Maura Capaul, our Family Nurse Practitioner, guest blogs this month on Needle Phobia.
While nobody loves getting a shot, for some children and adults fear of needles rises to the level of a full blown phobia.
Many children are afraid of getting shots. They may cry or be extra clingy during well child check-ups. Patients with more extreme reactions may have tantrums, agitation, or may become immobilized with fear. Adult patients with needle phobia often describe a feeling of impending doom when thinking about shots. Some patients have a neurological reaction, called a vasovagal reaction that causes fainting, pallor, nausea, or cold sweats. These types of reactions are very unpleasant and can lead to the development of phobias. In extreme cases, fear of needles can lead people to avoid medical care altogether.
We know our reactions to phobic patients can make things either better or worse, so it’s important for us to know in advance if needle phobia is a problem. There are some good strategies families can use to make the experience a little better.
The first is to recognize that phobias are not acting out, being overly dramatic, or otherwise an example of ‘bad behavior’. Reassuring patients that this is a common problem (one that often runs in families) and not something they are choosing often helps.
Prepare before the visit
It is important to be honest with patients about what is going to happen and why it needs to happen. Parents should not use shots as a way to threaten children into good behavior (“if you don’t sit still the doctor will give you a shot!”). For older children and adults, having some choices may help, so a conversation before the visit could include:
- Is it better to get the shots right away, so you don’t have to spend all that time thinking about it?
- What else would help – listening to music with your earphones in? Watching a video? Would it be better to be lying down (this is important for people with vasovagal responses)? Is it better to have siblings or other family members with you, or should they wait outside?
- Is it better for you if you don’t see the needles in advance, or do you need to see what is happening the whole time?
Practicing deep breathing and guided relaxation at home can be very helpful. People can imagine a quiet and safe place, or imagine breathing out fear and stress, breathing in calm. Sometimes patients may want to try alternating between tensing and relaxing different muscle groups on their body. Practicing these techniques at home can make it more effective and automatic when it comes time for a visit to the clinic.
At the visit
A few minutes before the shot an ice pack can help numb the area. Vibration applied directly to the skin (like from a handheld massage tool) can confuse the nerves, so that it becomes impossible to feel the pinch of the needle. A prescription numbing cream applied about an hour before the injection works in a similar fashion.
For some patients, these strategies are not enough. A prescription anti-anxiety medication like Ativan can be given 15 minutes before the shot, and can help make the experience much less traumatic.
In all cases, we want to help people through the experience of getting a shot or having blood drawn with as little trauma as possible. This means we strongly prefer not to restrain patients, as that can add to the panic and feelings of helplessness, and make the phobia even harder to overcome in the future.
If any of these strategies seem like they would be helpful, we can help put them in place. If you decide to get shots first, we may need to talk briefly by telephone before your visit to review what shots are needed. If a prescription for Ativan is needed, let us know at the time you make the appointment.