Panicked by the poke

from Our Children Spring 2022

The job I wanted most

How to talk to your kids about their needle phobia

By Ameeta Vohra

With in-person learning back this winter and vaccination efforts ramping up, children continue to navigate an uncertain world with COVID-19.

Children face heightened anxiety if they have trypanophobia. IWK pediatric-health psychologist Dr. Elizabeth McLaughlin says that this is a common syndrome as two-thirds of children fear needles. The level of fear ranges from mild to very severe. McLaughlin says the higher the fear is, the most likely it will interfere with a child’s ability to get a needle.

“Most children report that they’re afraid of the discomfort that comes with having a needle,” she says. “Others have memories of experiences with needles in the past that make them afraid. For other children, just like with other common fears, like a fear of spiders, or snakes, they don’t know where the fear comes from. It’s just something they can always remember.”

While children want to get the needle and understand the importance of getting medication or in many cases these days, a vaccine, the procedure often causes panic.

“We know that the fear of needles has always been a factor in some people avoiding needles or vaccine hesitancy,” she says. “What I’ve noticed with COVID-19 is we’ve seen a large number of people working hard to overcome their fear to get the vaccine.”

For parents, McLaughlin says the signs are easy to tell if their child exhibits fear of needles.

“As soon as the idea of a needle is mentioned, the child may say that they’re afraid, or that they won’t do it, or just display emotions such as fear or anger,” she says. “Some other children try to avoid going to places where there might be a chance of getting a needle, like their family doctor’s office or a dentist. In other cases, the strong rush of feelings comes as a complete surprise at the last minute to both the child and the caregiver.”

After a lot of research on trypanophobia, many coping strategies have emerged which have proven effective for children. Parents play a crucial role in helping their children overcome those fears. It starts with demonstrating to their child the confidence and resilience to do things even when they are scared of the situation.

“Most children have overcome other fears in their life, like going to school, the first day of primary or going to sleepover for the first time,” she says. “It can be really helpful to remind them of that and to talk together about what tools they use to get through those situations.”

If a child becomes anxious when talk begins about needles, parents will avoid having the discussion. However, McLaughlin says there are benefits to having that talk.

“Talking to them (children) in advance gives us an opportunity to talk about some coping strategies, answer their questions, honestly and create a plan, whether they want you to be in the room with them, or what they want to bring with the appointment, or to talk about why the needles important,” she says. “Even if their anxiety goes up when you have this conversation, it usually goes back down again soon, and everyone will feel more prepared, and in fact, experiencing the epidemic of anxiety also shows everyone that the child can cope with these feelings.”

To ease the anxiety children have from the pain and discomfort of having a needle poked in their skin, pharmacies and drugstores offer topical anesthetic cream to numb the area that parents can purchase without a prescription.

“Once the cream has been on for the recommended amount of time, I usually like to have the child poke the area with something like a toothpick or a pen cap to prove to themselves that numbs the skin, and this can give them a lot of confidence,” she says.

Parents can also create a distraction plan during their child’s needle time. McLaughlin says having it could be as simple as talking about something fun or looking at something on the phone. However, a small number of children want to watch the needle procedure, so it can be a challenge to distract them. One coping mechanism for that is practicing deep breathing in advance as it calms the body. Many apps are available to help children breathe for relaxation.

There is also the option of doing a dry practice run with your child. “For some families, you can even practice at home with an empty syringe that you might have on hand for giving liquid medication and alcohol wipes and a toothpick,” she says. “If you decide to do that, go slowly in small steps and keep it positive.”

PHOTO: NANZEEBA IBNAT

Offering a small reward to children for going through the needle procedure is encouraged. Still, McLaughlin says it’s essential not to give or withhold based on an expression of emotion such as crying. Feelings and emotions are normal, but the key is to reward based on what they have done to help the procedure be successful such as holding still. How a child remembers a needle will influence their coping strategy for the next one.

“When your child’s needle is done, help them to focus on what went well and their resilience,” she says.

“Something like, ‘Yes, you were nervous before the needle went in, and at the same time, you did a great job holding still, and you felt so proud of yourself as soon as it was over.’ ”

McLaughlin says parents have the opportunity to set the tone in the moment. How they behave and react can reflect how a child perceives the needle situation.

“If the child looks to their parents and they can see that their parent is calm and confident, that they’ll get through, that’s going to be helpful,” she says. “On the other hand, if they see their parent is anxious, that might make them feel more unsure. If anxiety feelings do come up for the child, like a tummy ache, or a faster heart rate, let them know that this is normal is just the body’s way of responding when they’re nervous. Even though those feelings can be uncomfortable or seem to be telling them to run away, you can still work together to get this needle done, let them know they’re doing well and coach them in strategies like deep breathing.”

If a parent senses that a child might have trypanophobia, resources are available to help them navigate the coping strategy. Talking to a health care provider ahead of time can also prove beneficial.

“There are lots of resources available online that review good evidence-based strategies,” she says. “Many children with needle fears will be able to have a good experience with needles after having some preparation, support from their caregiver and support from the health care provider giving the needle since the COVID-19 vaccines have become available. I’ve heard countless times in my professional and personal life how children with needle fears were able to move through the experience in a positive way. Nurses, pharmacists and other health care providers giving the needle know how to help, especially if you let them know that your child is feeling nervous. However, if attempting a needle would be unsafe, if your child is refusing to try, or if your child has had a very difficult experience with a needle in the past, there are additional resources available from nurses, child life specialists, and psychologists.”

The IWK Health Centre website has vaccination resources for youth and families. It includes a toolkit that summarizes what parents can do before, during and after needle injections.

“We also know that how children’s experiences with needles can influence how they feel about future health care encounters,” she says. “Anything that we can do as parents or healthcare providers, help every needle be more positive, is worthwhile.”