Whether it’s an immunization, blood draw, or an IV, the idea of a needle stick typically produces anxiety in both children and adults. It’s natural for parents to want to protect children from needle stick pain, but moving them through the process effectively builds confidence—and the ability to build coping skills that they will use as they grow into adults.
At the Children's Hospital at Dartmouth-Hitchcock (CHaD), we work to reduce needle stick pain, and anxiety with the Helping Achieve Positive Poke Experiences (HAPPE) program. This program was developed at CHaD by Holly Gaspar. HAPPE brings caregivers, patients and providers together to determine a customized approach to diminish—and often, eliminate—needle stick anxiety.
HAPPE is rooted in open communication and making all pain management options available to all children. While each child may need a different combination of solutions, we always recommend parents remain calm and offer encouragement and praise that can build upon the coping strategies that the child is learning, for example, “You are so good at holding your arm still,” or “You are the best bubble blower!”
The following medication, distraction and positioning strategies may be used alone or together to reduce needle stick pain and anxiety:
Numbing cream is available by prescription and can be applied 15 to 40 minutes before a needle stick (depending on the brand). Use a half-dollar amount above the inside of the elbow for blood draws, and wherever immunizations are expected (e.g., top of the thighs for babies and upper arms for older children). Cover the cream with a transparent film dressing or plastic wrap until the needle stick. If you are uncertain about the best place to apply it, please ask!
Topical anesthetic misting sprays, or Freeze spray, can be used on an area before a needle stick.
Babies under 12 months often benefit from pacifiers dipped in sucrose, like Sweet-ease®. The sugar helps mask pain.
Nursing babies during and/or after needle sticks is encouraged. If a mother is uncomfortable nursing in front of medical staff, Sweet-ease is an alternative.
Two effective tools that go “between the brain and the pain” are Buzzy® and ShotBlocker®. Buzzy (a bee or ladybug device the size of a computer mouse) uses cold “wings” and vibration to stop pain sensations. ShotBlocker is a c-shaped tool that can be pressed down around the needle stick area. It creates enough sensory information for children to confuse the pain with the feeling of the bumps on the tool.
Deep breathing helps calm and distract children. Taking big breaths in through the nose and out through the mouth makes it difficult for muscles to become tense. Children can be encouraged to blow bubbles, a pinwheel, or pretend they are blowing out candles on their favorite type of cake.
Play strategies are only limited by the imagination. Kids love to play I Spy, listen to a story, sing a song, count, play on a mobile app or look at books during needle sticks.
The traditional way to give immunizations is to lay children on their back and hold them down, which makes anyone feel vulnerable and scared. The use of comfort positioning can shift this experience. This allows children to feel cuddled and comforted while the providers have access to a nursing baby’s legs, hips and arm, and older children can sit in-between the parent’s legs on their lap. They can sit back to belly, or belly to belly, with the parent’s arms over the child’s. This feels like a bear hug and delivers much comfort.
Older kids get anxious, too
To a 12-year-old immunizations can be especially anxiety producing. Often, this age group hasn’t experienced needles regularly since early childhood. Breaking down the visit beforehand often helps. Parents can ask, “Will checking your height and weight be hard? Will it be hard when they wash the skin? Or is it just the needle? What helps you when you’re feeling worried?” Discussing strategies like closing their eyes, deep breathing or listening to music—during the needle stick will alleviate stress. Talking about the experience afterward is an important part of building coping skills. Asking, “was the needle easier or harder than you thought it would be” can help to distinguish what went well and the opportunities to build future coping skills.
Provide Smooth Transitions
The most successful needle stick experiences include the input of the child and parent, and moving through the process in a timely way. Lingering afterward can make anxiety worse, so having a good transition plan is important. This could include, picking out bandages and stickers, visiting a play area within the hospital or pediatrician’s office, or going out for ice cream.
By providing kids with coping skills and positive health care experiences, we can successfully grow the next generation of health care consumers.
As CHaD’s Child Life Manager, Jessica Laperle supports the developmental, psychological and social needs of CHaD’s patients. She works to ensure a bridge between the playful child and the high-tech medical science of the hospital. She may be reached at Jessica.M.Laperle@hitchcock.org.