My 13 year old loves to hear stories about her experiences that she was too young to remember. She often asks us to recite the story about the day she was born or her first interactions with us after birth, how she behaved when I was still pregnant and my husband would play “catch” with her.

She came up to me and said, “Mommy I don’t think other kids get the numbing medicines like I did for my shots and for my ear piercing. Why did you do that? Well, I know, you didn’t want me to hurt, but I’m just curious. When I fall and hurt myself, you just try to tell me it’s no big deal and it isn’t unless I hurt myself really bad, but then why are “shots” a big deal?”

I find it interesting that she raised this question during the World Immunization week (April 24-30). Nonetheless, that got me thinking; did I do it because like any parent I want to do all I can to prevent any harm, perceived or real, from coming upon my child? Or is it because as a pain doc, what I know about pain and its effects on our mind, body, lives and families? This quote from Dr Boyd Haley, Professor University of Kentucky, sums it up better than anything I can say.

“A single vaccine given to a six-pound newborn is equivalent of giving a 180-pound adult 30 vaccinations on the same day.”

Now, I realize that there is a divide, or should I say a chasm, between the camps that believe vaccination is unnecessary and the one that is for vaccinations. I’m certainly not going the debate the merits of one camp or the other. I do, however, know that as parents, if we could protect our children from ever experiencing any hurt, physical or otherwise, we would. However, I know that our children are and will be exposed to painful events in their lives.

So, until we can be super heroes and heroines that can eradicate all hurt from our kids' lives, I thought I would take this opportunity to share how experiences with minor procedures like vaccination, blood draw or circumcision can linger with our children and perhaps even us, longer than the few minutes in the pediatrician’s office or the lab. I will also talk about what simple Proactive tools you can use in partnership with your health care providers to make these experiences as positive as possible

So what's the big deal with vaccinations and minor procedure pain??

Anna Taddio and her colleagues in 1995 conducted a study showing children who had circumcision at birth without any numbing medicine (local anesthetic) were much more likely to have exaggerated crying, and pain behaviors with their immunization at 4-6 months of age as compared to those who did it with the numbing medicine and even more so than those who were not circumcised at all. These researchers concluded that early exposure to painful stimulus like circumcision may leave a memory of the pain experience have longer lasting effects on pain response and perception.

In looking at infants/children requiring Intensive Care Unit stay may undergo as many as 14 painful events per day of their stay and it has been observed that these infants develop a reflex response to even non painful things like just holding their foot (a common site for blood draw) or cleaning the area with an alcohol wipe triggers intense cry and distress behaviors.

Looking at these facts, we must be aware that our body and brain have the ability to feel and remember pain as an unpleasant experience and even anticipate it.

Proactive tools for you to use in partnering with your healthcare provider and child.

Here are a few age appropriate pearls I want to share with you to consider when planning for procedures like shots or blood draws for your children.

For Infants (New born to 1 year of age):

1. Ask for your health care providers to use techniques that have been shown to reduce pain like allowing you to breastfeed during the procedure

2. Using a sugar solution dipped pacifier during the procedure

3. Holding the baby in your arms

4. Soothing music (that you can bring and play either as musical toy or on your smartphone that your child may have been used to.

5. Using numbing creams or patches. These take some time to work (usually 30-45 minutes), so you can ask your doctor to prescribe them ahead of time and you can place them on your child’s thigh/arm as directed by your health care provider. Some numbing creams are available as over the counter so you can also chose to use that as long as you know what to do.

6. There are several other non medication tools available that stimulate the skin in non painful ways like vibrating toys, shot blocker – a small piece of plastic with blunt spikes, to name a few. These tools/toys create counter stimulation of the skin in the area of shot/blood draw and prevent or decrease pain. Ask your doctor/health care provider if they have any other tools that they use to decrease the pain with shots or blood draws.

For older children:

1. Soothing music (see #4 above)

2. Ice on the area

3. Counter irritation toys (see #6 above)

4. Video games, play their favorite movies, show or songs on your smartphone, IPad etc.

5. Distraction with asking them to blow bubbles, play a game, sing a song, tell you a story or just ask questions about something or someone that they like. Sometimes I ask them to blow on the syringe and see if they can “blow it away” or change the color or anything that seems to work with your child. You know them, their habits and responses better than anyone else.

6. Use guided imagery by guiding them to imagine being at their favorite place, doing their favorite activities etc.

7. Using numbing creams and patches (see #5 above).

I hope you find these tools useful for your children, patients and loved ones.

Share your tricks and tools that you find useful in keeping your children comfortable and calm during unpleasant events in the comments below.

Please leave your comments, questions and suggestions below or contact us about how we can help further.