Here’s how to prepare children for the COVID-19 vaccine

As parents and pediatricians celebrate the news from Moderna and Pfizer this week that their COVID-19 vaccines are safe and effective in children ages 5-11, it’s time for us to prepare our children and patients for the experience, and that includes addressing one of kids’ biggest concerns: the pain and fear of injections. 

When one of my adolescent patients came to see me this year to talk about getting her COVID vaccine, we reminisced about how far she has come with her fear of vaccines. At age 4, she wept and screamed and her parents tried everything they could think of, including promises of lollipops, stickers and special bandages. Eventually, thanks to the lightning-quick hands of the nurse and the lure of ice cream, the family emerged from the room 20 minutes later with their daughter vaccinated for several serious childhood diseases. Still, the ordeal traumatized them. Each fall’s flu shot was a dreaded occasion for her distressed mother.

Fear of needles — or, more specifically, the pain that comes with an injection — is the primary reason children resist getting vaccines. Many parents and pediatric offices underutilize simple pain management techniques. With the United States now facing the largest pediatric vaccination effort in history — an estimated 28 million children will be eligible when the Food and Drug Administration (FDA) authorizes emergency use of the COVID vaccine for those under 12 — now is the time to change that.

The adage that painful experiences “build character” persists; yet studies show that addressing the emotional component of a painful event builds confidence and resilience, skills that have lasting benefits. Equipping kids (and adults) with strategies to manage life’s painful experiences improves their ability to cope and endure these moments with competence. And it doesn’t have to be complicated.

For infants, being swaddled and held by a caregiver have been shown in multiple studies to reduce pain during vaccinations. A review of 10 studies that included over 1,000 infants showed that infants who were breastfed during vaccines cried for shorter time periods and measured lower on pain-assessment scales.  

For older children, parents can purchase lidocaine cream over the counter and apply it to their child’s arm 30 minutes prior to vaccination (step-by-step directions from St. Jude Children’s Research Hospital are available here), or employ the ultimate low-tech numbing agent: ice. 

Studies also show that applying a vibrating device near the injection site distracts nerve endings from sending pain signals. A 2018 review of 27 studies of 31 different pain interventions found that devices that combine ice and vibration were most effective in reducing self-reported pain, fear or distress among patients ages 4-15. The most commonly available device looks like a buzzing ladybug with tiny ice packs for wings, and parents can bring their own to a visit or suggest their pediatrician invest in a few. For children and teenagers, distraction with books, music or smartphone videos can help. 

Parental worry can have a significant impact on a child’s experiences. Some studies suggest that parental anxiety about a procedure can amplify the child’s fears and increase pain. In contrast, equipping parents with knowledge and strategies helps both parents and children experience less distress. 

Caregivers can prepare themselves and their child by reviewing handouts or videos in advance to visualize what will happen and to practice calming techniques. (Watch a delightful child coach her mother about needle stress here). 

Untreated pain from any procedure requiring a needle (such as blood draws) not only contributes to vaccine hesitancy but can negatively impact future doctor visits and contribute to poorer health outcomes. Studies show that 60-100 percent of children under age 10 are afraid of needles, and for many, this fear continues into adulthood. The pain and distress children feel during vaccines affects their parents as well, causing parental distress and anticipatory anxiety about future experiences for their child. 

To be sure, we can never fully eliminate the pain of injections, but using these strategies can improve the experience for children and families and build skills for coping with pain. 

Over the years since that difficult visit as a 4-year-old, my patient and nurses experimented with methods to help her manage anticipatory fear of injections — which turned out to be worse than any actual physical discomfort. Her preferred strategy: singing along to the song “My Shot” from Hamilton, her favorite musical. She is still nervous about needles, but she successfully received both doses of her COVID-19 vaccine this year.

Experts anticipate the FDA will approve emergency use of the COVID vaccine for young children within weeks. Now is the time for parents and pediatricians to prepare robust pain management strategies to help children to accept this vaccine and make their experience of receiving all their health care more humane. This is an urgent step we can take toward saving lives and ending the pandemic more quickly. It’s a shot we can’t throw away.

Susan R. Hata, M.D., practices internal medicine and pediatrics at Massachusetts General Hospital. She is an assistant professor of pediatrics at Harvard Medical School and a Public Voices Fellow with The OpEd Project.