Transcription:
NeedlePhobia: How to Ease Anxiety in Preparation for Routine Childhood Vaccinations

Prakash Chandran (Host): Anxiety when receiving a shot or vaccine is very common, especially in children. If you're a parent, you've likely witnessed this panic, when your kids come in for their routine shots. Here to tell us all about anxiety and preparation for routine vaccines is Jessica Liles. She's the Director of Volunteer and Family Support Services at Le Bonheur Children's Hospital.

This is the pizza pod by Lubana children's hospital. I'm your host hundred.

So Jessica, thank you so much for joining us today. I really appreciate your time. I wanted to get started by asking, you know, as a Child Life Specialist, your work is all about normalizing hospital experiences for children. So can you explain why that's so essential, especially in a pediatric setting?

Jessica Liles (Guest): Yeah, thanks so much for having me on today. And I think the biggest thing to point out about this and why normalizing the hospital setting is important, is that being in the hospital setting for a child is not normal. And we want to make sure that we do what we can to help answer questions and reduce any stress that children might feel from experiences that they might have in a healthcare setting, whether it's a really quick visit to the doctor or if they're having to stay overnight in the hospital.

Host: I wanted to ask a question about fear and phobia. And this is in regards to the fact that, you know, a lot of people just don't like needles. They don't like getting shots. But I imagine that sometimes this can grow into a fear that prevents families from getting that vital medical care that they need, like vaccinations. So can you talk about that distinction and what that could potentially lead to?

Jessica: So that's a great question. And so fear is really our response that is normal to things that create stress or might feel like a threat to us. And the things that we fear can be based off of our own experiences, or maybe the experiences of someone else around us. And a phobia is when that fear is really elevated and escalated. And so we feel this overwhelming anxiety or stress related to that fear, even when we're not in danger. So the thought of that fear, the sight of that fear, may create a lot of stress or anxiety. So if you have needle phobia, the thought of going to the doctor or the thought of having to have any type of pokes or shots, might prevent someone from even getting the care that they need, just because of how heightened their anxiety is around that specific experience.

Host: Yeah. So it's kind of like a linear progression I suppose. You have fear, which is that normal response, but over time that can produce that phobia, which is that overwhelming anxiety that really causes you not to go in and get the care that you need. Is that relatively accurate?

Jessica: Yeah, I would say that that is, and I think what tends to happen is when we have those fears or phobias, is that they might impact the people around us. And so if there is something that maybe it's something I'm fearful of, but the person next to me, they have a phobia about it and they're going to avoid it. Then it might change what, how I view my experiences. And it might mean that I don't pursue the care that I need to get based off my own experiences or it might also be based off of the phobia that they have.

Host: Yeah, that makes a lot of sense. So, you know, you talked about people sometimes avoiding the care that they need. So how might we help actually manage these fears so that we can overcome them and actually go in to get this care?

Jessica: So we're thinking about fears around needles specifically. I think step one is just acknowledging that this is something that is uncomfortable and can be painful. Pain is something that is subjective. And so we like to say that it is whatever someone says it is. And so we need to first just say, this is something that's uncomfortable and it might be painful. Let's recognize that. Let's acknowledge it. And then from there, I think it's about learning healthy coping techniques. What does this person need in this situation to help make that needle stick a little bit easier? Are there things that we might be able to do to make it less painful or to take their mind off of what is happening to help get them through whatever is ahead.

Host: Yeah. And you talked about making it less painful. Is there an actual way to do that?

Jessica: Yes, there are. There's a lot of different techniques that exist that can help with making needle sticks a little easier. Some of them involve topical creams. And with those it's something that you have to have a prescription from your medical provider, to be able to have that topical cream placed that would numb your skin.

But then there's some other things that might be helpful. There is something that's called Buzzy For Shots and it's this, it looks like a little bumblebee and it vibrates. And so you place it against your skin, right above where the needle stick is going to happen. And what it does is those vibrations we like to say that it confuses your brain. So that the vibrations, when you feel the poke, that hopefully the message of oh, that's the poke that's supposed to be painful, the vibrations will confuse your brain and that you won't feel that painful sensation. You'll just feel what feels more like a tingling sensation.

And then there is another device that's called a Shot Blocker and it is the small round plastic device that has these little bumpy nubs on it. That does essentially the same thing, where it's about just confusing our brain so that we may not feel that pain sensation. And so those are just a few of the things that can be done.

But in the past, when people have used ice cubes, or something cold, here in the hospital, we have what we call our freezy spray that can help to make the skin feel a little bit more numb before the poke.

Host: That's so interesting. This is the first time I've heard of like the shot blocker and the buzzy for shots. Out of curiosity, is this something that a patient needs to request or a parent needs to request for their child or is It just done automatically?

Jessica: It might depend on where they are and who's providing the care. And it's always good to ask. And so if they're here at Le Bonheur, they're always welcome to ask for those specific things. But if they're receiving care somewhere, that's not here on Le Bonheur's campus, they can ask, or they could even bring their own. We have some people who have their very own shot blocker and it goes with them anytime they go to the doctor. We have one family that their mom keeps it in her purse and that way, if they need it, they know that they have it. And it's just a way that they can be prepared no matter where they are.

Host: So up until this point, a lot of what we talked about is just kind of general fear or phobia around going in and getting the care that you need. And specifically the fear around needles. And I can understand that it's important for the adults in the room or the parents in the room; because like you said, the way or their disposition towards getting these shots, can affect their children.

So let's say that there's a scenario where the parent might be fine. They understand that their child needs care, but their child expresses a real fear about receiving a shot. What might they do to help that child? Do you have any advice there?

Jessica: I do. So I think, one of the benefits to being partners with parents is that they know their child better than we do. And so they're going to pick up on things that are going to let them know if their child is feeling anxious about getting shots. And, depending on the age of their child, it might be that their child actually tells them, or they might just notice certain behaviors that tell them, hmm, there's probably something they're afraid of here. And I think one of the biggest things is for parents just to really engage with their child, if the child is old enough and the child tells them that it's something they're afraid of. Listen to their child, validate their feelings and talk about ways that we can help try to make the poke a little bit better.

We encourage giving space. Sometimes people don't want to talk about what might be uncomfortable. So if you know that your child is afraid of needles sticks, you may think I don't want to talk about it because it's not fun for me to talk about, it's going to make them anxious. But some kids really benefit from talking about things ahead of time and having a plan.

But then there are some kids where talking about ahead of time, talking about it ahead of time actually creates more stress and anxiety. And so this is where we have to lean on, on parents as our partners, to know their child best. And I think one of the biggest thing our parents can do is to be an advocate for their child and speak to their care team about how their child is feeling, or maybe the behaviors they noticed and, and talk to them about the ways that we can help make this experience a little bit more positive.

Host: Yeah. So that actually leads me to my next question. You said talk to the care team. What exactly can they do to improve the situation for the child and the family?

Jessica: So part of it is that we can work with the child and the family to make accommodations that are reasonable for them. And we can work to provide choices for the child and the family to help them feel like they have a sense of control. If a child is coming in for vaccinations, and it's something that the parent has, has decided, you know, this is important as part of your care, the child may not feel like they have a choice in that.

And so what are, what are things that we can do to help the child feel like they have a sense of control? What are things that we can do to help the caregiver feel like they have a sense of control and it might be for the caregiver, do you want your child to sit in your lap? Or we might ask the child, if it's an older child, do you want to sit in your caregiver's lap?

Or would you like to sit in the chair by yourself? And, so part of that is really kind of hearing what works for them. And a lot of times I like to ask families about their child's preferences. And we might even ask about the experience that they've had before, maybe with their last vaccine, something like that to determine what can we do, based off their last experience to enhance it.

Host: So I remember when I was younger, I'd like to say that I'm a little bit better about getting shots these days. Maybe I'm not, but I do remember a couple of times where the caregiver kind of used this method of distraction, right? Like where I was talking to them, they were jus in the middle of a sentence, and then all of a sudden the shot was administered and it actually really helped. Right. Cause I just wasn't anticipating it. Can you talk a little bit more about the power of distraction and if that's a tool that is utilized to help make things a little easier?

Jessica: Yeah. So we talked earlier about how pain is based off our own perception. So if we have things that are drawing our attention away from the potential pain than our perception of the pain is going to be less. So if I think, oh, this is going to hurt and I'm watching it, and all that I'm thinking is, oh, this is going to hurt. This is going to hurt. Then guess what, it's probably going to hurt. But if I'm not really thinking about what's happening and I'm doing things that are keeping me calm, then chances are, it might not feel as painful as if I were looking at it saying this is going to hurt. So distraction really is about focusing on something other than what could be perceived as painful or uncomfortable.

And there's a lot of different ways that you can do this. For kids, we really like to involve their senses. And so it might be, what can you look at, or tell me about things that you smell in this room. Or we might even ask them to smell some of the things that are part of the process for the vaccines, meaning, what we use to clean our skin, the alcohol wipes has kind of a stinky smell.

So we might encourage them to smell that, to use their senses as part of allowing them to experience everything, but also as part of the distraction. And then also encouraging them to listen in and seeing what they hear. And then also taking big, deep breaths. It is amazing what taking a big deep breath can do to help calm and relax our body.

And if our body is more relaxed, then things like needle sticks are going to hurt less because of the fact that our body is relaxed. Some easy things that we can do for distraction, that don't require anything other than us, is that we can sing a song or we can count to 10. We can tell jokes. Tell a favorite story, a place that you love to go on vacation, things like that.

For child life specialists, we have a lot of different tools that we also use that can be great for distraction. So we might have a light spinner, that lights up and we can talk about the different colors. Sometimes we will use devices like an iPad, and there may be different games that you can focus on or different things from that visual standpoint.

But it also brings in the auditory things of what you might hear. We also love I Spy books. So, you know, you're looking for a hidden picture in an image. And so it takes your mind off of what's happening with the needle stick and you can really focus on looking for something else and for some kids, then they don't experience as much pain with needle sticks and they feel like it made it go much easier because they were thinking about something completely else, something completely different.

Host: So, you know, obviously it is an emotional process leading up to getting the shot, getting it, and sometimes even after you leave, it can still be anxiety producing. So can talk about different coping strategies for children based on their ages given what I just mentioned?

Jessica: Yeah. So I'll go through four kind of primary age groups knowing that each child is different. So what I'm saying it's really general. So for an infant or maybe a young toddler, one of the things that you can do is have someone hold them and as they get older, have them in a position where they're sitting up and not laying back. And so having someone hold them, especially if it's someone they know, allows it to feel like they're being embraced during the poke versus being restrained or overpowered. And then if they're old enough giving them space to sit up. Give them that sense of control. When we are laying flat on our back, we don't feel like we have control, but if we're sitting up and we can see what's happening around us, that will automatically impact our coping because we feel like we, we just have control over our environment.

Other things with infants, if there are light up musical toys or if it's an infant that benefits from either having their pacifier or nursing or feeding, if they're allowed to do that during it, those are things that can be beneficial. For preschoolers, one thing that's really beneficial for their coping is helping to explain what is going to happen. And you can use really simple words and really simple phrases. So you can let them know that we have to give them a vaccine, or medicine for their body. And so there's different words you can use. And, this would be something that someone could even just do a search of. How do I talk to my preschooler about this? But you can say it's medicine for their body. They're going to feel a poke. Some kids we tell them it feels like a pinch and give them really simple explanations and then give them choices. Again, ask them if they want to sit in a caregiver's lap, provide options for distraction. And then some kids really benefit from incentives of when we're done with this, we get a high five, when we're done with this, we get a sticker and when it's done, make sure they get the sticker, make sure they get the high five.

The big thing with infants, preschoolers and even some of our school aged kids, coping does not always mean that they are going to be calm and collected because with needle sticks, it's uncomfortable, it's painful. And so we also give space for them to cry. And we tell them that tears are okay. What I'm looking for is after the needle stick, how long does it take for them to go back to being their normal self? If they're able to cry when we're doing it, and then quickly bounce back to being their normal self, that tells me that they're likely coping well. However, if we do the needle stick and then, you know, 10 minutes later, they're still crying and upset, then chances are they're having a much harder time coping with that.

So for school age, a lot of the things that we do are similar for preschoolers, but more age appropriate. Some of our school aged kids really benefit from playing video games or looking at someone's phone. And then for teenagers, it's about engaging them in their care and really just finding what they need. Do they want someone to sit next to them and hold their hand? Do they want us to count for them? Do they want to watch or do they want to look away? So it's about giving them choices so that they can have some autonomy.

Host: So let's say a parent is listening to this and they're like, you know what? She is speaking directly at my child. My child is going to need some extra help or support if they come in. What do you suggest that they do to make the process as easy as possible?

Jessica: I think asking for help is step one. Let someone know that you need help. Here at Le Bonheur, we have a child life team that has child life specialists who want to support our children and their families through these experiences. And so even if we're not able to be there for that visit where these needles sick might be happening, we can be available to answer calls or questions and provide some coaching to families and talk about things that might be helpful. So I would just encourage, if that is your child, tell someone, tell them that they have a hard time coping. Ask for child life specifically. Ask if there's things that can be done to help make it a little bit easier, because usually there are things that we can do.

The other piece is that sometimes we might try things to help children cope, and we may not see an immediate result. So it might mean the next time you have their vaccines or any type of needle stick it, it might still be a little challenging, but hopefully each time it gets a little bit better and they get a little bit better and are able to build really healthy coping techniques for these different procedures.

Host: Yeah, that makes a lot of sense. And finally, if a parent is listening and they're interested in going to one of the pop-up events, that's happening this spring and summer in the Memphis area, where should they go to sign up?

Jessica: They would go through our website, which is www.LeBonheurL-E-B-O-N-H-E-U-R.org/vaccines.

Host: Well, Jessica, thank you so much for your time today. This has been a truly informative conversation.

Jessica: Thanks so much for having me.

Host: That was Jessica Liles, the Director of Volunteer and Family Support Services at Le Bonheur Children's Hospital. For more information regarding routine vaccines, you can visit LeBonheur. org/vaccines. That's L E B O N H E U R.org/vaccines.

Prakash Chandran (Host): Thanks for listening and make sure to subscribe to the pizza pod by Labatt our children's hospital on apple podcasts, Google podcasts, or wherever you listen to your podcasts, you can also check out the lubana.org podcast page for the entire podcast library.

Host: I'm your host Prakash Chandran. Thanks so much. And we'll talk next time.