It’s very common for myths to keep a family from immunizing, and we do our best as pediatricians to combat them. But another thing that keeps kids from getting the shots they need to protect them from serious illness isn’t a myth, but a child’s very real fear of needles.
There have been several heartbreaking stories in the news lately of kids not receiving a vaccine due to needle phobia, and becoming sick, or worse. You might have heard the heartbreaking story of the six-year old in Florida who died by contracting rabies from a bat. His parents knew he was injured by the bat, but cited his fear of needles as the reason they opted to treat him at home rather than bring him in for appropriate treatment including a rabies vaccine. Unfortunately, once the symptoms of rabies start, it is almost always fatal.
There is almost certainly more to that story than we know, and a lot of reasons to be angry and upset that it happened. It’s so difficult to think about someone refusing a lifesaving vaccine for a child, and there is no question that this was a case of medical neglect. However, parents refuse vaccines because of their child’s needle phobia all the time - a 2012 study found that 8% of vaccine refusals were for this reason. Teens often fail to be immunized due to needle fear as well. Most of these refusals are for routine vaccines, ones that are not immediately life saving, as a rabies vaccine is. But refusal of any vaccine can be potentially dangerous. For example, we know that most children who die from influenza are unimmunized.
I bring these examples up, not to scare parents into immunizing, but to help parents understand why it’s so important to create a culture in their house in which children can become comfortable and accepting, rather than fearful, about vaccines. Here are some of my suggestions on how you can do this. I’d love to hear your stories about how you help your child cope with immunizations on Twitter or Facebook.
Read about it. From the earliest age, you can read to your child about immunizations. It’s a great way to spend some of that important daily time reading together. There are a ton of books that can help walk your child through what a checkup is like, and how to cope with getting a vaccine. And if you’re looking for one specifically about getting a flu shot, I recommend The Shots Book: A Little Brother’s Superhero Tale, by then-fourteen-year-old Ethan Posard. It's by far my favorite vaccine-related children's book.
Act it out. Perhaps my favorite advice is to play-act doctor visits with your child. Seriously, one of the best birthday presents for a two or three year old is a toy doctor's kit, as long as it is intended for the right age. When you play with your child, act out the parts of the doctor visit, including getting a blood pressure taken, and ear exam, and giving an immunization. Some of my favorite well-child visits are with young kids that are anticipating the parts of the exam in advance!
Walk the walk. Remember that your kid takes his or her cues from you (it's even been studied), so model good checkup and vaccination behavior. If you're getting your flu shot (and you should be) consider bringing your child along. Talk to your child about how why you're getting it - you know it keeps you from getting sick, and can keep others from getting sick. If you're nervous about getting the shot, it's okay to talk about that. Just follow it up by talking about how you know it's the right thing to do, you're going to be brave, and it won't hurt for long. And when it’s over, talk about how you’re glad you got it done, and are able to fight off a nasty germ without getting sick.
Get shots done on time. There are two reasons that it's a generally bad idea to space out shots. First, is that it increases the amount of time that a child is vulnerable to a disease. But more pertinent to this topic is that spacing out shots means more visits with needle pokes, more pain, and probably more anxiety. One study, for example, looked at the pain response in infants when they get shots - and they didn't have a higher stress response if they got more than one shot at once. And since getting multiple vaccines doesn't come anywhere close to being more than the immune system can handle, there's just no good reason to not get them over and done with.
Stay on message. When your child goes for his or her checkup, talk positively about shots. Please don’t promise that your child is not getting a shot at any particular visit. Even if you don’t believe your child is due for any routine immunizations, you never know if there needs to be a catch-up vaccine that was missed earlier, or if they will need to get an injection of a medication, such as an antibiotic. Or for that matter, if a blood draw will be needed, which is essentially the same as a shot to a child, and often more painful.
If you find that your child will be getting some shots, recall what you’ve practiced at home and stay positive! Nothing sets the stage for a meltdown like introducing the topic of shots with a foreboding "Uh oh..." Instead, remember the message. Shots are important for staying healthy, they only hurt for a little while, and your child is brave and strong and is going to do great.
Don’t threaten. This cannot be repeated enough, and is perhaps one of the biggest, most frustrating pet peeves of pediatricians. Please don’t suggest that shots are going to a punishment for poor behavior in the physician's office, or tease about how much it's going to hurt. It's a poor discipline tactic in general, and puts pediatricians in an extremely bad position. For the definitive discussion of this, read this piece by friend and fellow pediatrician Dr. Daniel Summers.
Finally, remember that some phobias are more serious. If your child's fear isn't improving with these ideas, be sure to talk to your child's pediatrician about pain reduction and calming techniques, or other resources that may help your child’s anxiety.
But the biggest point I can make is to start early. Talking, reading, and role-playing about doctors and vaccines can go a long way to making sure your child gets the point.
"Gets the point." Did I try too hard to stick the landing there?
Eh, I’m leaving it in. It's sharp.