Children and their caregivers often view routine vaccinations as painful (and stressful) experiences, but it doesn’t have to be that way!

Although early experiences with pain may have long-term consequences, including more medical fear and pain in adulthood, there are many behavioral strategies that caregivers and children of all ages can engage in to minimize pain and fear during routine vaccinations.

You don’t need to be a professional to effectively manage your child’s discomfort during vaccinations and to improve the experience for everyone involved. Below is a list of helpful strategies for caregivers of children across the lifespan.

Strategies for Parents of Infants:

• Use vaccination time to feed your child: Breast or bottle feeding during the injection can help reduce your infant’s distress. You can also use a pacifier during vaccinations to help soothe your infant.
• Use a comfort position: Holding your infant during vaccinations instead of lying them down on the procedure table reduces distress. You can also stroke your infant’s face, swaddle your infant, or do skin-to-skin contact during the vaccination.
• Ask about the availability of sucrose solution: This is a sweet solution that can be administered by the care team and put into your infant’s mouth to help comfort them during painful procedures.
• Use distraction: Light up or musical toys, singing or playing music, and looking at pictures can all be used to distract your infant.

Strategies for Parents of Toddlers and Preschoolers:

• Use a comfort position: Hold your child in a comforting position, such as sitting up in your lap, instead of lying them down on the procedure table.
• Ask your pediatrician about use of a numbing cream: Over-the-counter and prescription topical anesthetic creams can be used to reduce pain during needle pokes.
• Utilize vibration or shot blockers: Devices that vibrate can be placed around the location of the injection before it is administered to help block pain signals and decrease pain. Shot blockers are also helpful tools; ask your provider if they are available for your child.
• Use distraction: Allow your child to pick a book, music, activities, or videos to watch before, during, and after receiving their injection. Using bubbles or pinwheels to help your child take deep breaths can help them learn to relax during vaccinations.
• Limit reassurance: Excessive caregiver reassurance, such as telling your child things like “It will be ok” or “It won’t hurt,” has been shown to increase children’s distress during vaccinations. Instead, caregivers should coach their children to use effective coping strategies, such as engaging in distraction or taking deep breaths.
• Model positive behaviors: Children at this age look to their caregivers for how to act in difficult situations. Caregivers who model calm and helpful behaviors, such as engaging in a distracting activity, can help children feel more comfortable during vaccinations.
• Ensure most painful vaccination comes last: Ask your provider to administer the most painful vaccination last. Getting a painful vaccination first can lead to increased sensitivity to pain, making the following vaccinations more uncomfortable. Administering the most painful vaccination last can minimize discomfort.

Strategies for Parents of School-Aged Children:

• Utilize vibration, shot blockers, and numbing cream.
• Lead your child in belly-breathing or other relaxation strategies: Caregivers can lead their child in deep-breathing techniques in the exam or waiting room to reduce anxiety and relax their body before receiving a vaccination. Encourage your child to use positive self-statements, such as, “I am strong, I am brave, and I can do this!”
• Let your child lead distraction: Allow your child to pick what they will use as a distraction tool, such as a video to watch, a book to read, or an activity to do together. Encourage your child to engage in distraction before, during, and after the injection. By giving your child appropriate choices, you give them a sense a control, which can help them cope better.
• Use a comfort position: Holding a child down to receive a vaccination does not work well and can create anxiety about future injections. Instead, try holding your child in a comfort position, such as sitting on the exam table with their back against your chest and their legs in between yours. As much as possible, avoid holding your child down to receive their vaccinations.
• Praise positive behaviors: Offer lots of praise to your children for being brave during vaccinations. You can even use a reward or a sticker chart to encourage your child to use his/her brave coping skills.

Strategies for Parents of Adolescents:

• Utilize vibration, shot blockers, and numbing cream.
• Make a plan: Adolescents can choose ahead of time what strategies they would like to use when receiving a vaccination in order to feel more comfortable and in control.
• Encourage adolescents to advocate for themselves: Help your teen feel comfortable speaking with the provider administering their vaccination about their preferred placement of the shot and needed coping strategies they would like to implement to manage pain.
• Pick a reward: Allowing your adolescent to pick a reward to receive after completing their vaccinations can help increase motivation to power through the pain.

Vaccinations can be scary for caregivers and children alike, but they are necessary to keep everyone healthy and safe!

Using coping strategies like the ones listed above can help reduce anxiety and pain, making the experience easier and setting children up for success during their next vaccination appointment.

Additional helpful resources for managing procedural and chronic pain can be found through the Meg Foundation and the It Doesn’t Have To Hurt Organization.

References

• Chambers, C. T., Taddio, A., Uman, L. S., McMurtry, C. M., & Team, H. (2009). Psychological interventions for reducing pain and distress during routine childhood vaccinations: a systematic review. Clinical therapeutics, 31, S77-S103.
• Taddio, A., McMurtry, C. M., Shah, V., Riddell, R. P., Chambers, C. T., Noel, M., … & Bleeker, E. V. (2015). Reducing pain during vaccine injections: clinical practice guideline. Cmaj, 187(13), 975-982.
• Walker, L. S., Dengler-Crish, C. M., Rippel, S., & Bruehl, S. (2010). Functional abdominal pain in childhood and adolescence increases risk for chronic pain in adulthood. Pain, 150(3), 568–572. https://doi.org/10.1016/j.pain.2010.06.018