A parent trying to keep their child calm while they get a shot is up against the tallest odds. And for good reason. Skin isn’t intended to be pierced, and quite frankly, it hurts. So the brain attempts to protect the body through a fight or flight response. The result? Tears, flinching, squirming, and general terror. But a recent study published in the journal PAIN gives parents of little kids a new insight about how to most effectively ease their child’s distress in the lead-up to and in the first minute after their children get a vaccine. And with the imminent emergency approval of a COVID vaccine for children 5 to 11 years-old, it could not have come at a better time.
The Vaccination Distress Feedback Loop
Researchers from the OUCH Lab at York University in Toronto recently observed over 700 parent/child pairs during vaccination appointments. During observation, researchers measured child distress before, during and after receiving shots. What they found was that children didn’t respond well when parents used verbal coping strategies to help calm them down during and immediately after shots. In fact, these attempts caused kids to become more distressed.
When those verbal attempts at comfort didn’t work, parents tended to resort to more heavy-handed tools, which just made things worse. “Their caregivers may display coping-promoting verbalizations in an attempt to soothe their highly distressed child,” researchers wrote. “By the second minute post-needle, these caregivers may be more likely to exhibit distress-promoting verbalizations, perhaps due to mild frustration or fatigue.”
Dr. Jennifer Hettema, Senior Clinical Director at Lifestance Health who was not involved with the study, notes that for parents to act as a calming influence for their children, they will need to hold it together. It’s a big ask because it’s difficult for a mom or dad to absorb their kid’s stress instead of reflecting it or amplifying it. And while the appointment window is short, time can feel like it’s dragging out as a child cries. The longer this goes, the more likely it is that parent’s shame triggers will activate causing them to attempt to control the situation through threats or coercion.
“When we communicate negative emotions like shame, frustration, or embarrassment to children who are experiencing distress, we are often compounding the problem by increasing stress and the likelihood that the child will be relying on their “downstairs brain” to flight/flight/flee,” says Hettema. “If a parent feels embarrassed when their child is anxious or distressed about vaccines (or any other stressful event), projecting that emotion and getting angry with a child is likely to make the child’s reaction worse.
How Parents Can Help Keep Kids Calm During Vaccinations
The OUCH Lab team found that kids can process words and find them comforting after about a minute following their shot. Before that point, including in the minutes before the poke is given, alternate techniques work much better. “Adopting techniques that allow the child to be approached without distressing them (e.g., allowing a child to stay close to their caregiver while viewing a video on a smartphone as a distraction) will help minimize the pain ‘domino effect’,” the study authors wrote.
“Bring a toy, tell a story, or sing a song to distract the child. Sometimes a support person can also be helpful,” says Dr. Steven Abelowitz, MD FAAP and Regional Medical Director of Coastal Kids Pediatrics. “But don’t show worry because preschoolers especially pick up on nervous cues and will pick up on anxiety. Simply be there for your child, and distract them to the best of your ability.”
Physical touch can be especially helpful, as is giving providing something tangible to look forward to as opposed to general assurances that everything will be fine. “While the shot is happening you can squeeze the child’s hand or foot, or talk about plans later in the day while they are receiving the injection,” Abelowitz says. “Tell them that after you will go get some ice cream or do an activity that you know they enjoy.”
It’s noted in the study from the OUCH Lab that clinicians would do well to have focused support for parents during vaccination appointments. Because while the adult brain is more capable of rational thought during stressful events, everyone has a point at which they will start to operate more from their brainstem the more developed parts of their brain. Parents are only human, after all.