A fear of needles is common in children. While some children may have no recollection of previous experiences with vaccinations, others may associate the idea of having a vaccine as a painful and scary procedure due to the involvement of needles.

For some children, adolescents and even adults, this fear presents as a significant phobia, resulting in severe persistent anxiety, fear, and an inability to sit still or even consider having a vaccination. 

Often this fear will lead to significant difficulties for children undergoing something as simple as an immunisation. Immunisation attempts may result in crying, screaming and running away, leaving both the child and parent distressed. Often there are simple measures that parents can take to prepare or distract your child that will make the process easier.

When it comes to vaccination, it is recommended that children and adolescents with anxiety, intellectual disabilities, and needle phobia avoid larger scale vaccination settings. These are loud and busy places and can increase a child’s distress and make the process more difficult. Families should consider visiting a smaller setting, such as a GP clinic.

Tips for parents  

• Needle phobia is real, and it is okay for your child to be afraid
• Try to make vaccination a positive experience for your child. Sometimes it is easy to explain that they are being given an invisible shield like a superhero to protect them, their family, and friends
• Do not criticise your child, support and encourage them throughout the process
• It is okay for your child to be scared or to cry. Everyone has different coping strategies, praise your child for being present and going ahead with the procedure
• Every child will respond differently to vaccination. An individual approach is recommended for each child
• Needle phobia can be a lifelong problem if not managed appropriately
• For children who are afraid of vaccinations, it is best to see a practitioner who is experienced in childhood vaccination

Strategies to support children with needle phobia

• Prior to the appointment, avoid excessive discussion of the needle and procedure. It is best to avoid calling the vaccine a needle. Instead, refer to it as a vaccine to protect your child, or as medicine that goes into the muscle
• Offer your child a treat or experience as a reward to look forward to after the procedure
• Make a plan with your immunisation provider prior to the appointment. It is a good idea to carry out pre-vaccination checklists and side effect explanation either over the phone or when your child is not in the room 
• Take your time with your child, do not feel the need to rush them through the procedure
• Remain as calm as possible when talking to your child about their vaccination
• Encourage the provider not to show your child the needle at any time
• Do not attempt to force or hold down your child, this can result in injury or unsuccessful vaccination attempts
• If your child becomes too distressed to reason with, stopping the procedure may be necessary. Take a break and take your child for a walk, or make an appointment for another day
• It is recommended not to continue to attempt the vaccination after multiple failures. Two failed attempts are enough before contacting specialist providers for advice or to explore sedation options

Management techniques

Distraction is a key component for successful vaccination in children. It helps to focus their attention away from the procedure or associated discomfort. The most successful techniques will involve interaction with another person, such as the parent. It is best to distract your child away from the immunisation provider.  

Distraction Techniques

• Bubble blowing and counting
• Interactive books
• Musical toys
• Breathing exercises
• Singing
• A tablet or phone with their favourite song or TV show playing
• Interactive games such as I Spy
• Age specific conversation i.e., a favourite superhero or movie star

Local anaesthetic creams

Local anaesthetic creams are available for purchase from pharmacies. These creams will numb the top layer of the skin, minimising the sting from the needle. This may help to minimise pain, but also make the experience a more positive one. Apply the anaesthetic cream to the upper arm region for vaccinations. If local anaesthetic creams are not available, ice or an ice pack applied to the site for 10-20 seconds will help to decrease sensation and help minimise pain.

Sedation

When all other options have been exhausted, sometimes sedation can be the only way to vaccinate a child without making it a traumatic experience. Several immunisation providers in metropolitan Melbourne and Geelong can offer sedation options for children with an extreme fear of needles. This service is available at The Royal Children's Hospital. Please contact our  Immunisation Service for more information. 

Key points to remember

• It is okay for your child to be scared of needles, support them at all times
• Distraction is vital to a successful vaccination in children
• Offer rewards for after the procedure is completed
• Encourage your child to look away from the immunisation practitioner
• If all options are exhausted, sedation is an available option  
  

For more information

• The Royal Children’s Hospital Immunisation Service
• Kids Health Info Podcast – Fear of needles. What helps?
• A Child’s Guide to Hospital episode –  Immunisation Clinic
• A Child’s Guide to Hospital episode –  Nitrous oxide
• Comfort Kids –  Positioning for Procedures
• Meg Foundation –  Empowering families to prevent and relieve pain
• Melbourne Vaccine Education Centre –  Needle phobia
  

Developed by The Royal Children's Hospital Immunisation and Comfort Kids departments. We acknowledge the input of RCH consumers and carers.

Reviewed January 2022

Kids Health Info is supported by The Royal Children’s Hospital Foundation. To donate, visit www.rchfoundation.org.au.