Reducing the pain and anxiety of immunizations

From DMM, on the Topics Suggestions page: “Any ideas for a kid scared of immunizations. I have a 5 year old who needs his kindergarten shots before August. He has anxiety issues.. He is now able to go to the Pediatrician and trusts her, but he knows that he will need to get some shots before school. Some of his friends have gotten them, and just the mention of them sends my son into meltdown/anxiety attack mode.
Any ideas on how to make this a doable situation for us all?”

I agree that the pre-kindergarten visit can be rough on the kids. The good news is that we can protect our children and their classmates from serious infections. The bad news is for the child himself: that’s 3 or 4 booster shots. Though many kids take this in stride, it can be a scary experience for many children.

There is some good research on ways to reduce the pain of immunizations for children. Among the most important for children older than toddlers is the parents’ reactions to vaccines. Excessive parental reassurance, apologies, or criticism makes the immunizations more painful; parents who remain calm and matter-of-fact, or are able to distract their child effectively, can help make the experience better. Among the best distraction techniques are story-telling, reading, blowing, or deep breathing.

Some topical anesthetics can reduce the pain of injections, though none works 100%. Ela-MAX is available over-the-counter. It has to be applied at least 30 minutes before the immunization to be effective. If you’re interested in using a medical anesthetic like Ela-MAX or another product, please check with your pediatrician beforehand to ensure that you’re using it correctly and putting it in the right place. Some doctors like to use a quick squirt of a cooling agent on the skin right before injections. Data on whether this really works is unclear, but it probably at least serves as a quick distraction.

There are also important ways that your pediatrician and nurses should employ to minimize pain. The correct length needle should be used—some nurses prefer to use shorter ones, but in fact longer needles are less painful because they put the injection where it is supposed to go. If more than one immunization is needed, they should ideally be given in groups together rather than one-at-a-time. Also, recent research has confirmed that the older style of “aspiration before injection” is unnecessary and increases the time and pain of the injection. Immunizations should given as a quick, controlled jab-and-squirt-and-get-out, quick as can be.

By age 5, the anxiety about the immunizations can be much worse that the pain of the vaccines themselves, so efforts to decrease the pain alone probably won’t help much unless that is accompanied by ways to decrease the anxiety.

A great way to help children learn to reduce their anxiety is called “belly breathing.” I found an excellent description of the technique here. (I don’t know much about that web site or their other products, so I can’t vouch for them, but that page on belly-breathing for kids is very well written.) Kids can also learn to belly breathe with the help of the book A Boy and a Bear by Lori Lite. The book cleverly hides the lesson by having the boy teach it to a bear. That kind of “indirect” lesson can sometimes be the best way for children to learn.

Thanks for the question, and let me know how it works out! Also, I’d welcome any other suggestions parents would have for this question. Feel free to post your best ideas as a comment, below.

© 2008 Roy Benaroch, MD from

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2 Comments on “Reducing the pain and anxiety of immunizations”

  1. Dr. Roy Says:

    Moved from another thread by mod:

    Debbie Says:

    July 9, 2010 at 10:46 am e

    I recently read about topical numbing creams that can be used to numb the area before dispensing the shots to lesson the pain. What are your thoughts about this and why aren’t they currently being used?


  2. Dr. Roy Says:


    Topical numbing creams have been around awhile (“EMLA” is by rx only, “ELA-Max” is OTC), but haven’t really caught on. They’re not very easy to use because they need to be applied at least 30-60 minutes in advance and covered with an occlusive dressing. But more importantly, they don’t really work very well– they only numb about a millimeter deep into the skin. For some kids especially anxious, they may be worth a try. Just call your pediatrician in advance for instructions.

    Creams like these do work very well when needles don’t go as deep, say in blood draws or IV starts. Again, they just need to be used correctly, and in advance.


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