Managing needle pain in infants and young children

A fear of needles is common in both children and adults. Needle fear and immunization pain can lead children and their families to hesitate or even delay childhood vaccinations.

This past year saw the approval of the COVID-19 vaccine for children and youth aged 5 years and up and has positively impacted the prevention of serious illness. Parents and health professionals are now preparing for children under 5 years to receive their COVID-19 vaccination. Canadian health professionals supporting children and youth with vaccines should become familiar with the easy, science-backed strategies to effectively manage immunization pain and needle fear.

Needle fear and needle pain contribute directly to vaccine hesitancy. Thankfully, there are simple, well-studied techniques that children, parents, and health professionals can use to ensure kids have a positive and calm immunization experience. Even young infants and preschoolers are beginning to develop their experiences with needles. Needle fears typically start in children as young as 5 years old. This means that managing needle pain and discomfort is critical in early life to prevent needle fears and continued engagement in healthcare later in life.

Solutions for Kids in Pain (SKIP) is a knowledge mobilization network that aims 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. SKIP is co-led by Children’s Healthcare Canada.


Infants (Under 12 months)

Why is it essential to manage needle pain from vaccinations in infants? No parents or health professionals want to see a child in pain. How we manage pain from an early age can change how people feel about the pain later on.

“As a parent, my goal is to be relaxed, prepared, and not to make it scary,” says Nadia Shular, a parent to a toddler and a pediatric nurse. “My advice is for parents and providers to partner to discuss what will work for their child.” This can include applying a topical anesthetic or numbing cream to the injection site approximately 45 minutes ahead of time. “As a nurse, I call this magic cream, and it makes the needle hurt less,” adds Nadia. “I have used it for all our son’s immunization appointments since he was an infant, along with cuddling him in an upright position and distraction techniques like singing or watching a show.” Babies under 12 months can also benefit from breastfeeding or non-nutritive sucking before and during the procedure. In addition, mixing a sweet solution of 1 tsp sugar and 2 tsp water and giving this to the baby just before the needle by syringe or on a pacifier helps stimulate sucking and releases natural pain-reducing chemicals. Physical contact from the parent combined with the sucking action helps to manage pain.


Toddlers & preschoolers

Many young children know how they may feel about visiting a clinic or getting a needle. Parents can help prepare by sharing with their child about the needle, typically a few days beforehand, while also talking with their child about comfort strategies that they will use. Parents are encouraged to be honest and use positive, age-appropriate language if the child asks if it will hurt. “It is important as parents and providers that we talk directly to the child about the procedure,” says Nadia. “Now that my son is a toddler, distraction is key! I have a favourite show on my phone to help distract him. Bubbles also work great because they not only distract but also help the child to take deep breaths. Also, do not forget the magic numbing cream before your appointment”.

After the needle, talking about what happened and creating positive memories is essential. This helps future vaccines to go well! Use words of encouragement and be sure to celebrate, saying things such as “You did it. I liked how you took deep breaths. Let’s go get a treat”.


Severe needle fears and special accommodation clinics

If a child has severe needle fear or additional sensory, behavioural, or other special needs, additional support may be needed. With the rollout of the COVID-19 vaccination for children over the age of 5 years, some communities now offer low-stimulus or special accommodation clinics. These are quieter spaces where children and adults can go, have reduced sensory input, and often provide more time and support during the vaccination appointment. In addition, families are encouraged to bring comfort items to help with distraction, and often there are staff and volunteers with special training in helping those with needle fears.

SKIP’s vision is 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 and resources or follow us @kidsinpain.