Reducing the pain and anxiety of vaccination in children

It is important to vaccinate children and to respect the immunization schedule in order to protect them from serious infectious diseases.

Most vaccines are administered with a needle, which may frighten both children and their parents. This fear can lead to some parents delaying their children’s vaccination, leaving them unprotected against many serious diseases.

The attitude and behaviour of parents towards vaccination is important to a child. In fact, children observe their parents to know how to act and feel. 

There are proven methods for reducing the pain and anxiety in children who need to get vaccinated. The following tips and advice will allow you to make the vaccination experience more positive for your child. You can use more than one method to obtain the best results.

Children old enough to understand can be prepared for vaccination. Here are some tips on how to prepare your child a few hours before the vaccination appointment:

• Discuss the vaccination with your child and answer his or her questions. Explain why the vaccine is needed. Mention, for example, that it is important for keeping him or her healthy.
• Describe to him or her how the vaccination appointment will proceed.
• Never use vaccination as a punishment for your child.
• Do not tell your child that the injection will be painless. Instead, explain that he or she will feel a stinging, tingling or pinching sensation and that it will not last long.
• Tell or read your child a story about a child who gets vaccinated.
• Watch a video about vaccination together.

Behave in the following ways to help your child feel safe and reassured regarding vaccination:

• Stay calm and smile, and talk in your normal voice.
• Avoid apologizing and using words that refer to pain. Doing so will only scare your child further.
• If you feel anxious, take a deep, slow breath to help you relax and keep calm.
• After the vaccination, hug, congratulate and reward your child.

It is recommended that you hold your baby in a cradle position when breastfeeding him or her during vaccination. In this position, your baby’s head rests on your forearm or in the hollow of your elbow, on the side of the feeding breast. Use your other arm to support your baby’s buttocks and to keep his or her feet out of the way. Make sure that the arm or leg where the vaccine will be administered is clear.

If your baby is less than 2 years old, you can give him or her a sugar solution before the injection. This is a proven method for relieving pain in children of this age.

Do not use sugar water to soothe your baby when he or she is crying or upset. The sugar solution must be used only as a way of relieving pain during vaccination.

Prepare the sugar solution with the following ingredients:

• 5 mL (1 tsp) of sugar
• 15 mL (1 tbsp) of water

Do not substitute the sugar with honey Honey can cause serious food poisoning in babies younger than a year old. You should therefore avoid giving them both pasteurized and non-pasteurized honey.

1 to 2 minutes before the injection, give your baby small sips of the sugar solution from a cup, spoon or syringe. You can also dip a pacifier in the sugar solution.

If you plan on breastfeeding your child during the vaccination, do not give him or her a sugar solution before the injection.

You can reassure your child by holding him or her in your arms during the vaccination. Holding your child properly will also ensure that he or she is vaccinated safely. Do the following:

• Hold your child on your knees in the position indicated by the person who is administering the vaccination. Make sure that your child is comfortable.
• Put your arms around your child, but do so gently; holding your child tightly might make him or her more anxious.

Here are examples of how to hold your child depending on where the vaccine will be administered.

Distracting your child while he or she is being vaccinated can help reduce pain and anxiety. The part of the brain associated with pain is less active when children are distracted.

Guiding principles

• There are many methods of distraction. Use methods that are suitable for your child’s age.
• If your child is calm, start distracting him or her before the vaccination.
• Choose a distraction that will allow your child to use several senses (such as sight, touch and hearing). Encourage him or her to participate actively. The more your child is absorbed in the distraction, the better it will work.
• Keep in mind that the methods you use to distract your child must never get in the way of the person who is administering the vaccine.
• You can use toys to distract your child. Ask beforehand what types of toys you can bring to the appointment.

Distraction methods for children under 3 years

• Bring along your child’s favourite toy or a blanket that he or she usually uses for comfort.
• Hold your child close to you. Distract and comfort him or her with hugs, songs and by talking softly or telling a story.
• You can distract your child by pointing out interesting things in the room, such as a poster or an object.

Distraction methods for children between 3 and 6 years

• Before the vaccination, help your child pick out fun and comforting objects that he or she can bring along to the appointment.
• Practise a few activities with your child that he or she could do at the time of the injection. For example, blow bubbles, blow on a toy windmill or blow out an imaginary candle.
• Distract your child with a mobile device, toys or music.
• Direct your child’s attention to something interesting in the room.
• Talk to your child about things that interest or amuse him or her in order to divert attention away from the injection. For example, talk about his or her favourite movie or tell a joke.
• Remind your child to breathe slowly and deeply before, during and after the injection. Breathing deeply will distract and relax him or her.
• Allow your child to watch the injection if he or she wishes. Some children handle the vaccination better if they watch.

When a child is getting more than one vaccine in a single appointment, apply the topical anesthetic in both places.

Reactions may occur in areas where the topical anesthetic is applied. For instance, skin may become pale, red or swollen. Your child may also feel itchy. These reactions will disappear by themselves in the hours after the vaccination.

After the vaccination

Analgesics help bring down fever and relieve pain. They can be used after vaccination. However, analgesics do not have proven effectiveness for relieving pain due to an injection. It is therefore not recommended that you use them before vaccination.

Different analgesics are available over the counter in syrup or tablet form:

• Acetaminophen (such as Tempra^® or Tylenol^®)
• Ibuprofen (such as Advil^® or Motrin^®)

Before using an analgesic, read the instructions on the package carefully.

Additional information on managing the pain and anxiety of vaccination in children is available on the following websites:

• Pain Management During Immunizations for Children 
  Immunize Canada
• CARD System for coping with fears and anxiety for kids and adolescents 
  Immunize Canada
• Tout ce qu'il faut savoir sur la vaccination  (Everything you need to know about vaccination)
  Naître et grandir, Fondation Lucie et André Chagnon (in French only)
• Comment réduire la douleur de vaccination chez bébé?  (How to reduce the pain of vaccination in babies)
  Mamanpourlavie.com (in French only)

Here are a few videos and books about vaccination that you can view or read with your child:

• It Doesn’t Have to Hurt  (video)
  Centre for Pediatric Pain Research, IWK Health Centre
• Grabouillon : Le vaccin  (video)
  Coproduction of France 5 and Blue Spirit Animation, 2006 (in French only)
• RASTOIN-FAUGERON, Françoise. Les maladies. À quoi servent les piqûres? Éditions Nathan, 2002.
• DE PETIGNY, Aline. Une piqûre pour Corentin. Chanteclerc, 2003.
• Livres pour enfants sur les piqûres  (Children’s book about needles)
  Vidéothèque  (Video library)
  Association SPARADRAP, association in France helping children understand health matters (in French only)