Posted by Amy Baxter, MD on July 6, 2012 · Leave a Comment
A recent post on an arthritis blog I belong to discussed a common problem, out of control needle fear. In many cases, it has grown so out of control that home shots are going to be transferred to the hospital, or effective IM medications are going to be swapped for less effective oral ones. If you’re on this path, here is a way to try to address the issue for children age 4 – 10: try a “do over”.
Kids are used to new rules being laid down, and so long as you are 100% consistent after calling a “do over” they usually adapt in one to three events. Say, OK, this isn’t working, before we decide to just do this at the hospital every time let’s make a plan for next time and you choose what you want to try. Write down the options to make the exercise super legit and read it to her or let her circle what she wants to give control.
- Freeze spray/no freeze spray: Research shows for children under age 6 freeze spray hurts more than helps on average. We don’t recommend it.
- Position (sitting in dad/mum’s lap, lying on side, etc): Tensing muscles makes shots worse (that’s awfully hard not to do when a child is freaking out). Since lying on the back is anxiety provoking, you can try lying on the side.
- Entertainment or distraction so as to NOT pay attention to shot: watching TV, blowing out on a kazoo (blowing helps naturally decrease fear), etc.
- Other sensations: take a big sip of something cold and sweet right at the moment of the shot, turn a Buzzy on and off in her hand, press Buzzy to her forehead (THAT’s a big counter stimulation) etc. (see the Buzzy story in Pediatric Safety).
- Poke-r chips or a token economy: Decide on a prize for working on this together, a treat you’ll both get like an outing to a movie or a favorite shop. Make a goal number of chips and a value for behavior, perfect = 3, but you get 1 no matter what, that kind of thing. Assign enough chips to behaviors so it’s attainable in that magic three events, and then let her decide how well she did and how well you did. Both of you performed the plan perfectly? Three chips for you, 3 chips for her, only 4 more to go! You forgot to have the cold sweet drink nearby but otherwise did well? 2 for you, 3 for her (and you got some feedback on what was most important to her). She lost it, freaked out, had to be dragged out from under a table? Well, one chip is the lowest you can get, so 1 for her, 2 for you maybe, and the prize is still within reach. Having a tangible token is important here. (*acknowledgement to Nancy Potash of the Platelet Disorders Support Association for this Poke-r Chips pun and concept.)
With so much going on, and having a plan and feeling more in control, perhaps you can reset the fear windup. When she starts ramping up a day or so before, remind her, “No, no, this is going to be completely different, remember? We have our plan.”
Not everything works for every kid…so if you have additional solutions that worked for you, I’d love to hear them…
A recent post on an arthritis blog I belong to discussed a common problem, out of control needle fear. In many cases, it has grown so out of control that home shots are going to be transferred to the hospital, or effective IM medications are going to be swapped for less effective oral ones. If you’re on this path, here is a way to try to address the issue for children age 4 – 10: try a “do over”.
Kids are used to new rules being laid down, and so long as you are 100% consistent after calling a “do over” they usually adapt in one to three events. Say, OK, this isn’t working, before we decide to just do this at the hospital every time let’s make a plan for next time and you choose what you want to try. Write down the options to make the exercise super legit and read it to her or let her circle what she wants to give control.
1) Freeze spray/no freeze spray: Research shows for children under age 6 freeze spray hurts more than helps on average. We don’t recommend it.
2) Position (sitting in dad/mum’s lap, lying on side, etc): Tensing muscles makes shots worse (that’s awfully hard not to do when a child is freaking out). Since lying on the back is anxiety provoking, you can try lying on the side.
3) Entertainment or distraction so as to NOT pay attention to shot: watching TV, blowing out on a kazoo (blowing helps naturally decrease fear), etc.
4) Other sensations: take a big sip of something cold and sweet right at the moment of the shot, turn a Buzzy on and off in her hand, press Buzzy to her forehead (THAT’s a big counter stimulation) etc.
5) Poker chips or a token economy: Decide on a prize for working on this together, a treat you’ll both get like an outing to a movie or a favorite shop. Make a goal number of chips and a value for behavior, perfect = 3, but you get 1 no matter what, that kind of thing. Assign enough chips to behaviors so it’s attainable in that magic three events, and then let her decide how well she did and how well you did. Both of you performed the plan perfectly? Three chips for you, 3 chips for her, only 4 more to go! You forgot to have the cold sweet drink nearby but otherwise did well? 2 for you, 3 for her (and you got some feedback on what was most important to her). She lost it, freaked out, had to be dragged out from under a table? Well, one chip is the lowest you can get, so 1 for her, 2 for you maybe, and the prize is still within reach. Having a tangible token is important here. (*acknowledgement to Nancy Potash of the Platelet Disorders Support Association for this Poke-r Chips pun and concept.)
With so much going on, and having a plan and feeling more in control, perhaps you can reset the fear windup. When she starts ramping up a day or so before, remind her, “No, no, this is going to be completely different, remember? We have our plan.” Not everything works for every kid, and if you have additional solutions that worked for you, I’d love to hear them…
