Managing Vaccination Anxiety In Children

Overview of vaccination anxiety

Vaccination anxiety refers to the stress or fear that some children experience when faced with the prospect of receiving vaccines. This anxiety can stem from several factors, such as a fear of needles, fearful expectation of pain or apprehension about an unfamiliar medical procedure.¹

The fear of vaccinations often manifests as a phobia, resulting in persistent anxiety or distress which can cause visceral reactions in the child. This can lead to physiological reactions such as crying, screaming or running away, leaving both the parent and child in a state of agitation.¹ Therefore, a parent or caregiver needs to take appropriate measures to prepare their child for a vaccination that will make the procedure a little easier for them to tolerate.

Children who have intellectual disabilities, severe anxiety or a phobia of needles may benefit from being taken to small-scale vaccination facilities, such as a GP clinic, to avoid the stress and feelings of overwhelm that come with being in a larger, open clinical setting. These larger institutions may aggravate the child’s already distressed state, thereby increasing their desire to leave or flee from the location harbouring medical equipment that they perceive to cause harm.¹

Advice for parents

The fear of needles is a real thing, so it is important not to criticise or scold your child for their reaction to a simple medical procedure.¹

Reframing your child’s perception of vaccination may encourage them to want to get vaccinated. For example, you could tell your child that getting vaccinated is like them being on a mission and the vaccination shot is a superpower that will transform them into a hero with a magical shield to protect their friends and family from invisible villains (i.e., germs).¹

Needle phobia may persist throughout a child’s life, so it is important to educate them on the importance of vaccinations or to ask a healthcare practitioner to do so to alleviate some of the child’s stress that comes from the idea of it¹.

Common vaccination anxiety triggers

The most common vaccination trigger is a phobia of needles or sharp instrumentation used during any medical procedure. Many children, and even some adults, have negative connotations with needles or injections, perceiving them to increase pain and suffering. Some children may also have had a previous negative experience during vaccination, thus increasing their anxiety in subsequent vaccinations.

Additionally, children may also fear vaccinations because their parent(s) also have a fear of them. While it is normal to feel uneasy at the thought of receiving an injection, it is important to remember that children may pick up on their parent’s anxiety or apprehension, and this might influence their feelings and perceptions about the procedure.

Strategies for managing vaccination anxiety

Preparing children for vaccination

Before the vaccination, avoid mentioning needles or bringing up details about the appointment in excessive detail. The child may become worried or anxious and expect to be harmed, which may affect their trust in the parent or care provider. If you do however mention the appointment, let the child know that they will receive a vaccine that will protect them.¹

If the child cannot tolerate the moments right before receiving the injection shot, it may be necessary to stop the procedure to allow them to catch their breath and for you to comfort them in their vulnerable state.

As a parent or caregiver, one way of getting around vaccination nerves in your child is to break down the vaccination procedure into simple, small steps, ensuring not to get too technical or specific about how the needle ‘pricks’ the skin.² Remember to use positive language when speaking to your child and to avoid words or phrases that may instil fear in their mind or create a skewed image of the medical procedure.

Creating a supportive environment

Remain as calm as possible throughout the vaccination, ensuring the child does not become unsettled by the idea of receiving a needle shot. Children look at your reaction to assess a situation, so make sure you comfort them and remind them that they are safe.

Do not force or hold down your child during the appointment, as this may cause them unnecessary harm or lead to unsuccessful vaccination attempts, which will both prolong the vaccination procedure and increase the child’s anxiety.

Remember to reward your child with a small treat for their cooperation, bravery and resilience.

After a certain amount of vaccination attempts, however, it may be ideal to terminate the procedure and seek specialist advice, such as exploring sedation options.¹

Common distraction techniques

Sometimes a conversation about the vaccination procedure may not be enough to comfort the child. You may need to explore some distraction techniques to keep their mind off of the appointment. Here is a brief list of distraction methods to consider: 

• Breathing exercises (encourage the child to take deep breaths)¹
• Interactive books or games
• Bubble blowing
• Tell them a joke
• Guided imagery (ask the child to imagine their favourite place or a positive memory. Ensure they walk you through what they see, feel and think)³

Alternative comfort measures

If the child cannot tolerate the needle or the distraction techniques have not worked sufficiently to relax them, consider using a local anaesthetic cream on the site where the needle will prick.¹ The cream is designed to numb the top layer of skin, minimising the sting that comes from the needle. These creams are commonly available at pharmacies.

Alternatively, if you are unable to access a numbing cream, you can attempt to apply pressure to the body site that will receive the injection, such as with an ice pack, for an average of 15 seconds to help decrease sensation in the area, causing reduced pain from the needle.

Community and educational initiatives

Getting vaccinated is a fundamental requirement to protect yourself and society from infectious diseases. Vaccines commonly contain a weakened component of an infectious pathogen, such as bacteria or virus, that is inserted inside the recipient and whose immune system will be trained to fight off the infection.⁵ This means that subsequent exposure to the same infectious agent will result in milder and more tolerable symptoms. Vaccinations have been known to either outright eradicate or temporarily eliminate a pathogen from a community. Diseases such as measles, for example, have been reduced by ~99% since their vaccines were produced and administered to the worldwide community.⁵

However, vaccines are not as effective if not a large enough proportion of people are accepting them. When the majority of people in a community get vaccinated, this creates something called ‘herd immunity’, which means that both vaccinated and unvaccinated people are protected.

To increase the uptake of vaccines in a community, educational campaigns in schools or a GP clinic may help inform parents and children about the importance of vaccinations, the biology behind them and how they prevent diseases. These campaigns can be distributed in the community in the form of educational flyers, videos or posts on social media, thereby helping the children understand why they need to get vaccinated.

Remember, it is important to consider the age of the child getting vaccinated. A younger child, such as a toddler, compared to a pre-adolescent will have a different perception and understanding of vaccines. Creating age-appropriate stories or interactive media that will educate the child on the vaccination process will help them appreciate the need to receive a vaccine in a manner that they understand for their specific age.

Rewarding the child for their cooperation is just as important as educating them on the vaccination procedure. Giving the child a sticker or a small toy may enforce positive associations with the vaccination process and eliminate anxiety about future vaccinations.

Case studies

Vaccine anxiety has been previously managed in children with the use of benzodiazepines, which are psychoactive drugs commonly prescribed for managing anxiety, thereby inducing a state of calmness.⁴ However, it is important to consult a doctor or trained professional about the use of any drug to manage a condition like anxiety, as there is a potential for drug dependency.

As mentioned earlier, children may receive a numbing cream or gel, known as topical analgesics, for reducing the pain that comes from injection needles.

Summary

Paediatric vaccination anxiety encompasses a fear of needles, doctor appointments, or being faced with an unfamiliar situation that the child perceives to cause them harm. As a parent, it is important to understand that needle phobia is a normal thing and is also prevalent among many adults receiving vaccinations. To manage vaccine anxiety in children, the parent or caregiver should consider age-appropriate conversations with their child about the vaccination procedure, or even explore some common child-friendly distraction techniques for younger children who will have a reduced understanding of the reasoning behind getting vaccinated. Parental support during the vaccination process is of paramount importance, as children look up to their parents to assess their reaction to a situation. Remaining calm and composed will help the child acclimatise to their surroundings and fear the vaccination procedure a lot less.

FAQs

What is the fear of injections called?

The fear of injections is often called trypanophobia, which is an extreme fear of medical procedures involving needles or sharp objects.

How can I help my child overcome the fear of needles?

Remind your child that vaccinations will protect them and their loved ones from getting sick. Having age-appropriate educational conversations with your child may help them understand and appreciate the need to get vaccinated.

How can I treat my child’s anxiety naturally?

Childhood anxiety can have a negative toll on a child and their caregivers. Professional therapy is often the route most parents take to manage their child’s anxiousness and nerves, however, there are some natural methods a parent might consider to reduce their child’s anxiety. These include breathing exercises with counting upon inhalation and exhalation, visualisation games where the child is asked to imagine their favourite place, and activities like drawing or dancing to get the child’s mind off of the vaccination process and onto something that they enjoy.