor when we leave!
12
I'm so glad to see.that children's pain and fear are finally being taken seriously! I once spent an entire year in the 70s dreading an upcoming booster shot. (I thought it was going to be done at the end of one school year until the doc casually said, "Eh, let's put it off til next year.") But the worst was in the early 60s when our pediatrician chased me around the room (in front of my mother and little sister!) then stepped on my foot to pin me down, and jabbed in the needle! Then my sister showed me up by calmly accepting her injection, declaring "That felt good! Can I have another one?" Traumatizing for me!
21
@Suzan Back in 1953, my family's GP had a much wiser approach. I was in my bedroom. He sat between me and the door holding a syringe. I'd fled into the farthest corner.
He just sat there, and quietly said "I have all the time in the world. I'm not going to chase you. I'll just wait here until you come to me."
I considered spending the rest of my life huddled in the corner. Then I took a deep breath and slowly approached him.
The shot was quick and didn't really hurt. I've never feared needles since that moment.
11
At about the age of 7 I was strapped to a table for several sutures given in the middle of my tongue, which was clamped, with no pain management what so ever. Terrified and in very memorable agony, I pretty much screamed for my life for the duration. As an adult I chose not to have children and to avoid most medical care whenever possible. It still equates to torture in my opinion. Although I do manage to get a flu shot these days. So yeah, there oughta be a better way..
48
@AMR so sorry. Some medical people are just brutal and unfortunately it still happens.
5
Seems to me that doctors and parents generate the anxiety which the children pick up and then things snowball. It seems less about the actual pain. The doctors don't know if the child will get hysterical and goodness knows, they have other patients to attend to. The parents don't know how to soothe the children. And so the children panic.
I think there should be some yoga exercises incorporated and lessons in imagining how one would construct a giant banana split, as a way to distract.
6
Simple techniques to distract the child or quick prep things like ice cubes should be employed, but to say that nitrous gas or sedation should be used is simply impractical and frankly too ridiculously indulgent for some minor discomfort in life that lasts two seconds. What does this teach our children except that life should be free of pain?
25
@Kenneth Bolin
the article is not clear I know the physician quoted and he advocates nitrous or sedation for significant painful,procedures NOT for immunizations....
2
As a parent of a child requiring daily injections, I'm surprised that there is no reference in this article to a "Buzzy", a US-developed, bee shaped device (with thin ice-pack wings) that vibrates when placed on the child's skin. The combination of cold and vibration numbs the area and creates a distraction. It's worked extremely well for us for a number of years, and doesn't require button batteries (an ingestion and choking risk).
69
For years I've wondered why dentists can so effectively numb my mouth before injecting it with xylocaine but no one ever tried numbing the skin on the outside, especially for kids. It must have something to do with thinking, "Why bother, it'll be over in a second or two."
35
yes it is over on a second. so you have a second of discomfort. is that really a big deal? are you really saying that there should never ever be any pain or discomfort in life? good luck with that. and just what type of adult person will that make in later life?
6
You know what else would help? If the media would stop using photos and videos of screaming children at the moment the shot is being given. I’m horrified at how often such a photo or video is used to illustrate a news story. Horrible
56
Just about every photo used by the media (including you NY Times) on an article about vaccines shows a screaming infant.
Is that reality? Usually the jab hasn’t even been given but still the kid is screaming.
An injection doesn’t actually hurt. Trust me, after 45 years as a T1 diabetic, an injection rarely hurts, and when it does the pain only lasts a second or two.
27
I disagree. Some vaccine and antibiotic injections are painful; it depends on what is being injected and where. In my experience, blood draws and flu shots are relatively painless, but it can also depend on the skill of the medical practioner.
31
Yes but there is a difference between you and a kid getting a vaccination. Kids get vaccinations much less than you inject yourself so you are more used to it in a sense than they are. You aren’t as scared of the needle because you need it to survive. My mom has been a type one diabetic since she was 13 and she’s almost 46 now and she says that the injections she has to take don’t really hurt now. That’s because she gives herself shots and draws blood much more often than a child gets a vaccination and so she’s more used to and anticipates the small amount of pain. I assume that that’s why it doesn’t hurt as much for you as well.
18
Some vaccines do hurt - measles for example- and some products also are painful. Still, I do agree with you that when you need to have blood regularly drawn from you or need regular injections, you do end up growing indifferent to that type of pain, even relishing its brevity. But it is very different for adults who can intellectualize the pain and assign it time and intensity boundaries thanks to experience; to children, the pain is infinite.
4
It’s the anticipation, the expectation: “This won’t hurt a bit”/“You may feel a little pinch.”
13
Now you're talking. This is wonderful. Kudos all around, and thank you.
24
When my daughter was two in Hawaii, the nurses numbed her arm with ice just prior to the vaccination. No pain. No tears. No stress. Seems like the perfect, simple solution.
44
Except in a potentially life-saving emergency situation, there is never ANY reason not to engage in pain reduction/elimination practices for these procedures--for children OR adults.
Perhaps if didn't have that stoic Calvinist "working through the pain is good for you and builds character" mindset so prevalent in this nation, we could see that more readily.
60
@Glenn Ribotsky
I’m helping you, so too bad! Would you rather be sick?
You will notice it’s the same justification for not attending to patients’ dignity regarding hospital garments or other situations involving unnecessary “exposure.”
28
@Glenn Ribotsky
I've long believed that our cultural expectation of stoicism in the face of trauma is character-eroding. And it insidiously reinforces the perception that compassion for the suffering is at the least, unnecessary, at the worst, unmerited.
3