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    New study urges clinicians to consider needle fears

    Fear of needles may play a larger role than clinicians think in vaccine compliance, both in the childhood years and beyond.

    Although the blame for deciding against vaccination may fall on parents who question the safety of vaccines, new research suggests there might be another reason for skipping shots—fear.

    Children often are afraid of shots, which are not only necessary but also frequent in a child’s early years. This fear, and frequency, can lead to long-term fears of shots, according to the new report.

    The study, led by Amy Baxter, MD, a clinical associate professor at Medical College of Georgia, found that children who received multiple injections at a time between the ages of 4 and 6 were more likely to be afraid of injections even as teenagers.1 Published in Vaccine, Baxter’s report suggests that a fear of shots develops around age 5 years and can have a negative impact on vaccine compliance.

    The research was supported by the National Institutes of health and data was collected at a private practive in Atlanta, and other studies have echoed the results. A 2012 study in Vaccine revealed that two-thirds of children and a quarter of parents in a poll of nearly 2000 were afraid of needles.2 This resulted in noncompliance with vaccine in 8% of the children polled and in 7% of parents, according to investigators.

    Related: Vaccine refusal impacts other routine care

    Baxter’s study assessed injection fears on a scale of 1 to 100, with 100 being the highest level of fear. She discovered that between ages 4 and 6, fear of injections correlated to the number of injections given at a singular visit, and that fear increased as the number of injections increased. Children were not assessed for fear in the school years, however, but later at age 10 to 12. The total number of shots wasn’t really the issue, she notes, but the number of injections given at a single visit. Specifically, by age 10 to 12, children associated multiple shots in their at 1 visit with increased fear, but only for injections given in the preschool years. In her study, Baxter notes that needle fears seemed to increase when 3 or more shots were given at a single visit in those early school years. 

    Needle phobia is long lasting

    “Our study shows that vaccination practice at the preschool visits has consequences that last at least 8 years in a dose response manner—1 injection multiple times, no fear; 2 injections several times, 9% fearful; 3 injections on 1 day, 26% were fearful; and 4 or 5 injections on a single day, 50% of those kids were in the highest fear quartile as preteens,” Baxter says. “There are probably many ways to solve this problem—pain relief, microneedles, combination vaccines—but we need to acknowledge that inducing persistent needle fear is our problem, not the children's weakness.”

    Baxter says this indicates that the ages of 4 to 6 years are a crucial time to address injection fears in order to prevent a lasting fear of needles.

    “Preschoolers are at a vulnerable period for developing phobias. Four-year-olds are developmentally more prone to fear, are very sensitive to their parents' anxiety, and are concrete thinkers for whom good and bad are binary. Doctor good, pain bad,” Baxter says. “They remember traumatic events, and tell themselves stories to make sense of the world. If a good place where they're supposed to be safe turns painful, they have to be held down, and their parent is upset, it makes sense that from their perspective it is a traumatic childhood event. To avoid causing a phobia, reduce the trauma.”

    Baxter suggests not holding children down for shots, and letting them sit in a parent’s lap. Hers and other studies show that multiple injections at once may cause more fear. Clinicians can use distractions, pain relief, or fewer injections to lessen the child’s trauma.

    “The longer children have to solidify a traumatic experience, the better they remember it,” she adds. “Get them out of the room quickly, have a treat, change the situation. Do quick distraction training with parents in the waiting room; they'll convey less anxiety if they have a job during injections.”

    NEXT: Injection fears vs vaccine compliance

    Rachael Zimlich, RN
    Rachael Zimlich is a freelance writer in Cleveland, Ohio. She writes regularly for Contemporary Pediatrics, Managed Healthcare ...

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