Needle anxiety and phobia

Making time before the procedure for the immunisation provider and parent/caregiver/support person to discuss the types of strategies to implement that will assist in the procedure going smoothly. The parent/caregiver/support person plays a vital role in the vaccination process because they know the vaccine-recipient best, including their past experiences, behaviours, communication methods, and what may be helpful. Preparing an individualised plan for how to approach the experience in advance, as well as having a backup plan and knowing when to abandon the attempt, will support everyone’s expectations at the appointment.

Reviewing the pre-immunisation checklist and discussing the expected side effects, any post-vaccination care required and gaining consent all in advance of the appointment will mean that there is less distraction and delay on the day.

It is generally recommended that children and adults with anxiety, intellectual disabilities or needle phobia avoid attending large scale vaccination sites for immunisation. These sites tend to be loud and busy which can increase distress. Smaller settings such as GP clinics are preferred as they are usually quieter and therefore less overwhelming. In addition, they do not have the same time constraints as busy clinics, alleviating the pressure to complete the procedure quickly.

Being able to dim the lights, reduce sounds, and having enough space for a person to move their body can support people who may be overwhelmed by the sensory stimulus as well as maintain staff safety.

It is important to consider the language used and the way to speak about immunisation with vaccine-recipients. Needle phobia is real, and it is okay for a person to be scared. Criticism can make the fear or anxiety worse.

It may be helpful for a carer/support person to inform a vaccine-recipient in advance about an upcoming appointment because the surprise may leave the person feeling a loss of control. How far in advance to provide this information is very dependent on the individual and is often based on a person’s age, past-experience, ability to understand the information. Keeping the conversation short and the information age/ability-appropriate is important. For example, using words like “arm medicine” or “vaccine” may be more helpful than “needle” or “injection”. Where possible, avoid telling someone to “be brave” as it may inadvertently encourage them to suppress their emotions.

Using clear (not ambiguous) and simple language and allowing pauses for information processing is helpful. Discussing one idea at a time also avoids overwhelming a person. Using a calm and low tone of voice can be soothing. Limiting choices or using “guided choices” can support the procedure by giving the vaccine-recipient control in the process. For example, asking a child “do you want to sit on mum’s lap or dad’s lap?” gives them some choice while controlling the outcome of sitting on someone’s lap.

Making sure that any equipment required is easily accessible. Needing to pause during the procedure to locate equipment can increase a person’s anxiety about the experience and possibly lead to an unsuccessful attempt. This includes any equipment required for distraction to reduce anxiety (e.g. bubbles, toys, books, music).

The application of local anaesthetic cream or patches to the site should be done a minimum of 45 minutes prior to appointment (available for purchase from chemists) and may help to settle a person’s fear of pain.

A person should never be restrained for a procedure. However, a comfort hold, provided with consent, can offer a supportive and secure cuddle for the vaccine-recipient and help them to feel safe in the process. Comfort holds also reduce the likelihood of needle-stick injury for the vaccine-recipient and immunisation provider.

Positioning the vaccine-recipient appropriately also supports good visualisation of the injection site. It is important to remove tight clothing to expose the entire limb and ensure safe and accurate injection technique.

Stimming (e.g. rocking or flapping) should be supported because they are behaviours that a person finds soothing during stressful situations. If stimming is stopped or prevented this will increase anxiety and distress and compromise the safety of the procedure.

Preparing the vaccine prior to the vaccine-recipient entering the treatment room and keeping it out of sight can help minimise distress. This includes keeping the vaccine to your side or behind your back until the very moment of injection.

Some people will benefit from a countdown or other indication of timing to avoid an extended period of anxiety not knowing when the injection will occur.

Keeping any conversations as short as possible will reduce anticipation and therefore prevent escalation of anxieties. Where possible, vaccine recipients should be encouraged to look away as watching the injection can cause distress. Observing the injection can also result in a vasovagal reaction (faint) which can further fuel anxiety and fear when facing future injections. Instead focusing on age/ability-appropriate distraction measures (e.g. bubbles, toys, book, song, tv), closing eyes or even wearing an eye mask can be helpful.

Do not rush the vaccine-recipient to accept the vaccine as this will likely lead to an unsuccessful attempt. There should be a low threshold for referral to specialist immunisation clinics for sedation in the case of vaccine-recipients with autism spectrum disorder (ASD) and some intellectual disabilities.

It is important to praise the vaccine-recipient (and carer/support person) for their efforts. Even if the vaccination attempt was unsuccessful, even entering the vaccine space is an achievement for someone with a phobia. Saying something like “You tried and even got as far as rolling up your sleeve, that’s amazing!” will have a huge impact on their confidence to try again next time.

Rewards can be helpful in creating positive memories about the vaccine experience and can build confidence and acceptance for future encounters. Though care needs to be taken not to add pressure/stress by using the reward as a motivator for getting the vaccine in; a threat of not getting a reward is unhelpful.

After any vaccination attempt for someone with needle anxiety or phobia, it is important to reflect on the things that helped and the things that didn’t. A conversation between immunisation provider, care/support person +/- vaccine recipient will ensure that each perspective is considered. Documenting this will assist in the success of future attempts.