Taking the Pain Out of Children’s Shots


Topical anesthesia, in the form of lidocaine cream, is available over the counter and safe even for infants, he said; it should be applied at least 30 minutes before the shot or the blood draw. At Children’s Minnesota, he said, it is offered to “every single child every single time,” which involves a great deal of planning and coordination. “It’s doable but it’s a lot of hard work,” he said.

Offer breast-feeding or a pacifier dipped in sugar water for infants under 12 months old when they are getting shots or blood draws. The effect, Dr. Friedrichsdorf said, is “spectacular.” A systematic review has shown that in infants, breast-feeding is more effective than topical anesthetics, said Christine Chambers, a professor and children’s pain researcher at Dalhousie University in Halifax, Nova Scotia.

Children should never be held down, which is frightening in itself; instead, put the child in an upright position on a parent’s lap. “In our hospital, it’s illegal to hold children down,” Dr. Friedrichsdorf said. “Unfortunately, all over America people are adhering to the old idea of just pin them down.”

When I was in training, we routinely restrained children when they needed stitches or other minor — and painful — procedures by velcroing them into what we called “papoose boards.” Very rarely, a child will need to be held down for emergency lifesaving procedures, when there is no time to lose. But in the vast majority of cases, with pain control and distraction for the child, that kind of restraint should be unnecessary. “Papoose boards should be illegal, they don’t make any sense,” Dr. Friedrichsdorf said.

Provide age-appropriate distraction with anything from a parent’s phone or iPad to blowing bubbles.

The kinds of statements that parents make about pain and needles can have a big impact on children, said Dr. Chambers. Research has shown, she said, that what parents may intend as reassuring statements about how it will be over soon, or it won’t hurt too much, are perceived as a signal of parent anxiety and can actually make kids feel worse and increase their pain. Instead, parents should “use distracting statements, or give suggestions about how kids can cope, like taking a deep breath,” she said.



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