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With kids age five to 11 now eligible for COVID-19 vaccines in Ontario, Jean Wilson of the University of Toronto's Lawrence S. Bloomberg Faculty of Nursing has some tips to help lessen children's fear of needles – and ease parents' anxiety, too. 

Jean Wilson

“Well before their child’s first scheduled vaccinations, I start by talking to parents about the importance of vaccinations,” says Wilson, an assistant professor, teaching stream and nurse practitioner at St. Michael's Hospital. “Every parent wants to do what is best for their child, so the more information they have the more comfortable they will be with their decision.”

Wilson was part of a panel of experts from the Leslie Dan Faculty of Pharmacy, Faculty of Nursing, Centre for Addiction and Mental Health and Niagara Region Public Health who shared insights last week in a talk titled The event aimed to provide parents and caregivers with helpful information to prepare their kids for vaccines including Health Canada-approved COVID-19 shots.

The line-up of speakers also featured Anna Taddio, a pharmacy professor who developed the CARD system to reduce pain and fear of needles among kids. CARD (Comfort, Ask, Relaxation and Distract) is an evidence-based system that invites students to choose a coping strategy to improve the vaccination experience (such as playing with their phones to distract them from getting a shot.)  

Wilson, who has worked for the Public Health Agency of Canada on communicable disease outbreak management, discussed how the mRNA vaccines work and the importance of vaccination.

She recently spoke with U of T's Rebecca Biason about how to help kids cope with needle phobia and how nurse practitioners can reduce vaccine hesitancy. 

How can parents help kids feel comfortable with getting vaccinated?

One of the first things I ask parents is whether they are afraid of needles. If the parent is anxious, the child can often pick up on this energy. I suggest that parents try to get as much information as possible about the decision they are making, appear calm and normalize the situation when discussing vaccines and needles with their children. Being honest with their child is very important. It is important to say, “We are going to get your needle today, it will pinch for a few seconds, but right after we will go to the store [or some other positive experience for the child].” Making it a part of a normal day helps the child feel more at ease and doesn’t make the vaccine experience feel so momentous.

This is also where parents and practitioners can utilize Professor Anna Taddio’s . I will often ask parents to help the child feel comfortable. Maybe that’s lying down or maybe that’s sitting on the parent’s lap. For babies who are breastfeeding, I would encourage mom to breastfeed before and after the vaccine as it has been shown to comfort, distract and manage pain.

Parents and practitioners can adapt the CARD system depending on the developmental age of the child as well. For older kids or teenagers, we might suggest they put headphones on and listen to their favourite song.

In my practice, I have liquid bubbles on hand to blow after a vaccine that works really well for children six months and up. Sometimes, we clap hands and/or sing songs after the vaccination – all of which can distract the child from any pain they might feel. I might also ask the child to wiggle their toes on the count of three before giving the shot. This distracts the brain/pain pathway physiologically, and can also help minimize pain.

The CARD system is an important part of the toolbox and I encourage practitioners and parents to try and utilize it to help make the vaccination process for their children more comfortable, less anxiety provoking and empowering for parents too.

How are the common misconceptions about the vaccine that you have encountered?

I get questions about the vaccine being rushed to market and whether it is safe. While the pandemic has required a more expedited process to help us get a vaccine, I discuss with parents that we have a comprehensive and robust vaccine approval process in Canada, and this continues even with the COVID-19 vaccines. While the vaccine manufacturer information and research data is coming in on an ongoing basis, experts at Health Canada, the Public Health Agency of Canada and provinces have been working hard to review the information in detail, strictly adhering to all the safety checks and balances that have always been in place to ensure that vaccines used in Canada are effective and safe.

The Pfizer-BioNTech COVID-19 vaccine approved for use in children by Health Canada shows side-effects that are very mild and similar to what we have seen with children 12 years and older receiving the vaccine. There were no severe allergic reactions or complications (such as myocarditis/pericarditis, multi-system inflammatory syndrome or deaths). This safety profile has also been seen in the 2.5 million children vaccinated in the United States where the vaccine was approved earlier this fall.

Another question I often get is does the mRNA change our DNA and/or interfere with fertility? The answer is no.

I tell parents how the vaccine works in the body. The mRNA in the vaccine is a small blueprint for only the spikes on the outside of the virus that causes COVID-19. When the person gets the vaccine, the mRNA goes into the cell but never goes into the nucleus where our DNA is stored. The mRNA stays in the cell liquid outside the nucleus and that is where the mRNA is read, processed and protein pieces move to the outside of the cell surface, so the person’s immune system starts to create protection called antibodies against COVID-19. The body destroys all the vaccine mRNA shortly after it is read. Once antibodies are created, if the person is ever exposed or infected with the actual COVID-19 virus, their immune system identifies the spikes and immediately starts to attack the virus and stops or minimizes the infection.

Why should parents vaccinate their children against COVID-19?

Parents want to make the best decisions for their children. This is where the “Ask” part of the CARD system comes into play. A parent’s hesitancy around vaccinations can be the result of a variety of things including their own experiences with vaccinations, mistrust of the health-care system as a whole or misinformation they have gleaned from the internet. Providers can often alleviate hesitancy by providing trusted information and online resources.

I often get questions about why children should get vaccines if they don’t get symptoms or only a very mild case of COVID-19. While this is true, unfortunately in the third and fourth COVID waves, we have seen more children becoming sick with COVID. While the risk of severe illness and hospitalization is less for children compared with adults, this still occurs and can happen to children who were otherwise healthy.

I discuss with parents the possible complications of COVID. Some children might develop multi-system inflammatory syndrome and require hospitalization. We also know from newly published research about children with COVID, regardless of the severity, can develop complications such as long COVID, a condition in which COVID symptoms remain with the child for months after the initial illness. We are still learning more about this.

Finally, I talk to parents about the social and psychological aspects of the pandemic on children. The faster we get as many people protected from this virus, the sooner we can get back to normal life for both parents and children. We know that children have been impacted by the change in routine, social isolation, disruption to school and extracurricular activities and the stressful impact COVID has had on their parents, family and friends. Part of the vaccination process is to assist in making the child’s environment stable again for their well-being. I encourage parents who are talking to their children about the COVID vaccine to explain that this will help us get back to activities they love such as going to school, sports activities, sleepovers, visiting grandparents and other elderly loved ones and taking family trips.

When I sit with people who have been hesitant, it takes such a short amount of time to answer their questions in a non-judgmental, respectful way. It doesn’t take much to reassure them. As practitioners, we must be able to take that time to listen and answer questions knowledgably and most of the time, parents are reassured and feel better informed to make this important decision for themselves and their children. Nurses are a highly trusted profession and viewed as being knowledgeable. Using that gift and skill is vital to helping people make evidence-based decisions.