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New guidelines help minimize vaccine trauma

Don't worry. It's just a little poke of the syringe. It'll be over in an instant.

Pain is often considered an inevitable part of getting vaccinations. But for children and for adults afraid of needles, the suffering that comes with these routine jabs is far from minor or temporary, says Dr. Anna Taddio, a professor of pharmacy at the University of Toronto.

"It's kind of a bigger thing, probably, than people realize," Taddio says, noting that the distress children experience as a result of painful vaccinations can have long-lasting consequences.

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A fear of needles can make them reluctant to get further vaccines, or hesitate to visit doctors and dentists well into adulthood, she explains, adding the pain can – and should – be mitigated.

Taddio and her colleagues have drawn up new guidelines for healthcare providers, published in the Canadian Medical Association Journal (CMAJ) on Monday, on how to minimize pain when administering vaccinations. While an earlier version released in 2010 focused only on children, the updated guidelines includes recommendations for all ages, such as avoiding aspiration, or pulling back on a syringe, and injecting the most painful vaccine last when more than one is given.

"There's a lot of anxiety around the needle that we can do a much better job addressing by changing how we deliver vaccinations, and just putting more care [into] addressing people's concerns about pain," Taddio says.

The guidelines, developed by Taddio's team of experts called Help Eliminate Pain in Kids, promote a shift in mindset about pain, treating it not as a normal, unavoidable part of vaccinations, but as a side effect. (There's actually two kinds of pain involved: the first is from the needle itself, and the second is from the chemicals in the vaccination.) The team's work is gaining traction internationally, as several of its recommendations on minimizing vaccination pain were adopted by the World Health Organization this April.

Among them are instructions to breastfeed infants during or just before the injection, to hold children under three years of age to provide comfort, and to ensure older children and adults are in an upright position to provide a sense of control. The guidelines in CMAJ also include using topical anesthetics, such as creams, gels and patches, before injections in children ages 12 and under.

About one in four adults is believed to be afraid of needles to some degree, and an estimated 10 per cent of people do not get vaccinations for themselves or for their children in order to avoid pain. But beyond the impact this may have on the health of these individuals and communities at large, Taddio says minimizing pain is simply good practice.

"Making people suffer unnecessarily doesn't make any sense. Why would you let somebody suffer?" she says, recalling her own child was so distressed, he struggled "like a wild animal" when he was forcibly held down for his vaccinations at the age of six. "It was the most traumatic thing I'd ever seen."

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The idea of mitigating pain in children is relatively new in health care. As recently as the 1970s and 1980s, it was believed babies could not feel pain as their nervous systems were not yet developed enough. Babies were often given only given paralytics to prevent them from moving during surgery, but not pain relief.

When it comes to vaccines, pain has generally been considered a small trade-off for their protection from illnesses. And in the early days of vaccines, people often received only a small number of inoculations over a lifetime.

But now, as children may encounter as many as 20 vaccinations, including flu shots, before the age of five, it becomes all the more important to address the pain involved, says Dr. Christine Chambers, a clinical psychologist with The Centre for Pediatric Pain Research in Halifax.

Minimizing the pain of vaccinations will be part of the centre's new It Doesn't Have to Hurt initiative, launching in September to share research with parents via parenting blogs, Twitter and other social media. (Other topics will include strategies for dealing with common pains, such as headaches and stomach aches, and how to measure pain in children.)

Dr. Chambers notes there are many distraction and relaxation strategies that have been shown to reduce vaccination pain and are easy to implement, such as directing young children to take deep breaths with a pinwheel or blowing bubbles, getting them to listen to music, or just talking to them.

She also recommends that parents prepare their children for an injection by giving simple explanations for why it's important. While some parents feel it's best not to warn their children, "common sense and research shows that's not the case," she says.

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And perhaps most counter-intuitive, Chambers advises parents against reassuring their children, with statements such as, "It's okay," as that can make children feel worse.

"It actually makes children think that their parents are anxious or worried, and that increases children's distress," she explains.

Instead, she suggests parents use neutral wording, such as saying, "This is something that needs to happen," and directing their attention to something else, like reminding them of activities they can look forward to after the vaccination.

"People think, 'Oh, come on, it's just a needle. You know, it's not a big deal.' But the reality is needles are a big deal for kids and their parents," Chambers says. "And when there are strategies that we can use based on research that we know make a difference, we think we should be using them."

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About the Author

Wency Leung is a general assignment reporter for the Life section. Before joining The Globe in early 2010, she has worked as a reporter in Vancouver, Prague, and Phnom Penh. More

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