Last week we shared a story on our Facebook page that got a lot of parents talking.  The study followed more than 700 infants through preschool and looked at their reactions to pain when receiving vaccinations.  The study found that the parent’s ability to prepare and comfort the child early in infancy determined the child’s pain response and fear of vaccinations later in childhood. Headlines from popular news organizations claimed the study showed that if a child was afraid of needles it was all the parent’s fault.  While these headlines may have encouraged readers to click on the story, they didn’t accurately describe the study’s findings.

In order to clear up the misconceptions about the study we spoke directly to the study’s lead author, Dr. Rebecca Pillai Riddell, a clinical psychologist and the Research Chair in Pain and Mental Health at York University in Toronto, Canada. Below is the first of a two-part interview with Dr. Riddell on children, pain and parents.  This post focuses on clearing up confusion around the study and what parents can do to help their kids deal with pain.  The next post in the series delves deeper into the study and how infant and children perceive pain.

We shared a story about your study on our Facebook page last week and it definitely got a response. Lots of parents felt like they were being blamed for something they feel is out of their control, but from the look of the study that’s not actually what your conclusions were.
I feel so awful about that! Our study showed that parents are actually really powerful over something they don’t think they have a lot of influence over. This study should serve as a wake-up call to the health care system that we need to empower parents at pediatric appointments. Health care professionals need to see the infant and parent as strongly connected, instead of seeing the infant as separate. If anything it shows that parents that are emotionally compromised and aren’t able to respond appropriately to their infant need support too. This is all about supporting parents and babies, not blaming parents. I’m a parent too! The last thing I want is to blame parents, especially when our study calls for them to be better supported.

That’s really interesting, because that’s not what I’ve seen written online about this study. Did you set out to prove that a child’s reaction to pain is strongly associated with the parent’s?
No, actually not at all. We originally set out to test the hypothesis that an infant that had a strong response to pain during their first vaccines would have more distress with vaccines (as an indicator of pain) in preschool, but we turned out to be completely wrong. That’s kind of the great thing and the awful thing about science, you conduct all of this secondary research [literature review], you create a hypothesis, apply for grants, put all this effort in only to find out you’re wrong.

A lot of parents told us that they wished the articles written about your study had included strategies for parents to make the vaccination appointment (or any event where the child may experience pain) go better. Do you have any suggestions?
I have been a part of a team that actually has a number of resources available including videos and pamphlets that parents can download, but a good device that our lab came up with for parents to remember is ABCD. That stands for:

Assess your own anxiety;
If you are anxious about the needle, take belly breaths to calm yourself;
Remain calm, close to your baby and give lots of cuddles;
Distract the baby shortly after the initial high distress of the needle has passed.

Distraction can be very simple, from a bottle or nursing, to bringing a favorite toy along with them. Also key is making sure the baby or child is facing you and can see you when they get the needle. I know a lot of parents will think, “I don’t want my baby to associate me with pain!” They don’t associate you with pain, which is why your face is a calming and reassuring presence for them.

More pain management resources are available at: http://phm.utoronto.ca/helpinkids/pdf/3p_babiesto1yr_e.pdf

More pain management resources are available at: http://phm.utoronto.ca/helpinkids/pdf/3p_babiesto1yr_e.pdf

Last year our family got our flu shots and my husband and I made sure we talked to our son about it before hand, and we took him to watch us get our shots. When we were at the appointment two kids were in the room next to us screaming, crying and what sounded like kicking or banging. When I asked the nurse what was going on, she said the parents hadn’t told them they were getting their flu shots and the kids became hysterical, so that kind of undid all of our prep with our son. I’m guessing that springing a needle on a child isn’t a good idea?
I’d never recommend springing anything like this on a child. As adults we don’t like to have things sprung on us, a child has less control over their environment so surprises like a needle aren’t received well. Generally speaking, what I’d recommend is telling the child the day-of the appointment. Let them lead the conversation and ask questions and be honest about it. Lying to kids doesn’t help. Needles hurt, don’t tell them it doesn’t.

With my kids I focus them on the fact that the needle part will be over quick. Yes it will hurt, but it will only hurt for a little while, then I talk about what we’ll do after. They’ll get a sticker or we’ll go for ice cream or they’ll get a cool bandaid, something fun. I also avoid telling my kids “don’t worry” or “it will be fine.” Using those phrases is kind of an indication that there’s a reason to worry or that things aren’t OK. When you take your kids to the park, you don’t stop them when they’re running around and say “don’t worry” or “everything’s going to be OK.”

So in the case of the children howling in the next room, if you’re the parent of those kids is it maybe a good idea to press pause or come back another day?
Yeah, that would probably be a good idea. I’m a working mother so I know how hard it is to make these appointments and get everyone in for them, so I wouldn’t necessarily suggest you leave and come back another day. Maybe you ask the doctor or nurse to leave the room until you can calm your child down. Maybe you go out into the waiting room or go for a walk around the block, something to break up the scenery and alleviate the tension.

I’d never recommend restraining a child to vaccinate them, that only worsens the problem for the next time around. If your child is truly hysterical and has an actual phobia of needles then it may be a good idea to see a behavioral specialist a few times and do some exposure therapy, but that’s only in extreme cases. Most kids that are afraid of needles don’t need that level of care, they just need some patience and help from mom and dad.

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Categories: Infectious Disease + Vaccines, Mental, Emotional, + Behavioral Health