Tips For Making Shots Hurt Less (Or Not At All)

Between annual vaccines like flu and Covid shots, and the many childhood vaccinations and boosters that accompany our kids’ well visits, parents spend a fair amount of time convincing their kids to get shots. As adults, we understand that a few seconds of squeamishness is a small price to pay for the life-saving protection that these vaccines confer. Kids, though, can’t quite grasp that trade-off so getting a shot can be pure anxiety. Turns out, though, there is a way to make shots not hurt a lot, if at all.

I first encountered the idea that shots could be a positive experience when I took my kids to get their first Covid shots in 2022. We went to a vaccine clinic at our local children’s hospital they were understandably nervous. What we encountered when we stepped off the elevator, though, melted the nerves away. Nurses in shiny capes greeted us with cheering and bubbles, the 15 minute waiting area was called the “party room,” and had been decorated as such. And when it came time for the actual jab, each child was offered a “comfort menu” of options the like Buzzy (more on that later) and “magic spray” (super cold water) to make the shot hurt less. It was such a simple thing, and the tools offered — the nurses told me — are easily available and inexpensive. The consideration and humanity that the offer of a comfort menu demonstrated moved me, and made our kids’ experience much better. It wasn’t 100% anxiety-free — when the needles showed up, so did some apprehension — but it was tear-free, and overwhelmingly good. Why isn’t every shot accompanied by a comfort menu? I thought.

Increasingly, they are, thanks to pediatricians like Dr. Stefan J. Friedrichsdorf, MD,FAAP, a pediatric pain and palliative medicine specialist at UCSF’s Benioff Children’s Hospital, who has been working for more than a decade to normalize the prioritization of children’s comfort in children’s hospitals. Fear of needles is a huge issue, Friedrichsdorf says, because kids that have negative experiences with vaccinations in childhood grow into grown ups that are scared of shots. “About one in four adults are needle-phobic, or very afraid of needles. That’s probably because we did something stupid, like holding them down for their shots as children,” Friedrichsdorf explains. “This has huge consequences. It means that these are, later on, teenagers and young adults who will not seek out healthcare.”

In 2016, Friedrichsdorf implemented the Children’s Comfort Promise at Children’s Minnesota, a system that aimed to create a new standard of care addressing what he called “common, underrecognized, and undertreated” pain associated with needles in children’s hospitals and pediatric clinics. Even if your pediatrician doesn’t yet offer a “comfort promise,” Friedrichsdorf’s pain management strategies are extremely simple. These low-cost, evidence-based approaches to reducing or even sometimes eliminating — depending on the child — pain associated with needles are easy and affordable for parents to DIY.

How to make shots less or not painful for kids

1. Numbing cream

Want pain-free (or nearly pain-free) shots for your kid? “The single most important thing is to buy over-the-counter numbing cream,” Friedrichsdorf says. Look for 4% lidocaine cream, which he says is widely available. It’s also inexpensive (under $10) and one little tube will last you for years. Find out where the injection site will be. “Typically, infants under 1 year will get injections in their upper thighs, and kids over 1 year will have them in their arms,” he says. Use a “pea-sized” amount of cream on your child — covered with a large bandage to help it stay put — and let it sit for about 30 minutes before they get a shot. When it’s shot time, the area should be numb, making the experience virtually painless. It’s a suggestion so simple, it floors me.

“The way I sold [numbing cream for shots] to my kids was like this: ‘we are going to put on some numbing cream. Numbing cream is amazing. Most kids have told me that they haven't felt anything at all after having it. Some kids they told me they felt a little. I wonder what it is going to be like for you?’”

And, it is true, he says, that most children don’t feel anything when getting a shot if they have numbing cream beforehand. But, he says “you can't promise it.” Especially if your child has had negative experiences in the past — perhaps they were held down for a vaccine, or they're quite anxious — he says that the first time you try numbing cream, they may still be a bit nervous. And while you can’t promise zero pain — though that is likely — you can promise them that you will prioritize their comfort.

2. The Shotblocker

For about $12, you can buy a Shotblocker if your pediatrician does not have one. It has been shown to reduce pediatric pain from injections. “Getting a vaccine is clearly one of the most anxiety-producing procedures for a child, and it is definitely important to manage that anxiety. I think these devices can be very, very helpful,” explains Dr. April Douglass-Bright, a pediatrician at Cooper University Health Center, who has studied the Shotblocker’s efficacy.

In her office, Douglass-Bright always encourages families to talk openly with kids and prepare them ahead of time for getting a shot. “I don't feel that this is a situation where the element of surprise works in your favor,” she says, reminding families to validate fears — yes, it might pinch for a moment — while also focusing on the why behind a shot.

If it turns out that this is a child has significant anxiety, though, that’s really the moment when she might mention the Shotblocker to a family. “It's just really a little piece of plastic with a bunch of little prongs that kind of press onto the skin. It saturates and sort of ‘distracts’ all those little small caliber pain fibers that carry from the brain to the central nervous system, and blocks the slower ones that carry more pain.”

If you can’t get ahold of a Shotblocker, Douglass-Bright says that parents can have a similar effect by rubbing your child’s skin where the shot will be given very vigorously for 10 seconds, while letting them know that doing so will help with pain. “I think that goes a long way as well. Whether we call it a placebo effect or not, I think it can definitely make a difference.”

3. The Buzzy

Though it is substantially more expensive than the Shotblocker, the Buzzy is a popular tool for parents with children who are particularly afraid of shots and has been shown to reduce pain associated with injections, though not as well as lidocaine cream. Because of this, Friedrichsdorf recommends using a Shotblocker or Buzzy in addition to numbing cream for maximum efficacy. The Buzzy uses both cold and vibration to take the sting out of shots, and is used in some children’s hospitals and pediatric clinics. If you don’t mind the steeper price tag, it’s also a lot cuter than a Shotblocker and so might be more appealing, especially to younger kids.

4. Sugar Water

It worked for Mary Poppins and apparently, a ‘spoonful of sugar’ can make shots less painful for babies under 12 months. Not a literal spoonful, mind you, but rather a dropper full of sucrose. To help make shots less painful for babies under one year, Friedrichsdorf says parents should either breastfeed or ask the pediatrician to offer them a few drops of sugar water. “Sucrose under the tongue or breastfeeding releases happy hormones in their brain and, basically, it works like morphine,” to reduce, or nearly eliminate, any pain they may experience during the shot. “It’s amazing,” he says.

5. Bubbles, lights & other tried-and-true distractions

Age-appropriate distraction is another one of Friedrichsdorf’s trusty tools, but there’s no one way to employ it during a shot or blood draw. Depending on your child, their age and preferences, parents may offer party blowers, blowing bubbles or a pinwheel, light-up toys — those are especially good for toddlers and preschoolers — or let your older child play or watch something on an electronic device.

Do NOT restrain your child

“Never ever, ever, ever hold down a child,” Friedrichsdorf begs. “The problem is that many clinicians are still trained this way. They think the best way is to hold down the child and sort of do it quickly, thinking it’s just one second [of pain]. What they fail to appreciate is that many children are already screaming in the parking garage of your doctor's office, and they're flipping out the 20 minutes before and afterwards.” Instead, he urges families to put these comfort strategies to good use, especially the lidocaine cream.

To watch or not to watch

My kid has always wanted to look at the needle as it goes in, and so I asked both Douglass-Bright and Friedrichsdorf if that’s considered OK or a bad idea. Both experts agreed that it’s OK to let kids take the lead here. If they’re curious, let them look. Any opportunity to let them feel like they have some say or control in the situation is a good thing, adds Douglass-Bright, down to choosing which arm or leg to have the shot in.

After the shot, a little positivity goes a long way

After the shot is done, and however the experience went, Friedrichsdorf emphasizes that it’s essential to talk through what happened and frame the experience in positive language. He gives a few examples parents can try, saying things like:

• I’m really proud of you!
• Do you remember, you were only bothered for a brief moment? And then you got that delicious candy (or sticker, or toy)!

Humorous, positive language is great, as is offering the chance for distraction from any distress (as long as it doesn’t invalidate their fear or discomfort). Dwelling on the bad can make things worse, he adds. But using positive language around how proud you are of them, or how well it went after the fact can have lasting impacts, and one sentence is all it takes to prevent getting shots from becoming a traumatizing experience. “Kids remember this as much less frightening, even if it didn’t go as well as you’d hope. And then, the next time they remember this as not such a big deal.”

Studies cited:

Friedrichsdorf, S., Eull, D., Postier, A., A hospital-wide initiative to eliminate or reduce needle pain in children using lean methodology. PAIN Reports, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6172821/

Douglass-Bright, A., Singh, S., Yiadom, M., Baumann, B (2009) Efficacy of ShotBlocker in reducing pediatric pain associated with intramuscular injections. American Journal of Emergency Medicine, https://pubmed.ncbi.nlm.nih.gov/19497458/

Experts:

Dr. Stefan J. Friedrichsdorf, pediatric pain and palliative medicine specialist, Medical Director, Stad Center for Pediatric Pain, Palliative & Integrative Medicine

Dr. April M. Douglass-Bright, M.D., Division Head, General Pediatrics, Cooper University Health Care