Best Distraction Techniques
As a doctor and a mother, Dr. Evelyn Cohen Reis knows how tough it can be to deal with immunization pain in very young children. "It's a challenge with infants and toddlers because you can't explain to them why you're doing painful procedures, unlike older kids where you can kind of rationalize it."
Dr. Neil Schecter, an associate professor of pediatrics at the University of Pittsburgh School of Medicine, says a parent's response to an upcoming immunization is the most important factor in pain and anxiety relief. A parent who is overly nervous, apologetic, worried, or solicitous can influence the child's feelings. Here is what he suggests:
- For infants, the best distraction techniques involve oral stimulation.
- For toddlers, explain that it will hurt for just a minute, then use distraction techniques such as blowing bubbles, reading, or singing.
- Never lie to a child and tell them it won't hurt. Be matter-of-fact, but honest.
A Twofold Approach
Dr. Reis has found that the best distraction technique in infants has a twofold approach: oral sucrose with oral tactile stimulation, combined with being held by a parent. The oral sucrose is a weak solution of sugar and water in a bottle given to the infants two minutes before the injection, which has been demonstrated to be the interval associated with the greatest analgesic effect. During injections, infants are encouraged to continue sucking a pacifier, bottle, or breast. In addition, make sure they're being cuddled by the parent during the entire procedure.
While these techniques won't eliminate pain, they will distract the child, ease pre-shot anxiety, and cut down on post-shot distress. Afterwards, cuddles, words of reassurance, an ice pack on the injection site, and an oral analgesic such as ibuprofen or acetaminophen (for children under the age of 2—check with your pediatrician before administering any over-the-counter medicine to your child) all help to ease pain and surprise. Again, don't make a big deal out of the aftermath. According to the researchers, a parent's best approach is "matter-of-fact, supportive, and unapologetic."
Distraction Beyond Immunizations
While immunizations are understandably upsetting to everyone, there's more going on in a doctor's office than just immunizing, and distraction can be valuable for other procedures as well. Dr. Gwenn O'Keeffe, CEO of Pediatrics Now, says that a child of a certain age can become very distressed by a doctor's visit, not because of any anticipation of pain, but because of their stage of development. For example, an 8-month-old, who is experiencing normal separation anxiety, may be fine as long as he or she is being held by Mom and feels secure, but become inconsolable when placed on the exam table. A toddler of any age may be uncooperative because they are going through the normal stage of negativity or "terrible twos."
Distraction techniques can be useful in any of these situations, as well as in other stressful situations such as going to the dentist. Dr. O'Keeffe finds parental closeness to be extremely effective and has a number of techniques she uses with the parents of her young patients so they can hold their child throughout the exam, without compromising the outcome or her ability to conduct the exam.
Dr. O'Keeffe also notes that regardless of the child's anxiety or fear, he or she should not be allowed to hijack the process, including delaying any procedures. Again, parents should be matter-of-fact and sympathetic, but also firm in their resolve that some matters are non-negotiable.