There are many things kids love about the fall — the cider, the pumpkins, the trick-or-treating and more. But with the rollout of annual flu shots and an impending authorization of the Covid vaccine for kids ages 5 and up, the fall season may not be so enjoyable for children who are terrified of needles.

Trypanophobia, as the fear of needles is technically called, is common — with some studies estimating it can affect most kids under 10. Some children get so worked up just by thinking of a needle or blood that their heart rate and blood pressure rises, and then drops rapidly, causing them to faint. The good news is that parents and caregivers can help children overcome their fears if they understand the best ways to offer support. Here’s how.

First, figure out the logistics of when and where you will vaccinate your child. Think about the qualities of the location that would make your child more comfortable: Do the providers have experience vaccinating children? Are they patient and do they have a pleasant bedside manner? If your child’s own health care provider has appointments and vaccine supply, you could try starting there. If that is not an option, consider somewhere that has experience with pediatric vaccines, like school-based vaccination sites, pediatric urgent cares or retail pharmacies. Some pediatric practices also have devices that make vaccinations less painful, like the Buzzy Pain Relief Device, which vibrates against the skin as a distraction.

Choose an appointment time when you and your child are less likely to be stressed and aren’t feeling rushed. If your child is in school, consider making an appointment for after school or on the weekend.

If you anticipate that your child will have a difficult time with needles or shots, try exposing them to needles starting a few weeks before their appointment. Reading them relevant books — like “The Berenstain Bears Go to the Doctor,” which depicts two little bears who must get a shot to stay healthy — can be helpful. Cartoon depictions of needles in books or online could also provide exposure without children getting too close to a real needle. If your child has a toy doctor set, they could use it to practice giving you a shot; or they could pretend to give you a shot with their finger. Children may also benefit from seeing you or another person who does well with shots get one in real life. (Adults can have needle phobia too.)

If your child is a little older, you could help them create a “fear ladder,” which involves listing all of the situations involving needles that cause them fear — for example, seeing a needle or getting a shot — and ranking those scenarios by how much difficulty or distress they cause, from the least distress (at the bottom rung) to the most distress (at the top rung). You can help your child “climb each rung” on the ladder by having them think about, explore or act out each step. Hopefully, by the last rung your child has overcome their fear of needles or at least significantly reduced their anxiety.

Before you go in, reflect on the previous times your child has gotten shots and take note of anything that worked well. Perhaps a favorite toy or person tagged along for the visit. Also decide if and when you will tell your child that they will be getting a shot. (The research isn’t settled on whether it’s best to let your child know ahead of the appointment.) Remember that every child is different: For some, knowing they’ll be getting a shot may ruin their entire visit; whereas others may do best if they have advance warning.

Let the health care team know that your child is really worried about the shot, but explain to your child that they are growing up, you believe in them and you will be there for them. If you’d like to numb the area, ask your health care provider about 15 to 20 minutes before the shot if you can do so. They may have an ice pack you can put on your child’s arm, or you may wish to bring and apply lidocaine cream, if approved by your child’s physician.

While the health care provider is preparing the vaccine, be present with your child and support him or her throughout the process. You might lead your child through mindfulness exercises or other relaxation techniques, like playing soft music or doing deep breathing or visualization exercises.

Once the shot is ready, your child’s anxiety may return, and you may need to use those same distraction techniques for a few more minutes. You might also encourage your child to look away or look at you so they don’t focus on the needle; or you might allow them to watch a favorite show or play a favorite game on a tablet or smartphone. Distraction techniques have proven effective in reducing distress and pain related to needles. If your child tends to faint during vaccination, try leading them through an “applied tension” exercise, where they tense or squeeze their arms and legs tightly for 15 seconds, until they feel warmth in their face, then relax. They can repeat this technique four or five times before they receive the shot, and continue until the shot is over.

All children are different and have varying levels of fear and anxiety. Some may need a more intense approach to relieve their anxiety, including cognitive behavioral therapy, hypnosis or anti-anxiety medication, but ask your child’s doctor if you need additional help. Nevertheless, these tips can be a good starting point for keeping your child healthy and get everyone back to enjoying the things that make fall special.

Dr. Nia Heard-Garris is an assistant professor of pediatrics and a practicing pediatrician at the Ann & Robert H. Lurie Children’s Hospital of Chicago and Northwestern University in Chicago.

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