DISCLAIMER: This material is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it. It is not intended to provide medical advice, diagnosis, or treatment, nor does it replace the advice or counsel of a doctor or health care professional. Reference to a specific commercial product, service, or external web site does not imply endorsement or recommendation of that product, service, or external web site content by CPCMG. We attempt to keep lists of resources and referrals as up to date as possible; however, this information is constantly changing. Please check with the service provider and your insurance company to verify coverage.
The Warning Signal: Learning HOW The Pain From Needle Pokes Works
CPCMG’s Approach
CPCMG takes a holistic approach to help children and teenagers with fear of needles that are used for vaccines and blood tests.
To start, please review these helpful resources for parents and caregivers:
1. Taking Fear and Pain Out of Needles-for Your Child and You -HealthyChildren.org
2. How to make Shots Hurt Less for Kids | Meg Foundation (megfoundationforpain.org)
3. FAST-A Needle Phobia Handout (3.22.22) (seattlechildrens.org)
4. Buzzy® - Needle Fear & Pain Relief (paincarelabs.com)
5. Needle Fear Education Kit: NFEK - Needle fear education Booklet
6. Help Kids Scared of Going to the Doctor | Child Mind Institute
When Medications May Be Helpful
In some cases, topical or oral medications may be recommended to help with need phobia. Your child’s CPCMG clinician will discuss the options with you, and help develop a plan to suit each person’s unique needs. For reference, we have included information below about topical (such as creams and gels applied to the skin) and oral medications that may be recommended.
Instructions for Medications
If your child requires medication to calm them prior to their vaccines and/or blood draws, it is important to plan ahead and follow the instructions given by your clinician carefully regarding the recommended dose and timing. They should be given 30-60 minutes prior to the appointment time. As clinic and lab schedules can sometimes be unpredictable, scheduling your child’s visit first thing in the morning would be ideal to ensure that your child is seen at the designated appointment time. Notifying the clinic or lab staff of the time you have administered the medication can also allow for staff to ensure that your child receives their immunizations or blood draws within the appropriate window of time.
If administering diphenhydramine (Benadryl):
It is important to try administering a dose prior to the actual appointment date as there is a small subset of patients who can experience a paradoxical or opposite effect of becoming more hyper rather than calmer. If your child has tolerated it well before, please plan to administer it 30 minutes prior to the appointment time.
If administering Topical Lidocaine:
Instructions:
If your child requires topical numbing medication applied to the skin prior to their vaccines and/or blood draws, it is important to plan ahead and follow the instructions given by your clinician carefully regarding the recommended dose and timing. It should be applied 30-60 minutes prior to the appointment time. It will also be a good idea to check with the nurse administering the vaccine or the lab technician drawing your child's blood the exact location that they plan to use PRIOR to the visit to ensure that you apply the medication on the right area. As clinic and lab schedules can sometimes be unpredictable, scheduling your child’s visit either first thing in the morning would be ideal to ensure that your child is seen at the designated appointment time. Notifying the clinic or lab staff of the time you have applied the medication can also allow for staff to ensure that your child receives their immunizations or blood draws within the appropriate window of time.
Of note, in very rare cases, a blood disorder called methemolglobinemia may occur with use of topical anesthetic such as lidocaine. Your child may be a higher risk for this rare side effect if they have underlying conditions such as G6PD deficiency and anemia or using certain medications such as to protect against malaria. Symptoms may include blueness of/around lips, shortness of breath, lightheadedness, headache, dizziness, fatigue, and in rare circumstances, breathing difficulties or seizures.
If applying Lidocaine gel:
It is important to try applying a small amount of the gel to the skin. While allergic reactions to topical anesthetics are rare, it can sometimes cause local irritation of the skin. If your child tolerates it well, please plan to apply it to the recommended site 30 minutes prior to the appointment time.
If applying lidocaine-prilocaine gel (EMLA):
It is important to try applying a small amount of the gel to the skin. While allergic reactions to topical anesthetics are rare, it can sometimes cause local irritation of the skin. If your child tolerates it well, please plan to apply it to the recommended site 60 minutes prior to the appointment time.
If administering lorazepam (Ativan):
It is important to try administering a dose prior to the actual appointment date to ensure that your child does not experience any rare, but serious side effects including confusion/disorientation, poor muscle coordination or balance, blurry vision, chills, or involuntary movements such as tremors or shaking. If your child tolerates it well, please plan to administer it 60 minutes prior to the appointment time.
If administering olanzapine (Zydis, Zyprexa ODT):
It is important to try administering a dose prior to the actual appointment date to ensure that your child does not experience any rare, but serious side effects including confusion, dizziness, poor muscle coordination or balance, weakness, pain in legs/arms/back. If your child tolerates it well, please plan to administer it 60 minutes prior to the appointment time.
If administering aripiprazole (Abilify) or risperidone (Risperdal):
It is important to try administering a dose prior to the actual appointment date to ensure that your child does not experience any rare, but serious side effects including confusion/disorientation, dizziness, poor muscle coordination or balance, blurry vision, chills, or involuntary movements such as tremors or shaking, or seizures. If your child tolerates it well, please plan to administer it 60 minutes prior to the appointment time. If your child already takes aripiprazole or risperidone once or twice a day, a third dose can be given as long as the total combined dose is at or below the maximum daily dose.