IMAGE: Dr. Howard Bennett, Ava Burka
J. Scott Applewhite  /  AP
Dr. Howard Bennett gives Ava Burka, 6, her checkup at his office in Washington D.C.   Bennett uses humor to relax anxious young patients and to distract them from the fear of getting shots.
updated 10/23/2006 4:31:57 PM ET 2006-10-23T20:31:57

Think preschoolers don’t know geography? Drive ’em to the pediatrician’s office. Starting around age 2, they’re crying before you make the final turn into the parking lot — they remember where they get shots.

Vaccinations and other needle-sticks are more than pinpricks to little kids, and often to older ones, too. They cause fear that can turn a simple checkup into a stress-filled battle.

It sounds too easy, but distracting your tot can reduce the distress, concludes a new medical review that examined psychological techniques for easing the pain.

Nothing will stop all the crying. But pick a distraction suitable for the child’s age and stage of development, and anything from a low-tech trick like blowing bubbles to bringing a video game can take their mind off the impending pain long enough to make a real difference.

“Needle procedures are really common, and among the most fear-and anxiety-provoking for children,” notes Lindsay Uman of Dalhousie University in Nova Scotia, who led the review published by The Cochrane Collaboration, an influential international network that assesses the evidence behind health care practices.

Still, “a parent can very easily help,” she adds.

Children can get 20 shots by age 2 from vaccinations alone, not counting blood tests or other needle-stick procedures if they have any of a variety of illnesses.

While injection pain doesn’t last long, the more scared they are, the more pain they perceive. Even at age 8 or 9, anxiety can still overshadow the memory that last year’s shot wasn’t all that bad.

“All she remembers is the fear from when she was 3 or 4,” explains Dr. Howard J. Bennett, a Washington, D.C., pediatrician and author of the new children’s book, “Lions Aren’t Scared of Shots,” that shows how imagination can help youngsters cope.

“There’s a cumulative effect, I think, that doctors do things that hurt,” says Bennett, who uses humor to distract his patients — and sometimes lets them give him a shot first, with a 2-foot-long clown syringe. “You just want to make things easier for them.

Ernie to the rescue
Bennett vividly recalls learning the value of distraction while in training at a children’s hospital. A 4-year-old in the emergency room needed a tube inserted into his vein, but was too hysterical.

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The boy was wearing Ernie pajamas. Bennett always carries around Sesame Street finger puppets, and pulled out Ernie.

“He is now putty in my hands,” Bennett remembers. “He sat there while I put an IV into his arm and didn’t move. ... This is as close to magic as it gets.”

There are medical strategies to ease the crying. Bennett’s office recently began what he calls tag-team shots. When a child needs two immunizations that don’t come together in one syringe, two nurses give them simultaneously. The child’s brain perceives just one prick.

Medication can numb the pain for children with severe needle phobias, or who are undergoing more invasive needle procedures. But that’s not practical for run-of-the-mill shots or blood tests.

Uman, who is completing her doctorate in clinical psychology, wondered how much scientific evidence there is that nondrug techniques can lessen shot stress. She evaluated 28 studies, involving more than 1,000 children ages 2 or older.

Hypnosis worked, she concluded. But so did easier-to-perform distraction, which significantly reduced youngsters’ own rating of their pain.

For older kids, adding a cognitive technique — such as repeating positive coping statements like “I can do this” or “I’m brave” — on top of distraction helped, too.

How parents can plan ahead
That simple methods work is important, Bennett says, because it means parents can and should plan ahead on ways they can help.

One of his patients recently needed blood drawn. If she sat still and calm, it would take only about 15 seconds. Her dad brought along a portable DVD player and turned on “Cinderella” as the nurses readied the tourniquet. Instead of the usual squirming and crying, she hardly flinched.

Last winter, Beth Bobb of Rockville, Md., brought her two oldest children, now 8 and 5, along when she got her flu shot, so they’d see that grown-ups get poked, too.

Later, “They didn’t cry at theirs. They were super strong and brave. We use that kind of vocabulary,” says Bobb, who advocates being honest with children that, yes, the shot will hurt some, “but it’s very quick and you’re going to get through it.”

Whatever you do, be honest about an upcoming shot, Bennett adds.

“After I give a child a shot, I just say, 'I’m sorry. You know you’re my buddy, and sometimes grown-ups have to do things to children we don’t like,”’ he says. “Some kids just need to cry, and that’s OK.”

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