Children don’t have time for the pain—of shots

by Tom Ulrich on May 14, 2012

Feeling "a little" pinch is a small price to pay for good healthcare. But we can do more to reduce the discomfort. (UNICEF Sverige/Flickr)

I remember distinctly both of my boys’ 4-month-old well visits. Mostly because of the shots: all four of them.

Neither boy was particularly happy about being poked that much (though the shiny Band-Aids afterward did help a little).

My wife and I would have loved to help ease the pain of the shots, but we didn’t have any idea how. Frankly, I don’t know that, in the moment, it crossed our minds that there was something we could do, and it wasn’t something we thought to ask our pediatrician about. I mean, it was just a little bit of pain, right?

The problem, though, is that those little bits of pain add up. “Millions of injections are given to children around the world every year,” says Neil Schechter, MD, a pain specialist in Boston Children’s Hospital’s Anesthesia Department. Schechter recently published an article in Pediatrics where he commented that while we’ve come a long way in the last 50 years in understanding and addressing pain in children—especially after surgery or due to chronic illness—pain in the pediatric office hasn’t received the same level of attention.

“The pain from shots and other minor procedures in a pediatrician’s office doesn’t have the same poignancy as pain in an inpatient setting,” he says, “but it is still pain. And if we want to encourage patients’ and families’ cooperation and participation in routine healthcare, we want to keep pain to a minimum.”

My older son (now a second grader) napping after his 15 month well visit. Note the shiny Band-Aid on his leg.

It’s not that we lack methods for reducing pain from injection or small procedures in the office setting, even if the evidence for some of them is more anecdotal than objective. There are many local anesthetics that can be put on the skin to numb the feeling of a shot, but they can take some time to kick in. Giving a baby a little sugar water or letting him or her breast feed during the shot(s) can help. Putting pressure on the arm or leg (depending on the child’s age) around the injection site can lessen the feeling of a shot. And though it seems counter intuitive, so does the use of longer needles: “Short needles don’t get far enough into muscle,” Schechter explains.

And then there is distraction—engaging the child with a game or a book—to turn their attention away from what’s going on. (Schechter showed me a video in which the pediatrician runs a vibrating toy up and down a little girl’s upper arm, telling her to say, “elbow” when he reaches her elbow. She’s so absorbed in the game that she doesn’t even notice the nurse giving her a pair of shots in her other arm.)

“You don’t want to start talking about the procedure too far ahead of time, nor too close to when it will happen; that can actually increase anxiety and pain.”

Parents can also play a huge role in making doctors’ visits less painful. For instance, parents’ demeanor at the time of a shot has an impact. “Sometimes parents can be overly apologetic or empathetic, or take a more critical, ‘tough it out’ approach. Both can make the child more anxious,” Schechter warns. “The best attitude is probably one that is more matter of fact.”

Preparing a child ahead of time can work, too, though timing it right can be tricky. “You don’t want to start talking about the procedure too far ahead of time, nor too close to when it will happen; that can actually increase anxiety and pain,” Schechter says. “In the end, parents know how their child will react and are best equipped to prepare their child.”

So the methods are there, but why aren’t they used in pediatrician’s offices more often? That’s something Schechter is trying to understand better. “Some of these methods can be time consuming, and can add to the cost of a visit,” he says, based on surveys his team has conducted over the last few years. “The logistics of using local anesthetics, for example, can be challenging because sometimes it can take a little while for them to take effect.

“At the same time, we know from our work here that, with education, practices can successfully employ these methods to the satisfaction of both families and staff,” he continues. “It can sometimes take a few extra minutes or a second staff member in the room, but it’s worth it to, in the long run, avoid anxiety for the whole family about going to the doctor.”

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