The question we get every single day, six or seven times a day, is,
"Am I getting a needle today?"
The painful experience of the needle is way up there in terms of what they're
most apprehensive about when they come into the office.
"I think she remembers last time she was here-- is that possible?"
Babies in their first two years of life get more immunizations
by needle injection than ever before.
"She was already worked up before it even started,
because she remembered."
And learning to calm your baby during these painful procedures
is important in the development of infant emotional and psychological well-being.
Many people ignore pain and distress during immunizations
or other medical procedures in babies because they don't
know what they can do about it.
"Look at the bubbles!"
"Go on, look!"
In this video, we'll tell you how to make immunization injections
more comfortable for your children.
Most of these methods cost little or no money
and are easy to do.
To prove this, my colleagues and I started videotaping my children,
as well as other people's children, to be able to
demonstrate how easy some of these interventions are.
We apply topical anesthetic creams.
These are medications that numb the skin, and we also
demonstrated the use of bubbles,
which is a distraction— and they work really well.
"Look, they're stuck together, sweetie."
Managing pain during immunization injections can be as simple as applying
a topical anesthetic, a cream or a patch,
20 minutes to an hour before your child's injection.
This is the patch, the emla patch.
It has the drug impregnated in it,
and you just put it on the skin, and you let it sit there.
And then when it's time to do the procedure, you just take the patch off.
The drug will have penetrated through the skin,
and you just wipe it away with a tissue.
And this is another topical anesthetic formulation.
So, this is emla cream, and with this, you apply some on a dressing,
and then you just put it over the skin.
Make sure the edges are sealed so the drug doesn't leak out.
And then when it's time to do the procedure, you can
just take the dressing off and wipe away the cream.
Or, if that dressing's not available, you can actually use plastic wrap.
Something like Glad Press 'N Seal, and you can put the drug on it
and press the edges, and that works pretty well.
For infants under 12 months of age, the anesthetic is applied to the upper thigh.
And for children aged a year or older, to their upper arm.
Instructions on these numbing creams will tell you exactly what to do.
Ask your doctor whether your child is scheduled for one or more shots,
so you know whether to put the medicine on one, or both legs or arms.
Research shows that breastfeeding your baby during painful procedures
is also a very effective way of managing pain.
"Okay, sweetie--1, 2, 3."
Start breastfeeding your baby about a minute before the injection,
and make sure there's a good latch.
Keep breastfeeding during and after the injection.
If you cannot breastfeed your baby, give your baby a taste
of sugar water right before the injection.
Hospitals can buy or make sugar water, but you can also make your own.
Just mix a packet of sugar, which is about a teaspoon
or 5 mLs, in two teaspoons, or 10 mLs, of water. And then
just mix that up until the sugar has dissolved.
And then just feed some to the baby, about a minute
or two before the injection.
And you can just put a drop at a time on the baby's tongue,
and the baby can lick it or drink it.
Or, you can feed it to the baby from the medicine cup, or with a pacifier.
It is safe and effective, but only use this as a pain treatment,
not for general comfort, or as a food.
Today, we know that infant pain management can have physical
and psychological effects across the lifespan.
During distressing times like immunizations, one of the best
ways to quickly become less stressed is to take a few deep
belly breaths while holding your infant.
Your baby will feel your rhythmic breathing, and this alone is very calming.
Simply take a slow, deep breath through your nose, for three seconds,
counting to yourself, "1... 2... 3...".
And breathing so that it's your belly and not your chest that expands.
And then exhale through your mouth for three seconds,
counting, "1... 2... 3..."
Take 3 breaths like this while cuddling your baby.
Babies should always be held closely during injections,
before, during, and after the needle.
We have showings who compare infants who are injected lying down,
compared to being held by the mother, that there's significantly less pain.
So, it makes sense that you should be holding, the mother should be holding,
the caregiver should be holding their infant at the time the vaccine is given.
If the needle is going into your baby's arm, make sure the arm is exposed,
holding it firmly but gently, so that your baby won't move it.
If the needle is going into your baby's thigh, make sure the thigh
is exposed, bracing it gently but firmly for the needle.
Breastfeeding counts as cuddling, too.
It is a very effective physical comfort for babies during painful procedures.
Also, calmly talk to your child after the needle.
After you let them know that you are there for them by bringing them close,
talk about anything but the needle, or the pain, and with a normal tone of voice.
Even if your baby doesn't understand your words, they understand your tone.
"Oh my. I know. That was kind of annoying, wasn't it?"
"Now you want to get down and play."
"You want to play with your brother, and do bubbles."
The way the mother smiles, the way the mother holds the baby,
the way the mother talks— what's the tone of the voice?
Sometimes it's a language they use.
"Not yet, not yet. Stay."
Sometimes they'll say, "This is going to hurt me more than you."
And we try to get parents to avoid using that kind of language.
Trying to distract when your child is not ready will cause
them to become even more distressed.
"Play ball."
If your infant isn't ready, just return to cuddling for a little longer,
sometime within 20 seconds to 1 minute after the needle.
Thankfully, not all children in Canada begin their lives with severe complications.
"It's going to be a little prick on the heel."
But all children are subject to roughly a dozen needle pricks in their first year alone.
"Okay, and we're finished."
The child's nervous system pathways are wired during
their first year of life, so pain experienced in that time can
impact the lifespan, both physically and psychologically.
Even healthy children at medical visits frequently encounter painful
procedures, and pain management knowledge translation isn't just
designed for parents.
It's something we're sharing with the medical community,
across medical platforms, and at a national level.
After watching this video, we hope you will speak with your health-care
provider about the things you want to do to help lessen your child's pain
during immunization injections.
"When they tried to make me distracted by the bubbles,
it kind of actually worked."
With the easy steps covered in this video, you will help your child
feel less pain during immunizations and other medical procedures,
and it will help you feel less stressed, too.