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It's okay to tell kids that shots hurt. |
The fear of needles or needle phobia is Known by a number of names - Aichmophobia, Belonephobia, Fear of Pointed Objects, and Medical Shots being the most common. The problem often significantly impacts the quality of life and can become life-threatening in some individuals when the refuse to seek medical care because of an intense fear of needles and procedures involving needle use.
Needle phobia is recognized by health care providers as a very real condition. Needle phobia mostly affects children but, if left unaddressed, can prevail into adult life. With modern medicine more and more reliant upon the use of needles for blood tests and the administration of drugs, the issue of needle phobia is becoming an increasingly important issue for health care providers, health care givers, and for patients.
Those with needle phobia are often terrified of routine needle procedures, and a few are so frightened that they would rather die than have a needle procedure. It can cause panic attacks and keep people apart from loved ones and business associates. Symptoms typically include shortness of breath, rapid breathing, irregular heartbeat, sweating, nausea, and overall feelings of dread, although everyone experiences fear of needle in their own way and may have different symptoms. Even such relatively minor needle procedures as venipuncture or subcutaneous injection can cause a vasovagal shock reflex and evoke patient resistance. When those with needle phobia do agree to needle procedures, they often experience syncope, fall and sustain trauma, have convulsions, lose bowel and bladder control, evoke the calling of cardiac codes, or otherwise cause great concern among staff and family members. Others with needle phobia are simply noncompliant with medical treatment regimens, eg, insulin self-injections.
Though a variety of potent drugs are often prescribed for fear of needle, side effects and/or withdrawal symptoms can be severe. Moreover, drugs do not "cure" fear of needle or any other phobia. At best they temporarily suppress the symptoms through chemical interaction.
Victims of needle phobia possess a heightened risk of morbidity and mortality simply because they avoid health care, sometimes for many years, and even when the need for treatment is compelling. Approximately 5% to 15% of the population, for example, decline necessary dental treatment, primarily because they fear oral injections. With an incidence of needle phobia of at least 10%, it is reasonable to hypothesize that a large hidden population goes without regular health care because of this condition. The recognition, acceptance, and communication of this danger by both the medical community and the public, and the development of methods to compensate for needle fear in clinical practice, represent probably the greatest challenges that this condition poses for family medicine.
CHILDREN AND NEEDLES
If the mere thought of a shot sends your child into a panic with squirming and screaming, a routine injection or any other procedure (such as blood drawing for tests) can be miserable for you both. The current vaccine recommendations from the Centers for Disease Control and Prevention call for no fewer than 27 needle injections by the age of 6. This is just the normal routine injections for things like measles and mumps. Medical treatment for kids can also mean injection of antibiotics, drawing blood, and taking bone marrow samples from cancer patients. Around age one, kids begin to fear needles, but there are steps you can take to ease those concerns.
One method is to calmly talk to your child and help her through what's going on while she holds a favorite stuffed toy or other security object. Tell her, "It'll be over in a few seconds. You'll feel a little pinch." And once the child knows she's going to get a shot, don't let too much time pass before the prick or anxiety will build and compound the pain. Do not tell your child a week in advance that they are getting a shot. This allows too much time and raises the child's anxiety level. It doesn't prepare them, it makes things worse and makes the child very unhappy.
Some medical treatment review studies indicate that distraction works better than murmuring comforting words to your child. Researchers found that techniques like suggestions and coaching were not effective at reducing the feelings of pain. Neither did asking kids to blow out a breath when the needle went in.
Diversion worked better for some kids. Focusing on another activity get the youngster's mind of the needle and the sensations tied to it. A distraction method may be used such as trying to get the child to blow soap bubbles or on a pinwheel. Getting a child to watch a video or play a video game got their attention away from the sharp jab of a needle. For older children, just talking to them about some other topic tends to divert their attention.
Another effective approach was hypnosis. It reduced the child's self-reports of pain. A medical hypnotist can train a child to relax, often by counting slowly and breathing slowly, and enter an altered mental state. The hypnotist then often suggests that the child focus on a happy memory, or that pain is distant and far away. As effective as hypnosis may be, it is not for the routine chickenpox or measles shot. It usually requires a few sessions to train the child. It may work well for a child who has a disease that requires ongoing injections, such as a cancer patient getting some kinds of chemotherapy or a bone marrow tap. For other types of injections, it requires a great deal of time. Most studies done showed that hypnosis worked best on kids with cancer.
For kids (and adults) who are acutely afraid or have to get shots or blood drawn frequently, can ask about EMLA cream or vapocoolant spray, which ease the pain by numbing the skin before the needle goes in. Here are a variety of methods to help a child or an adult to overcome their fear of needles.
HELPFUL TREATMENT METHODS FOR NEEDLE-FEAR-PHOBIA
Freezy Spray: Ethyl chloride spray is used immediately before the procedure to numb the surface of the skin.
EMLA (Eutectic Mixture of Local Anesthetics): EMLA is a prescription topical anesthetic cream in the United States. It is available in Canada as an over-the-counter purchase. It is a mixture of lidocaine and prilocaine that is a liquid at room temperature, even though both lidocaine and prilocaine, separately, are solids at room temperature. EMLA cream should be applied one hour before the procedure involving needle use. Some people may require more time. EMLA works quite well for most people whose needle phobia reaction is triggered by the sensation of the needle going in. EMLA does not work well for most people whose primary problem is an acute sensitivity to pain. EMLA is made by Astra-Zeneca Pharmaceuticals. An EMLA patch is also available. EMLA Web Site.
Iontophoresis: An FDA-approved medical device made by Life-Tech called the NeedleBuster is now available to health care providers to be used for numbing the injection of venipuncture site. Topical lidocaine alone will anesthetize the skin to a depth of 2 or 3 millimeters. This devices uses a mild electric current (iontophoresis) to drive the lidocaine into the skin so the injection or venipuncture site can be quickly anesthetized to a depth of 1 or 2 centimeters. A similar device called Numby Stuff from Iomed Clinical Systems is also available. The iontophoresis units cost a few hundred dollars and may be purchased by individuals with a prescription for the device.
Ice Pack: If neither EMLA or an iontophoresis device is available, ice can often be used to carefully numb the injection site (we often used to use this method when we were doing in-home ear piercings). This works for some people whose reaction is triggered from the needle going into the skin but it doesn't help much for those with acute sensitivity to pain. Ice doesn't work as well as EMLA or iontophoresis, but it can be sufficient to help some individuals.
Anti-anxiety Medication: Some individuals may be given an anti-anxiety medication such as diazepam (Valium) before the procedure. Dosage will depend on the individual and must be prescribed by a health care provider. These type of medications can be highly effective in individuals whose main problem is fainting (vasovagal reflex reaction).
Elevation of Legs / Lying Down: Reclining with the legs up during the needle procedure can reduce the vasovagal reflex and help to prevent loss of consciousness and other physical symptoms. Some individuals must lie with legs elevated and their head lowered. The person, after the procedure, must be encouraged to remain lying or sitting until she/he feels quite comfortable and slowly stand up. Most often this takes about 15 minutes or so. Light-headedness or dizziness may be experienced when rising.
Beta-Blockers: Beta-blocker medications may be useful for people with fainting problems. The older beta-blockers, such as propranolol (Inderal) and atenolol (Tenormin) are very inexpensive and very safe. When used only intermittently in healthy people, they are almost completely free of side effects. Beta-blockers are most commonly used as blood pressure medications, but they have many other uses. One big advantage of beta-blockers over other medications is that they rarely have any significant effect on thinking and reaction time. So, unlike large doses of tranquilizers or anti-anxiety medications, beta-blockers usually don't affect a person's ability to do things like driving.
Nitrous Oxide: Some health care providers report that nitrous oxide can be useful, either alone or combined with oral anti-anxiety medications. It is probably the safest and most convenient anti-anxiety method for milder cases of needle phobia. However, it is rarely available in health care provider's offices.
Experienced Medical Care Providers: Relatively inexperienced medical personnel should not treat children or adults with fear of needles or needle phobia. They should gain their experience with patients that have no fear of needles. Problems that can arise with an inexperienced medical person can cause severe reactions in an individual with needle phobia. A needle phobic patient or parent/guardian of a needle phobic patient can request than only an experienced individual perform the procedure involving a needle. If the patient becomes agitated, the procedure may have to be aborted and rescheduled at another time.
Controlled Breathing: Fear of needles and needle phobia can produce shallow and rapid breathing patterns as a reaction to needles used in a procedure. A conscious attempt to breath deeply and slowly will help to control this reaction. A parent may want to breathe deeply and slowly with their child using eye to eye contact and soothing words (similar to a coach breathing with a laboring women in childbirth).
Preferred Locations: People afraid of needles should never hesitate to express their information to the medical staff. Many needle phobic may have certain preferred needle puncture locations that make the procedure easier to deal with and less obvious than other locations.
Other Methods: Some other non-drug methods of therapy may include: Hypnosis, Cognitive Behavioral Therapy, Meditation & Relaxation, Visualization-Distraction-Imagery, Rational Emotive Therapy (RET), Exercise, Physical Therapy, Chiropractic, Thought Field Therapy (TFT), and Herbal Anti-Anxiety Formulations. These methods may work for some individuals, for others they may not have much or any effect. Acupuncture is often recommended for needle phobics and can be a successful treatment.
Acupuncture & Needlephobia: The Pediatric Patient's Perspective
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Photo from Diagnosis in color Obstetrics and Gynecology by Symonds and Macpherson.
