Needle phobia

Background

Many people may find the experience of having a needle an unpleasant one. However, for some people, the experience is much more difficult, presenting as a real phobia characterised by both severe and persistent anxiety and fear. As a result, this patient group often avoid needle-related experiences. This needle avoidance extends to the area of immunisation, resulting in the individual being left susceptible to vaccine preventable diseases. This can result in further procedures involving needles should they become unwell.

Generally speaking, it is recommended that children and adults with anxiety, intellectual disabilities and needle phobia’s avoid attending large scale vaccination sites for immunisation. These sites are loud and busy and can increase distress. Smaller settings such as a GP clinic or pharmacy may be preferred. It is important to have a discussion with your immunisation provider prior to the appointment in order to make an individualised plan for how to approach the immunisation experience.

Strategies to manage needle phobia and immunisation- information for individuals and care givers

• needle phobia is real and it’s ok to be scared
• do not criticise the child or individual, this can make it worse
• with young children, it may be best not to tell them until you arrive at clinic, as this will stop them overthinking the needle
• use words such as “arm medicine” or “vaccine” and avoid using words like “needle” or “injection” when descibing what is about to happen
• the use of rewards for children may help encourage bravery
• the application of local anaesthetic cream patches to the site a minimum of 45 minutes prior to appointment (available for purchase from chemists), may help to settle the fear of pain
• needle phobia can be a lifelong problem if not treated appropriately.

Specialist phobia treatments

Specialist trained psychologists and more recently hypnotherapists have had significant success in giving an individual mechanisms and strategies to help overcome or manage their needle phobia. Considering either pathway is recommended as a long term strategy to overcome needle phobia.

Strategies to manage needle phobia and immunisation- information for health care providers

Effective preparation, distraction techniques, pain management strategies and addressing the core reason for the phobia are all important steps in ensuring successful immunisation.

Children and adolescents

• encourage parents not to over discuss the vaccine/needle with the children prior to arrival as this can build up their fear
• have a plan in place with the parents prior to their arrival at the clinic (in known phobic children)
• carry out pre-immunisation checks and side effect explanation with parents when the child is out of the room or prior to arrival
• minimise discussions in front of the child as this can increase distress
• an individualised approach is more likely to lead to success
• do not rush or attempt to force children to be vaccinated, this is likely to result in failure to vaccinate
• take you time with clearly distressed patients, calmly talk them through the procedure and tips to manage their anxiety (deep breathing, looking away or counting).

People with autism spectrum disorder (ASD)

The following strategies may assist in managing needle phobia in individuals with ASD:

• discuss the individual’s communication style and capabilities with their parent/carer
• explain everything you are going to do using clear, simple language
• involve the individual as much as possible by considering their likes/dislikes
• provide support and positive reassurance
• remove distracting/disturbing stimuli
• try not to stop stimming behaviours (eg. rocking, flapping) that may help the individual deal with distress
• do not attempt to restrain the individual
• older individuals with ASD can be very difficult to immunise due to significant needle phobias. Restraining these children can result in injury to the carer, child or health care provider
• have a low threshold to refer to a specialist immunisation provider for sedation.

Distraction techniques

Young children or the intellectually disabled:

• bubbles upon entering the room and before and after needle
• musical toys
• if able have one person blowing bubbles or creating noise with toy intermittently to maintain attention of child
• TV on with kids shows
• child watching their favourite show on parents’ phone.

Older children, adolescents or adults:

• phone/iPad with headphones watching their favourite show or music (give them time to settle into watching it)
• make conversation eg. sport, upcoming holidays
• countdown so they know when to be ready
• strongly encourage them to look away.

Administration techniques

• prepare the vaccine out of view of the individual or before they come into room
• avoid showing the individual the prepared vaccine and needle prior to administration
  • place the tray containing vaccines out of sight
  • hold the vaccine to your side or behind you back until about to inject
  • encourage the individual to close their eyes, look away or focus on the distraction method
• don’t over discuss the needle and administration of the vaccine
  • do necessary pre-vaccination checks and side effects only
  • make the process as quick as possible to give the patient minimal time to over-think the needle
• encourage adult individuals to bring a support person if they wish
• a phobia in adolescents or adults can lead to a vasovagal or faint response. It is important that the individual is supported to lay down if needed.

Sedation

If immunisation attempts are unsuccessful, a referral for vaccines to be administered under sedation may be considered.

Paediatric services

• The Royal Children’s Hospital – Referrals for this service can be sent to Nurse Practitioner Immunisation via [email protected]
• Monash Health – Referrals can be submitted as a HealthLink referral
• Family Immunisation and Travel Specialists (FITS) – Make an appointment via webpage / web referral

Adult services

• Monash Health – Referrals can be submitted as a HealthLink referral.

Resources

RCH resources

• The Royal Children’s Hospital Clinical Practice Guidelines for Procedural Pain Management
• The Royal Children’s Hospital Be Positive: Nitrous Oxide
• The Royal Children’s Hospital comfort kids- for kids
• The Royal Children’s Hospital comfort kids- for parents
• The Royal Children’s Hospital Be Positive: Immunisations
• RCH Kids Health Info Podcast: Fear of needles. What helps?

Other resources

• Dr Daryl Cheng’s Needle Phobia interview with The House of Wellness at Channel 7
• RACV: Scared of needles? Try these simple tips
• The Conversation: Is your child frightened of needles? Here’s how to prepare them for their COVID vaccine