Rarely people ‘like’ visiting healthcare professionals. Children are no exception! We find that by the age of 15 months children associate visiting the MD with having a painful procedure, immunizations!
Most toddlers learn to experience high distress during these immunizations. Unmanaged pain can elevate both child and parent anxiety during injections. Children in Ontario receive a total of 11 to 12 vaccinations by the time they reach 15 months of age.
In the last year, the recommedation is to provide some sort of pain relief prior to injections. Examples include:
1. Provide tactile stimulation by rubbing or stroking the skin near the injection site before and during vaccine injections. This has been shown to reduce pain in children aged four years and older.
2. Breastfeeding is also a great option because several aspects of breastfeeding (holding the child, skin-to-skin contact, the sweet-tasting milk and the act of sucking) minimize the pain response. You need to have an adequate latch for about a minute before the injection.
3. Topical anesthetics are appropriate for older toddlers. They block the transmission of pain signals. We do not believe that they interfere with the effectiveness of vaccines. They need to be applied ahead of time, about 20–60 minutes before the injection. The cost per use (i.e. each patch) is $5–$10.
4. Distraction directs the child’s attention away from the procedure. Distraction is effective for children of all ages. The guidelines provide age appropriate examples of distractions strategies: toys (for infants), bubbles (for toddlers), video games (for school-age children) and music (for adolescents).
5. Finally, deep breathing or tummy breathing can be tried in children three years of age and older. You can have your child blow bubbles or spin pinwheels with the breath.
In the words of the guidelines published in the Canadian Medical Association Journal last December: “More positive experiences during vaccine injections also maintain and promote trust in health care providers.”
Finally, doctors can also examine the child on the parent’s lap instead of on the exam table. This is the method I teach my medical student and residents. Further comments and suggestions are appreciated!
The guidelines can be found at http://www.cmaj.ca/cgi/reprint/182/18/1989.pdf Reducing the pain of childhood vaccination: an evidence-based clinical practice guideline