Needle Phobia: What it is, what it isn’t and how to help

Research has shown that one of the biggest fears children have about visiting their pediatrician is a fear of needles (Kortesluoma & Nikkonen, 2004). For chronically ill children who undergo frequent procedures such as intravenous infusions (IVs), blood draws or steroid injections, repeated exposure to needles can generate significant fear and anxiety.

While it’s true that very few people regardless of age enjoy procedures involving needles, for millions of people that fear can be classified as an actual diagnosable condition (American Psychiatric Association, 2013).

Although there may be a genetic component that makes some children more vulnerable to the fear of needles, most people with needle phobia report either experiencing a painful or traumatic event as a child that led to the fear or watching someone else experience something similar (Orenius, et al., 2018). In essence, the child learns to associate the experience with a fear-based response. In many cases of needle phobia, that fear response can become generalized. This means it may not just be the actual needle that brings out a response, but things that remind the child of the needle such as pulling into the driveway of a pediatrician’s office or seeing someone in a doctor’s white coat.

Often, frustrated parents will try to dismiss the fear in the child or say things like, “It doesn’t hurt” or “It’s just a pinch”. The science behind a child’s nervous system and pain receptors suggests otherwise. Children tend to have a lower pain threshold than adults. Their nervous systems also have a harder time slowing down the pain signals from the skin to the brain. So, in a way, a shot does “hurt” a child more than an adult (de Lalouveiere, et al., 2014). Also, the younger a child is, the less sophisticated their self-regulation of emotions and coping skills are. The more anxious one is, the more intense the pain reaction will be. This heightened sensitivity and hyperarousal sets up a negative feedback loop.

If your child has a needle phobia, it is important to first discuss with your pediatrician any concerns you may have and potentially come up with strategies for lessening the fear.

The good news is there are things that you as a parent/caregiver can do.

Here are some helpful hints when dealing with a child who has significant needle anxiety:

  • Listen With Your Ears and Eyes

Some children will openly voice their opposition to getting a shot, often going so far as refusing to get in the car or walk into their pediatrician’s office. Others, however, react to the anticipatory fear by withdrawing emotionally. In the hours leading up to the procedure, be aware of any non-verbal displays of anxiety such as nail-biting, restlessness, shaking, or lack of eye contact. If you notice any of these, ask the child open-ended questions such as “how are you feeling?” This allows the child to identify the emotion driving the behavior and express it.

Try to avoid making assumptions about the child’s emotion and/or implying emotions. Asking a child if they’re scared puts a thought in their head they may not have had before. It may also shut down communication by only giving the child an answer of yes or no.

As you’re getting ready to leave for the procedure, try to give the child some options and choices, even if it’s something simple. Ask them if they’d rather wear a red or a blue t-shirt or if they’d rather take their stuffed bear or stuffed pig. This allows a child to feel some degree of control.

  • Offer Firm, Yet Kind Communication

Before the procedure begins, set the child’s expectations and explain their role in specific, but developmentally appropriate terms. Always use a calm, reassuring tone with a firm manner.

It’s helpful to follow these steps when explaining what to expect.
–The action
–Their “job” during the procedure
–Their reward
For example, if a child is having blood drawn, you can explain that you’ll be using a special, small straw to check how healthy their blood is. Suggest that some children have said they feel a little pinch when the straw starts checking their blood. If using a tourniquet, explain they might feel a tight squeeze on their arm (Action).

Then, explain that when the nurse/phlebotomist says “start”, they are to blow as many bubbles as they can or count how many red objects there are in the room (Job).

Make sure they know that when they’re done, they will get to pick a prize out of a box (Reward).

  • Distraction techniques — Active and Passive

In the example above, the child’s “job” is basically a redirection of their attention from the fear-provoking activity to a more neutral activity. These techniques are broken down into active and passive categories. The use of which type of technique varies by individual, but broadly speaking, since younger children have a more difficult time regulating their emotions, they tend to respond better to active distraction techniques that passive ones.

○ Passive techniques watching videos on a tablet or phone, reading to a child, singing a song or repeating a nursety rhyme

○ Active techniques blowing bubbles, blowing on a pinwheel, looking through a kaleidoscope, playing a video game on a tablet or phone, guided imagery, controlled breathing.


* Please note:
There is a specific needle phobia called blood-injection-injury phobia (American Psychiatric Association, 2013). Blood-injection-injury phobia (BII)actually responds negatively to controlled breathing/relaxation techniques.  Many people with this phobia experience what is called a vasovagal response. This means that they experience an increase in blood pressure leading up to the injection, but then experience a rapid decrease in blood pressure, oftentimes causing them to faint or pass out. For this very specific phobia, slowing down the nervous system with controlled breathing is not recommended. People with this phobia respond better to an increased tension technique paired with exposure therapy. For more details on BII and applied tension, click here.

  • Education

As mentioned in a previous article, preparation and open communication are key to reducing some of the anxieties related to procedures. For younger children, picture books may be an engaging way of preparing a child who is anxious for an injection.

If you’re looking to something more specific than a broad internet search, The American Psychological Association (APA) has a children’s book companion website called Magnination Press.

Many of the books listed on the site are award-winning books and they all deal with a wide range of mental health issues in a developmentally appropriate manner.

There is no denying that needle phobia can be a significant fear that sometimes leads to oppositional and avoidance behavior. There are evidence-based strategies that parents and caregivers can do at home to help lessen some of the stress.

References

American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental

Disorders
(5th ed.). https://doi.org/10.1176/appi.books.9780890425596

deLalouvière, L.L.H., Ioannou, Y., & Fitzgerald, M. (2014). Neural mechanisms underlying the

pain of juvenile idiopathic arthritis. Nature Reviews Rheumatology, 10, 205-221.

https:/doi.10.1038./nrrheum.2014.4

Kortesluoma,  R.L., & Nikkonen, M. (2004). ‘I had this horrible pain’: The sources and causes of

pain experiences in 4-to 11-year old hospitalized children. Journal of Child Health Care,

8(3), 210-231. https://doi.10.117723779608 1

8759442journals.sagepub.com/home/son

Orenius, T., Säiilä, H., Mikola, K., & Ristolainen, L.  R.L., & Nikkonen, M. (2018). Fear of injections

and needle phobia among children and adolescents: An overview of psychological,

behavioral and contextual factors. SAGE Open Nursing, 4, 1-8.

https://doi.org/10.1016ij.pmn.2008.07.002




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