I’ve seen a few kids this season who have influenza despite the fact that they had the vaccine. When the family hears that the flu test is positive (or that symptoms are consistent with influenza and testing isn’t done), they often say they won’t do the flu shot again because it didn’t work.
Don’t rely on Tamiflu to treat flu symptoms once you’ve gotten sick.
Tamiflu really isn’t that great of a treatment. It hasn’t been shown to decrease hospitalization or complication rates. It shortens the course by about a day. It has side effects and can be expensive. During flu outbreaks it can be hard to find.
Parents hear about fever seizures and are afraid the temperature will get so high that it will cause permanent brain damage. In reality the way a child is acting is more important than the temperature. If they’re dehydrated, having difficulty breathing, or are in extreme pain, you don’t need a thermometer to know they’re sick.
Fever is uncomfortable.
Fever can make the body ache. It’s often associated with other pains, such as headache or muscle aches. Kids look miserable when they have a fever. They might appear more tired than normal. They breathe faster. Their heart pounds. They whine. Their face is flushed. They are sweaty. They might have chills, causing them to shake.
Fever is often feared as something bad.
Parents often fear the worst with a fever:
Is it pneumonia? Leukemia? Ear infection?
Fever is good in most cases.
In most instances, fever in children is good. It’s a sign of a working immune system.
Fever is often associated with decreased appetite.
This decreased food intake worries parents, but if the child is drinking enough to stay hydrated, they can survive a few days without food. Kids typically increase their intake when feeling well again. Don’t force them to eat when sick, but do encourage fluids to maintain hydration.
Fever is serious in infants under 3 months, immunocompromised people, and in underimmunized kids.
These kids do not have very effective immune systems and are more at risk from diseases their bodies can’t fight. Any abnormal temperature (both too high and too low) should be completely evaluated in these at risk children.
Fever is inconvenient.
I hate to say it, but for many parents it’s just not convenient for their kids to be sick. A big meeting at work. A child’s class party. A recital. A big game or tournament.
Whatever it is, our lives are busy and we don’t want to stop for illness. Unfortunately, there is no treatment for fever that makes it become non-infectious immediately, so it is best to stay home. Don’t expose others by giving your child ibuprofen and hoping the school nurse won’t call.
Fever is a normal response to illness in most cases.
Most fevers in kids are due to viruses and run their course in 3-5 days. Parents usually want to know what temperature is too high, but that number is really unknown (probably above 106F). The height of a fever does not tell us how serious the infection is. The higher the temperature, the more miserable a person feels. That’s why it’s recommended to use a fever reducer after 102F. The temperature doesn’t need to come back to normal, it just needs to come down enough for comfort.
Fever is most common at night.
Unfortunately most illnesses are more severe at night. This has to do with the complex system of hormones in our body. It means that kids who seem “okay” during the day have more discomfort over night. This decreases everyone’s sleep and is frustrating to parents, but is common.
Fever is a time that illnesses are considered most contagious.
During a fever viral shedding is highest. It’s important to keep anyone with fever away from others as much as practical (in a home, confining kids to a bedroom can help). Wash hands and surfaces that person touches often during any illness. Continue these precautions until the child is fever free for 24 hours without fever reducers. (Remember that temperatures fluctuate, so a few hours without fever doesn’t prove that the infection is resolved.)
Fever is an elevation of normal temperature.
Normal temperature varies throughout the day and depends on the location the temperature was taken and the type of thermometer used. Digital thermometers have replaced glass mercury thermometers due to safety concerns with mercury. Ear thermometers are not accurate in young infants or those with wax in the ear canal. Plastic strip thermometers and pacifier thermometers give a general idea of a temperature, but are not accurate.
To identify a true fever, it’s important to note the degree temperature as well as location taken. (A kiss on the forehead can let most parents know if the child is warm or hot, but doesn’t identify a true fever and therefore the need to isolate to prevent spreading illness.) I never recommend adding or subtracting degrees to decide if it is a fever. You can look at a child to know if they’re sick.
The degree of temperature helps guide if they can go to school or daycare, not how you should treat the child.
Fevers in children are generally defined as temperatures above 100.4 F (38 C).
Fever is rarely dangerous, though parents often fear the worst.
This is the time of year kids will be sick more than normal. Kids get sick more than adults. With each illness there can be fever (though not always).
What you can do:
Be prepared at home with a fever reducer and know your child’s proper dosage for his or her weight.
Use fever reducers to make kids comfortable, not to bring the temperature to normal.
Push water and other fluids to help kids stay hydrated.
Teach kids to wash their hands and cover coughs and sneezes with their elbows.
Stay home when sick to keep from spreading germs. It’s generally okay to return to work/school when fever – free 24 hours without the use of fever reducers.
Help kids rest when sick.
If the fever lasts more than 3-5 days, your child looks dehydrated, is having trouble breathing, is in extreme pain, or you are concerned, your child should be seen. A physical exam (and sometimes labs or x-ray) is needed to identify the source ofillness in these cases. A phone call cannot diagnose a source of fever.
Any infant under 3 months or immunocompromised child should be seen to rule out serious disease if the temperature is more than 100.5.
Many families travel when school’s out of session, which over the winter holiday season means traveling when illness is abound. I get a lot of questions this time of year about how to safely travel with kids.
Sleep deprivation can make everyone miserable, especially kids (and their parents). Make sure your kids are well rested prior to travel and try to keep them on a healthy sleep schedule during your trip.
Bring favorite comfort items, such as a stuffed animal or blankie, to help kids relax for sleep. If possible, travel with your own pillows.
If you’re staying at a hotel, ask for a quiet room, such as one away from the pool and the elevator.
Be sure to verify that there will be safe sleeping areas for every child, especially infants, before you travel.
Try to keep kids on their regular sleep schedule. It’s tempting to stay up late to enjoy the most of the vacation, but in reality that will only serve to make little monsters of your children if they’re sleep deprived.
If your kids nap well in the car, plan on doing long stretches on the road during nap time. If kids don’t sleep well in the car, be sure to plan to be at your hotel (or wherever you’re staying) at sleep times so they can stay in their usual routine.
Some families leave on long trips at the child’s bedtime to let them sleep through the drive. Just be sure the driver is well rested to make it a safe trip!
If you’re changing time zones significantly, plan ahead. Jet lag can be worse when traveling east than when going west. Jet lag is more than just being tired from a change in sleep routine, it also involves changes to the eating schedule. Kids will often wake when they’re used to eating because the body is hungry at that time. Try to feed everyone right before they go to sleep to try to prevent this. Breastfed infants might have a harder time adjusting because mother’s milk production is also off schedule.
Tired, sick, and hungry all make for bad moods, so try to stay on track on all accounts. Sunlight helps regulate our circadian rhythm, so try to get everyone up and outside in the morning to help reset their inner clocks. Keep everyone active during the day so they are tired at the new night-time.
Keeping track of littles
Toddlers and young kids love to run and roam. Be sure that they are always within sight. Use strollers if they’ll stay in them.
Consider toddler leashes. I know they seem awful at first thought, but they work and kids often love them! I never needed one for my first – he was attached to parents at the hip and never wandered. My second was fast. And fearless. She would run between people in crowds and it was impossible to keep up with her without pushing people out of the way. She hated holding hands. She always figured out ways to climb out of strollers – and once had a nasty bruise on her forehead when she fell face down climbing out as I pushed the stroller. She loved the leash. It had a cute monkey backpack. She loved the freedom of being able to wander around and I loved that she couldn’t get too far.
Parents have a number of ways to put phone numbers on their kids in case they get separated. Some simply put in on a piece of paper and trust that it will stay in a pocket until it’s needed. Others write it in sharpie inside a piece of clothing or even on a child’s arm. You can have jewelry engraved with name and phone number, much like a medical alert bracelet. Just look at Etsy or Pinterest and you’ll come up with ideas!
It’s a great idea to take pictures of everyone each morning in case someone gets separated from the group. Not only will you have a current picture for authorities to see what they look like, but you will also know what they were wearing at the time they were lost.
The great news is that air travel is much safer from an infection standpoint than it used to be. Newer airplanes have HEPA filters that make a complete air change approximately 15 to 30 times per hour, or once every 2-4 minutes. The filters are said to remove 99.9% of bacteria, fungi and larger viruses. These germs can live on surfaces though, so I still recommend using common sense and bringing along a small hand sanitizer bottle and disinfectant wipes to use as needed. Wipe down arm rests, tray tables, seat pockets, windows, and other surfaces your kids will touch. After they touch unclean items sanitize their hands. Interestingly, sitting in an aisle seat is considered more dangerous, since people touch those seats during boarding and when going to the restroom, so if you’re seated in the aisle pay attention to when surfaces need to be re-sanitized. Sitting next to a sick person increases your risk, so if there is an option to move if the person seated next to you is ill appearing, ask to be moved.
Most adults who have flown have experienced ear pain due to pressure changes when flying. Anyone with a cold, ear infection or congestion from allergies is more at risk of ear pain, so pre-medicating with a pain reliever (such as acetaminophen) might help. If you have allergies be sure to get control of them before air travel. The best allergy treatment is usually a nasal corticosteroid.
It has often been recommended to offer infants something to suck on (bottle, breast or a pacifier) during take off and landing to help with ear pressure. Start early in the landing – the higher you are, the more the pressure will change. Older toddlers and kids can be offered a drink since swallowing can help. Ask them to hold their nose closed and try to blow air out through the closed nostrils followed by a big yawn. If your kids can safely chew gum (usually only recommended for those over 4 years of age) you can allow them to chew during take off and landing.
Airplane cabin noise levels can range anywhere from 60 – 100 dB and tend to be louder during takeoff. (I’ve written about Hearing Loss from noise previously to help you understand what that means.) Use cotton balls or small earplugs to help decrease the exposure, especially if your kids are sensitive to loud noises.
Learn about cruise-specific opportunities for kids of various ages. Many will offer age-specific child care, “clubs” or areas to allow safe opportunities for everyone to hang out with people of their own age group. Cruises offer the opportunity for adventurous kids to be independent and separate from parents at times, allowing each to have a separate-yet-together vacation. Travel with another family with kids the same ages as yours so your child knows a friendly face, especially if siblings are in a different age group for the cruises “clubs”.
Talk to kids about safety issues on the ship and make sure they follow your rules. They should always stay where they are supposed to be and not wander around. There’s safety in numbers, so have them use a buddy system and stick with their buddy. Find out how you can get a hold of them and they can get a hold of you during the cruise.
Of course sunscreen is a must. Reapply often!
Be sure kids are properly supervised near water. That means an adult who is responsible for watching the kids should not be under the influence of alcohol, shouldn’t read a book, or have other distractions.
Car seats (for planes, trains and automobiles)
I know it’s tempting to save money and not get a seat for your child under 2 years of age on a plane, but it is recommended that all children are seated in a proper child safety restraint system (CRS). It must be approved for flight, but then you can then use the seat for land travel.
I always recommend age and size appropriate car seats or boosters when traveling, even if you’re in a country that does not require them. Allowing kids to ride without a proper seat will probably lead to problems getting them back in their safe seat when they get back home. Besides, we use car seats and booster seats to protect our kids, not just to satisfy the law.
So… my section header was meant to be cute. Trains don’t have seatbelts, so car seats won’t work. But they are a safe way to travel. Car Seat for the Littles has a great explanation on Travel by Train.
When should pregnant women and new babies avoid travel by air?
A surprising number of families either must travel (due to a job transfer, death in the family, out of state adoption, or other important occasion) or choose to travel during pregnancy or with young infants.
Newborns need constant attention, which can be difficult if the seatbelt sign is on and needed items are in the overhead bin. New parents are already sleep deprived and sleeping on planes isn’t easy. New moms might still have swollen feet and need to keep their feet up, which is difficult in flight. Newborns are at high risk of infection and the close contact with other travelers can be a concern. And traveling is hard on everyone. But the good news is that overall young infants tend to travel well.
It is advisable to not travel after 36 weeks of pregnancy because of concerns of preterm labor. Pregnant women should talk with their OB about travel plans.
Some airlines allow term babies as young as 48 hours of age to fly, but others require infants to be two weeks – so check with your airline if you’ll be traveling in the first days of your newborn’s life. There is no standard guideline, but my preference would be to wait until term babies are over 2 weeks of age due to heart circulation changes that occur the first two weeks. Waiting until after 6 weeks allows for newborns to get the first set of vaccines (other than the Hepatitis B vaccine) prior to flight would be even better. Infants ideally have their own seat so they can be placed in a car seat that is FAA approved.
Babies born before 36 weeks and those with special health issues should get clearance from their physicians before traveling.
Overall traveling with an infant is not as difficult as many parents fear. Toddlers are another story… they don’t like to sit still for any amount of time and flights make that difficult. They also touch everything and put fingers in their mouth, so they are more likely to get exposed to germs.
Who wants to be sick on vacation? No one. It’s easy to get exposed anywhere during the cold and flu season, so protect yourself and your family.
Teach kids (and remind yourself) to not touch faces – your own or others. Our eyes, nose, and mouth are the portals of entry and exit for germs.
Wash hands before and after eating, after blowing your nose, before and after touching eyes/nose/mouth, before and after putting in contacts, after toileting or changing a diaper, and when they’re obviously soiled.
Cover sneezes and coughs with your elbow unless you’re cradling an infant in your arms. Infants have their head and face in your elbow, so you should use your hands to cover, then wash your hands well.
Make sure all family members are up to date on vaccines.
Everyone over 6 months should have a flu shot if it’s flu season (fall-winter).
Take pictures of your passport, vaccine record, medicines, insurance cards, and other important items to use if the originals are lost. Store the images so you have access to them from any computer in addition to your phone in case your phone is lost.
Have everyone, including young children, carry a form of identification that includes emergency contact information.
Create a medical history form that includes the following information for every member of your family that is travelling. Save a copy so you can easily find it on any computer in case of emergency.
your name, address, and phone number
emergency contact name(s) and phone number(s)
your doctor’s name, address, and office and emergency phone numbers
the name, address, and phone number of your health insurance carrier, including your policy number
a list of any known health problems or recent illnesses
a list of current medications and supplements you are taking and pharmacy name and phone number
a list of allergies to medications, food, insects, and animals
a prescription for glasses or contact lenses
Last, but not least: Enjoy your vacation!
Don’t overschedule. Your kids will remember the experience, so make moments count – don’t worry if you don’t accomplish all there is to do!
Take a look at some of the Holiday Health Hazards that come up at vacation times from Dr Christina at PMPediatrics so you can prevent accidents along the way.
Take pictures, but don’t make the vacation about the pictures. Try to stay off your phone and enjoy the moments!
There’s good news though. There’s a vaccine to help prevent the flu.
There are many reasons people don’t get the flu vaccine, but many of those reasons deserve a second thought.
1. The flu vaccine doesn’t work.
While it’s true that the vaccine has variable efficacy, it’s important to get the vaccine each year. The more people vaccinated, the less likely the flu will spread through a community. Take a look at this really cool representation of how herd immunity works. How it was developed is described on IFLS.
No one claims that the vaccines against influenza work perfectly. The influenza virus can mutate by shifting and drifting. Until there’s a universal flu vaccine, we must rely on experts to look at the viral patterns and predict the strains that will be most predominant in the upcoming season and make a vaccine against those strains.
Despite not working 100% of the time, the flu vaccine has been shown to lessen the severity of illness and decrease hospitalizations and deaths. Even if there’s not a perfect match, it can still help those who are vaccinated have a lesser illness. That’s worth something.
2. I got the flu from the vaccine.
The influenza vaccine that is currently available cannot cause the flu. Only live virus vaccines can lead to forms of the disease. The vaccines available in the US this season are either an inactivated or a recombinant vaccine. These do not cause flu symptoms. The vaccines cannot mutate to cause symptoms. They simply don’t work that way.
There are many reasons you could have gotten sick after a flu vaccine that were not due to the vaccine.
You were exposed to influenza before the vaccine had time to take effect and protect.
You caught a strain of influenza that wasn’t covered in the vaccine.
You caught one of a number of other viruses that cause flu – like illness.
The vaccine did cover the type of virus you have but your body didn’t make the proper protection from the vaccine so you were still susceptible.
In each of these scenarios, you still would have gotten sick if you hadn’t had the vaccine, but if you recently had the vaccine it’s easy to understand the concern that the vaccine caused the illness.
The FluMist is a live virus vaccine, so it could cause mild symptoms of influenza viruses, but it is not recommended for use in the US this year.
3. I can prevent the flu by being healthy.
It is important to eat right, exercise, get the proper amount of sleep, and wash hands. All of these things help keep us healthy, but they don’t prevent the flu reliably.
We cannot boost our immune system with megadoses of vitamins. (Vaccines are the best way to boost our immune system.)
Organic and non-GMO foods don’t offer any benefit to our immune system over other healthy foods. If these things did as some claim, people generations ago would have been healthier since they ate locally grown organic foods, got plenty of fresh air, and exercised more in their day to day life than we do these days. Instead of being healthier, they were much more likely to die from infections. The risk of death between the first and 20th birthday had decreased from over 3 in 100 children in 1900, to less than 2 in 1000 children today. One of the major causes of death historically (and still today) is from influenza, but it has been shown that the flu vaccine reduces the risk of death. Why not help your body prepare for flu season with the vaccine?
4. Flu vaccines shouldn’t be used during pregnancy — they’ve never been tested and can lead to miscarriage.
Pregnancy is considered a high risk condition for severe complications of influenza disease and the vaccine can help prevent those complications. It is recommended that all pregnant women get vaccinated against influenza. If a pregnant mother gets the vaccine, it not only helps to prevent complications during pregnancy, but it also helps prevent influenza in newborns since they can’t be vaccinated until 6 months of age.
There are some who assert that since the package inserts state the vaccines have not been studied in pregnancy that they aren’t safe, but in the next breath they say that they aren’t safe because a study showed a high rate of miscarriage after the vaccine.
Think about it… you can’t argue that it’s never been studied and then quote a study. It’s been studied. A lot. The Vaccine Safety Datalink is a huge database designed to document adverse events associated with vaccination, allowing researchers access to a large amount of data.
The flu vaccine has been safely given to pregnant women for over 50 years. Despite a recent small study suggesting a potential risk of miscarriage, the flu vaccine has been studied extensively around the globe and found to be not only safe but effective at decreasing the risk of influenza disease during pregnancy and beyond.
5. I have a chronic illness and don’t want to get sick from the shot.
People with chronic illnesses (including diabetes, heart conditions, and asthma) are more at risk from serious illness from influenza disease. The influenza vaccine can prevent hospitalizations and death among those with chronic diseases. People with chronic diseases should be vaccinated, as should those around them to protect with herd immunity.
The flu shot cannot make anyone sick, even those who are immunocompromised. You do not need to avoid being around someone who is sick or immunocompromised if you’ve recently been vaccinated.
6. If I get the flu I’ll just take medicine to feel better.
There is no medicine that makes people with influenza feel better reliably.
There is no medicine that decreases the spread of influenza to friends and family of those infected.
We can take fever reducers and pain relievers, but they don’t treat the underlying virus. They suppress our immune system so we don’t make as much inflammation against the virus, which decreases the symptoms and our body’s natural defenses.
As for antiviral medicines, I have written about Tamiflu and why I rarely recommend it.
Megadoses of vitamin C or other vitamins, homeopathic treatments, essential oils, and other at home treatments have not been shown to significantly help.
It is important if you get sick, you should limit contact with others. This means missed school and work for at least several days with influenza. Prevention with the vaccine simply is better than trying to treat the symptoms.
7. I don’t like shots. (Or my child doesn’t like shots.)
I’m a pediatrician. Most of my younger patients hate shots. Like really hate shots. They cry, scream, kick, try to run and hide — you name it, they’ve tried it to try to avoid shots. They fear shots, but we can help them with techniques that lessen the pain, and they often say “it wasn’t that bad” afterwards. For more on how we can help lessen the pain, check out Vaccines don’t have to hurt as much as some fear.
People who have had only hives after egg exposure can safely get flu vaccines following standard protocols.
People who have symptoms of anaphylaxis with egg exposure that requires epinephrine (respiratory distress, lightheadedness, recurrent vomiting, swelling – such as eyes or lips) should still get the vaccine, but they should be monitored at the appropriate facility (doctor’s office, hospital, health department) for 30 minutes to monitor for reactions.
9. Vaccines are only promoted to make people money. Doctors are shills.
Very little profit is made from any vaccine. Really. Some doctors and clinics lose money by giving vaccines. I often tell my own patients that I don’t care if they get the vaccine at my office, the local pharmacy, or at the parent’s office – whatever works for them best. I just want everyone vaccinated. This in the end will decrease my revenue because they will not come to the office seeking treatments for a preventable illness. But I am a pediatrician to take care of the health of children, not to make money. Pediatricians are consistently on the bottom of the list of physician salaries. If I was in it for the money, I would have gone into orthopedics or another surgical specialty.
There are many things to consider when addressing this argument and the Skeptical Raptor does it well, including links to more information.
10. The flu vaccine contains mercury.
While it is true that some flu vaccines contain thimerosal, not all do. Thimerosal was removed from the majority of childhood vaccines in 2001 due to lawmakers responding to constituent demands, not because it was shown to be a risk medically. Since the flu vaccine is not only for children, there are multidose vials that contain thimerosal. If that really bothers you, ask for a version without thimerosal. But since it was removed because people thought thimerosal caused autism and the rates of autism haven’t gone down since it was removed, that’s pretty strong evidence that it never caused autism. Just like the scientists said. It’s a preservative that is effective. I would gladly get a flu vaccine with thimerosal, and have over the years, but the majority of flu vaccines given to children in the US are thimerosal free. Just ask.
Flu Vaccine Information and Recommendations for the 2017-2018 Season
Both trivalent (3 strain) and quadrivalent (4 strain) vaccines are approved for use this year. There is no preference officially of one over the other, but the vaccine should be appropriate for age.
No FluMist Nasal Spray flu vaccine is recommended. The nasal spray did not work well in the last few seasons it was used in the US. Until it is understood why it wasn’t effective then how to make it effective, it will not be recommended.
Pregnant women should be vaccinated to protect themselves and their baby.
Everyone over 6 months of age should be vaccinated. Children 6 months to 8 years who have only had one flu vaccine in their past will need two doses this season. This is because the first dose acts as a primer dose, then a booster dose boosts the immune system. Once the body has had a boost, it only needs a boost each year to improve immunity.
Infants under 6 months of age can gain protection if their mother is vaccinated during pregnancy and if everyone around them is vaccinated. They cannot get the flu vaccine until 6 months of age.
People with egg allergy can be vaccinated. If there is a history of anaphylaxis to egg, they should be monitored for 30 minutes.
The CDC is encouraging everyone to be vaccinated by Halloween if possible, but it’s not too late to be vaccinated after that if not yet done this season. It takes up to 2 weeks for the vaccine to be effective. Flu season typically starts in January, but the peak can be as early as November and as late as March.
It is acceptable and encouraged to give the flu vaccine along with other recommended vaccines needed.
Many kids are scared of shots. Some even fight parents and nurses when it’s time to get shots. The more they fight and worry, the worse it gets. But it doesn’t have to be that way.
Increasing the fear
In general there are some things that increase anxiety about shots or just make them seem bad.
Do not tell kids it won’t hurt. Shots can hurt. Lying doesn’t help. It just minimizes their fear and makes things worse. It might hurt, but how much is variable. Pain is a very individualized feeling. You can describe it as a pinch. Some kids do better with advance warning.
Never tell kids they won’t get a shot at the doctor’s office. They might be due for one (or more) and if they were specifically told they won’t get one, they are usually more upset.
Don’t threaten kids with shots if they misbehave. This makes kids see shots as a negative.
Siblings can increase anxiety with their teasing. Don’t share the need for shots with siblings and if it’s possible to leave siblings at home when one child will need shots, that might work best.
Some kids worry more because parents are worried or presume the child will be worried. When the parent starts talking about shots in a worrisome manner it feeds into the fear. Try to be factual. Don’t start telling them it’s okay and not to worry. That tells them there’s something to worry about.
Some kids do best if they don’t know shots are coming. If they ask if they’ll get shots at an upcoming visit, you can say you don’t know. If you think your child will lose sleep for days worrying about the shots, this is often the best way to handle it. Then the doctor and nurse at the office can deliver the news and it isn’t your fault.
How to prepare
If you want to prepare your kids before bringing them in for shots or if you just need some help when you’re at the office, follow these tips:
Risks and Benefits
I often ask kids if they’ve ever gotten hurt playing outside. They usually say yes. Then I ask if they still wanted to play outside again. They usually say yes. I might sound surprised that even though they know that they can get hurt, they still want to play, but then I “realize” that it was because the benefit (playing) outweighs the risk (getting hurt). Then we talk about the benefits of the shot are so much more than the quick poke and a little pinch feeling. This works really well for the middle school shots because they’re old enough to get the connection.
Don’t pre-treat with an oral pain reliever. Studies have shown that acetaminophen and ibuprofen decrease the immune response, which might make the vaccines less effective.
Don’t tell kids to not cry. It’s okay to be scared and to feel pain. Let them know what is and is not okay. If they cry it’s okay. It is not okay to kick, hit, run, or do anything that can harm others or themselves.
Educate kids about how vaccines help us. There are many resources available. When they understand why the shots are good for them, it helps them to accept them.
Practice what happens when we get shots.
Have them practice sitting still and making their arms loose.
Wipe the arm with a tissue as you explain the person giving the shot will clean the area with a very cold wet tissue to clean the area. (I avoid the term alcohol swab because the term alcohol confuses younger kids who learn about drug prevention in school.)
Pinch the arm to show them there will be a small pinching feeling.
Put a bandaid on the area if they like or just explain that they can get a bandaid when it’s over. (If your child hates bandaids, tell the person giving shots that they prefer to not have them.)
Let them practice giving you a “shot” too.
Show that the poke will be fast and they can move their arms up and down afterwards to make the sting go away.
Bring a comfort item from home, such as a stuffed animal or blankie.
There is evidence that blowing out or coughing during the injection helps decrease the pain. We often recommend this for kids old enough to blow or cough.
Sometimes we’ll entice preschoolers with bubbles or pinwheels. It really helps!
Other forms of distraction can help too. Telling stories, reading books, or watching a video on a smart phone or tablet are great distractions.
Sit vs Lay Down
Studies have shown that allowing kids to sit (rather than force laying down) during shots is perceived as less painful. The less restraining the child needs, the better. It makes sense that if they need to be held down they will be more scared and it will be perceived as more painful.
I have seen tweens and teens prefer to lay down if they have a history of getting light headed with needles or they’re worried about fainting.
Order of vaccines
Ask the person giving the vaccines to save the most painful vaccine for last, if applicable. (Our nurses do this routinely.)
Pain DISTRACTOR devices
Our office sometimes uses Buzzy when kids are especially afraid of shot pain. As long as the child isn’t overly worked up and they aren’t opposed to the coldness of the ice, Buzzy works fantastically! If kids have worked themselves into a frenzy it isn’t sufficient to distract in this way.
I used to think bribery was not a good parenting technique… until I had kids. It can be very effective. If you can promise a reward for being brave, such as stopping for a smoothie or getting a favorite treat, that can work wonders.
Just do it
I like this Dr. Mom’s take on getting shots. Dr. Corriel knows that her son will just need to do it. Fear and all.
Help with anxieties in general
(great for life worries, not just shots!)
Build up bravery
After kids do things that they were afraid of, congratulate them for the attempt. Remind them that even though they were scared they did it. This helps set the pattern that they can be brave when faced with any fear.
Kids can even keep a list of things that they did despite being scared to try. Make a “Bravery Book.”
They can use the list whenever a new fear pops up to see how many things they’ve already done and how brave they really are.
video to future self
I’ve started recommending that parents take a video of kids to show their future self if they can say it didn’t hurt as much as they worried it would.
We all tend to remember the anxious phase of excessive worry, but forget that it wasn’t that bad.
Show the video the next time shots are due. Their own self stating it wasn’t bad can be reassuring!
Use a meditation app, such as Stop, Breathe & Think. It’s free and helps with general anxieties as well as mindfulness. Download it and use it at home several times to let them get comfortable using it.