Improving vaccine confidence through better pain management for children and their families

COVID-19 vaccines have already been approved for adolescents, and efforts are underway to approve COVID-19 vaccines for children under 12 years of age. To support increased vaccine confidence and uptake, immunizers and healthcare professionals can become familiar with strategies for managing immunization pain and needle fear.

Studies tell us that fear of needles is the primary reason why seven per cent of adults and eight per cent of children avoid immunizations. Poorly managed needle pain and discomfort contributes to the development of needle fears as well as avoidance of vaccines and healthcare later in life.

Mass vaccination against COVID-19 poses a unique opportunity to ensure a generation of children grows up with less fear of needles and immunizations, as well as more confidence in the health system.

Thankfully, science-backed strategies exist to address these challenges. Solutions for Kids in Pain (SKIP) is a knowledge mobilization network on a mission to improve children’s pain management by mobilizing evidence-based solutions, including strategies to mitigate needle fear and pain as contributing factors to vaccine hesitancy.

“Our kids have long had strong needle fears… they would scream as we walked from the car to the office, hide behind chairs in the doctor’s office, and multiple staff would hold them down,” says Megan MacNeil, parent and SKIP Knowledge Broker. “I was doing my best with what I knew, but when I became a SKIP team member, I realized that getting our COVID-19 vaccines was the perfect opportunity to take a completely different approach.”

Creating a positive vaccination experience starts with developing a plan with the child being immunized. The CARD (Comfort Ask Relax Distract) System is an excellent resource in this area. Immunizers should inform children about what to expect and allow them to make decisions to make them feel empowered with both information and appropriate choice.

“CARD gave us a simple way to break down the steps to make the needle more manageable. It made all the difference to plan ahead with our kids, and to take it slow. We listened to music on the way there, took a few minutes of deep breathing before going in, and spent the entire appointment watching videos and chatting about treats we planned to pick up afterwards.”

Before the immunization, talk with the child to determine their preferences. Discuss with the child about whether they would like to sit up, either alone or on their parent’s lap, or if they would like to recline (this can be helpful for those who have a history of fainting with needles). No one should hold down the child during the procedure.

Ask children what type of distraction they prefer, such as watching a funny video or listening to music. Distraction should be used leading up to, during, and following the immunization. Having the child blow bubbles or a pinwheel while being immunized can also encourage deep breathing.

Immunizers should also partner with parents to discuss options. For infants, breastfeeding a few minutes before and during the immunization is encouraged to reduce vaccination pain. If the infant is not breastfeeding, a small amount of sugar water given before the needle can also reduce pain and distress.

Numbing cream (topical anesthetic) can be used effectively in combination with any of the strategies described above for both infants and children alike. It should be applied 20-60 minutes prior to the immunization, depending on the product.

Research urges parents and immunizers to avoid common reassurances such as “It will be over soon” or “You will be fine” before or during an immunization. Rather, positive verbal affirmations are helpful. Letting the child know specifically what they did well (staying still, breathing deeply, etc.) after the immunization also helps to ensure vaccines go well in the future.

If children have severe needle fears (also called needle phobia), additional support from a mental health professional may be needed. Treatments such as cognitive-behavioural therapy, in combination with pain management strategies, are supported by research to effectively treat severe needle fears for a positive immunization experience.

Developing a plan in consultation with the child and using simple, straightforward strategies for pain management helps children develop a sense of agency and builds trust between healthcare professionals and families.

SKIP’s vision is to build healthier Canadians through better pain management for children. SKIP brings together Canada’s world-renowned pediatric pain research community, front-line knowledge user organizations and end beneficiaries. Visit for more information or follow us @kidsinpain.

This article was provided by SKIP.