Needles and Children

Needles and Children

Needle fear and phobias can be a highly stressful situation for a child and their caregivers to manage. Sometimes as a parent it can be difficult to decipher the difference between a developmental (and often temporary age-appropriate fear), anxiety, and a phobia. 

Fear

Fear and worry can be a normal and typical part of development and day-to-day life. Often children’s fears will be rooted in their developmental understanding of their world around them. For example, children around the age of 4-5 might have fears based on magical thinking, whereas children in the 7-9 age range might have increased understanding that bad things can happen and might fear things like getting hurt, family members getting hurt or bad people. It is not unusual for children to express a fear of needles, with many children experiencing temporary fear or discomfort – or even experiencing the fear for a period of time, but they will usually (and often through some caregiver discussion and support) overcome the fear. At times, the fear may pop up again around immunizations or bloodwork – but otherwise the child doesn’t really think about needles on a frequent basis. The thought of needles, while maybe associated with being unpleasant, likely does not impede the day-to-day routines and functioning of this child. 

For these children it is helpful to:

1. Validate their feelings
2. Demonstrate what to expect (e.g, through videos, books, play, etc.),
3. Offer calm support through the expected task 
4. Offer positive and specific praise for effort 

Anxiety

Anxiety and worries are a normal part of life and all people experience some level of both. There can be varying levels of anxiety that a child may feel towards needles – some of these experiences may be typical with a child demonstrating reluctance and emotion but ultimately, they are able to get a needle when needed. Some children experience such significant levels of worry that they become highly overwhelmed (i.e., fight or flight) – this feeling can feel very unpleasant and uncomfortable. Some of these children might be Superfeelers (i.e., deep feelers of emotions) and others there may be a familial or biological tendency towards anxiety – and some may experience both.  To cope with and manage the intensity of their anxiety, some children may utilize short term strategies that temporarily alleviate the feeling, but in the long term these strategies will exacerbate the patterns of anxiety. For example, a very common short-term strategy is avoidance in which the child may avoid getting a needle. Another common pattern is rumination in which the child may think about and worry about a needle frequently – they may create entire “what if” scenarios in their mind which will cause increased and heightening anxiety.  Both patterns carry the risk of reinforcing and perpetuating the anxiety response.

For these children it can be helpful to:

1. Validate feelings and offer emotional support while also encouraging non-avoidance
2. Use numbing cream, cold, distraction, and other strategies to make the experience more comfortable
3. Consider vaccinations outside of a school environment, informing medical staff of a heightened fear or anxiety response prior to the appointment, and asking for the option of laying down or other help the child feel more at ease
4. Seek out counselling to help better understanding of anxiety-related patterns, coping strategies, education on brain and body reactions, and if needed creation an Exposure with Response Prevention (ERP) plan 
5. Provide specific praise and encouragement for any efforts made towards getting a needle

Often caregivers will note a decrease in anxiety symptoms with the introduction of counselling and the implementation of strategies at home. 

Phobias

A phobia, while often related to anxiety, is typically a prolonged and disproportionate level of fear, stress, and/or anxiety in comparison to the object of the phobia. For example, a child may feel and react as if needles are a threat to their life, rather than a necessary and unpleasant discomfort. The child may demonstrate significant fear, anxiety and avoidance daily and even the thought of the object of phobia can cause a significant reaction both internally and externally. Strategies such as avoidance may temporarily diminish the stress response but if consistently repeated can impede the day-to-day functioning of the child.  Additionally, the child themselves, as well as family members and caregivers, can unintentionally exacerbate symptoms of the phobia by reinforcing the perception that the object of the phobia is unsafe, something to fear or something that requires avoidance.

For example, a child may notice that they feel fear when anyone says the word needle, so they ask their family members to refrain from use of this word – the family, wanting to be supportive and keep the child regulated agree. In the moment, this strategy works and it feels good to alleviate the stress response from the child, however it unintentionally reinforces the fear and teaches the brain and body that avoidance is necessary. Often initial avoidance and protective strategies only work for so long, and it is common for this pattern to grow and slowly include additional things to avoid. Sometimes caregivers may observe that the child is avoiding things that seem to have no connection to the phobia – however, often the child has made a connection in their mind and seeks to avoid anything that creates (or could create) the unpleasant experience of anxiety. 

It is common for these children to have physical reactions during the process of getting a needle. Well-meaning parents who feel they have little choice may opt to hold or retsratin their child and while this may be effective in terms of ensuring that medical needs are met – it can have direct co-relations to children’s feelings of anxiety and safety. Other caregivers may choose to put off immunizations in the hope that it will get better, potentially delaying important medical intervention. Caregivers can feel worried and fear for their child and often feel like they don’t know what to do or how to intervene.

 The process of working through a phobia can benefit from psychological and counselling intervention. Interventions can include all or some of the following: 

1. Counselling 
2. Formal Assessment and diagnosis 
3. Medical Assessment and intervention – including medication 

Next Steps

Counselling can be beneficial for all experiences related to needles – whether it be a developmentally appropriate fear, anxiety or a phobia. At times, prolonged (e.g., months or longer) anxiety or phobias may benefit from exploring a formal psychological assessment and possible diagnosis. This is to better understand and treat the symptoms of the child. Additionally, there can be complicating factors, such as the child having to undergo needles regularly for medical reasons, medical trauma or a heightened vasovagal response (fainting at the sight of needles).

At Wildflowers we can assist in informing caregivers and help with a treatment plan that best meets the needs of the child and family. 

References 

Caletti E, Massimo C, Magliocca S, Moltrasio C, Brambilla P, Delvecchio G. The role of the acceptance and commitment therapy in the treatment of social anxiety: An updated scoping review. J Affect Disord. 2022 Aug 1;310:174-182. doi: 10.1016/j.jad.2022.05.008. Epub 2022 May 7. PMID: 35537544.

Orenius, T., Säilä, H., Mikola, K., & Ristolainen, L. (2018). Fear of injections and needle phobia among children and adolescents: An overview of psychological, behavioral, and contextual factors. SAGE Open Nursing, 4. https://doi.org/10.1177/2377960818759442

Blog Post Written by: Andrea Rhodes-Reilly, Social Worker with Wildflowers