In this comprehensive needle poke guide, Certified Child Life Specialist, Child Life on Call founder, and expert Piper + Enza contributor Katie Taylor discusses how to prepare and support your child through any needle poke procedure they could experience. This guide may be used in conjunction with our children’s book, “The Difference Between Needles and Noodles.”
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As a child life specialist working primarily in hospital settings, I’ve seen lots of kids showing signs of anxiety, fear, and/or dislike towards receiving injections, some of them so severe that they refuse outright to go through with them—and sometimes skip the entire injection process entirely.
You may be thinking about your own experiences with needles. In fact, fear of needles is real and has been shown to be present in most children and 20%of adults.
The consequences of letting a needle phobia overcome your family may be too costly to ignore. Fear of injections can cause anxiety and stress for both children and their parents. It can also cause missing appointments or even refusal to get necessary bloodwork. It’s important to realize that this fear isn’t just limited to one kind of needle (e. g., shot) or one age group (young children). It is relative to any kind of needle poke and can affect children and adults at any age.
Being fearful or anxious about medical procedures, like shots, IV starts, or vaccines can manifest in both physical and emotional reactions. Our goal in creating this resource is to provide you with one trusted place to reference when your child has to have a poke. After reading these evidence-based practices, you will feel equipped and empowered to help your child for whatever needle comes their way.
While we will address specific needle pokes in this resource, you will find that much of the evidence-based information translates to many, or all, of the procedures. Before we get into the different types of shots, here are some considerations for all ages and stages. This chart builds on conclusions derived by developmental theorists including Jean Piaget, Lee Vygotsky and Erik Erikson.
| Stage of Development | Common Medical Fears | When to Prepare | How to Support |
| Infant + Toddler
|
Separation from parents | Immediately before procedure |
|
| Preschool | Lack of Control; punishment | < 4 hours before the procedure |
|
| School-Age | Fear of pain; threatened sense of self-confidence | >1 day before the procedure or ask them when they want to know something is going to happen |
|
| Adolescents | Loss of independence; fear of pain; body image | Ask them when they want to know something is going to happen |
|
How to Create a Coping Plan for a Needle Poke
Coping plans can be made in many different forms, including a brief verbal discussion, a written list of steps, or an elaborate set of instructions. Since we know that the “preliminary” period before the vaccine shot can cause anxiety symptoms, this can serve as an excellent time to talk about options and give children some degree of autonomy.
Environmental components of the coping plan:
Start by giving patients some freedom to choose their own positions and environmental stimulation. Here are some ideas to promote opportunities for children to take charge of their own experience:
- Lights bright or dimly lit (if lights must stay on, can the patient wear sunglasses or close their eyes?)
- Blanket on or off? If you have a blanket available, consider allowing the patient to cover a portion of their body to help them from feeling so exposed.
- Caregiver or support person close by or waiting in another room.
Coping skill choices for the coping plan:
Next, discuss how getting the shot will unfold and encourage your child to partner with you to come up with a plan on how to handle it.
- Walk through the sequence of events focusing on what the patient will hear, see, feel, smell, and taste. Which part do they want to focus on, and which do they want to be distracted for? Piper + Enza has some fun distraction cards they will love.
- Ask questions about what your child thinks will help them get through it.
Preparing for the end of the procedure:
The end of the procedure (my favorite part!) should be included in the preparation. This can help your child visualize the end and understand that the poke does not last forever.
- As soon as the poke is over, ask your child what you think the site will look like and what the nurse or tech will do.
- Come up with something to do when the poke is over.
Procedure Specific Considerations and Details:
(The following procedure information is copyrighted by Child Life On Call, LLC, and is for educational purposes only)
Blood Draw
What is it?
Your child is having a blood draw to get lab values in their blood.
Why is it happening?
This information can help with diagnosis or treatment of an illness or disease.
What is the sequence of events?
- A staff member will look around on your child’s hands and arms to determine the best place to complete the blood draw.
- A warmer pack or blanket may be placed on the spot or numerous areas for a few minutes to help the veins become more visible.
- Once a spot has been chosen, it will be cleaned with a wet alcohol wipe or swab, and a tight rubber band or tourniquet will be placed on the arm or wrist above the chosen spot that the blood will be drawn from. This helps the veins get as large and visible as possible.
- A small needle will be inserted into the vein to get the blood needed.
- The rubber band will be released and the needle quickly removed while a bandage is placed over the area.
How to advocate for your child:
Ask if the tourniquet (rubber band) can be placed on the child’s clothing rather than directly on the arm. If your child is old enough to sit on their own, you can advocate to sit with your child in a “comfort position.” This means you will sit in the bed first, with your child’s back to your chest. Open your legs so that your child’s bottom is between your legs. Cross your legs over your child’s. Place your arm over your child’s shoulder to help keep them still. If there is advance time, you can ask for a numbing spray or cream to be placed on your child’s skin. Consider making a coping plan.
IV Start
What is it?
The care team has determined that your child needs medication or liquids directly into their veins (intravenously) and this is necessary for treatment.
Why is it happening?
Your child needs an IV (a thin, flexible straw in the vein) to get medicine or fluids intravenously.
What is the sequence of events?
- The nurse or technician will place a tourniquet (rubber band) on your child’s arm and examine the limb to look for veins.
- The nurse or tech will clean the site with an alcohol swab or wipe.
- The nurse will slide the needle in your child’s vein with a small plastic straw around it. Once in the vein, the nurse will remove the needle while keeping the straw in the vein.
- The nurse will place skin-friendly tape around the straw to hold it in place.
How to advocate for your child:
Ask if the tourniquet can be placed on the child’s clothing rather than directly on the arm. If your child is old enough to sit on their own, you can advocate sitting with your child in a “comfort position.” This means you will sit in the bed first, with your child’s back to your chest. Open your legs so that your child’s bottom is between your legs. Cross your legs over your child’s. Place your arm over your child’s shoulder to help keep them still. This is possible for ages as young as 6-8 months. If there is advance time, you can ask for a numbing spray or cream to be placed on your child’s skin.
Heel Stick
What is it?
Your baby is getting a “heel stick” to draw blood. This information can help with newborn screening information, and diagnosis or treatment of an illness or disease.
Why is it happening?
The heel stick is now the most common way to draw an infant’s blood.
What is the sequence of events?
- The nurse will collect supplies and wash hands.
- The nurse will verify the baby’s identification and labs ordered by the doctor.
- The baby’s foot will be warmed for 2 to 3 minutes
- The nurse will put on gloves and complete the heel stick at the base of the heel and massage the foot to get blood to flow.
- The nurse will hold pressure on the skin once the blood has been collected.
How to advocate for your child:
Talk with your nurse about pain management. Options that help infants cope with pain include sucking on a pacifier, soothing white noise, skin-to-skin contact or containment holds to help manage pain.
Shot or Vaccine
What is it?
Liquid medication given in the shallow part of the arm or leg through a small needle.
Why is it happening?
Your child needs a shot for medication or vaccination of some kind.
What is the sequence of events?
- An area will be chosen and cleaned with an alcohol wipe by a staff member.
- Typically, younger children have this done in the thigh, while older children have it in the arm.
- The skin of the spot for the injection will be pinched together and the injection will be given quickly.
- A bandage will be placed over the site.
How to advocate for your child:
Let your child choose their own bandage to bring. Ask staff if the child can choose which arm (or leg, if needed) the shot is given in. Provide distraction for the shot if warranted by your child. You can do this by counting, singing, or encouraging deep breathing. Consider playing soothing sounds, which may help your child feel calm. For infants, let your child suck on something or ask if you can breast or bottle feed immediately after.
Botox Injections
What is it?
A series of shots of Botox (the number is predetermined by the medical team).
Why is it happening?
These shots help treat muscle stiffness or spasms.
What is the sequence of events?
- The medical team will determine the area for Botox injections and the amount of shots needed.
- Once location of the body is determined, the medical staff will clean the area.
- The skin at the location may be pinched together for accuracy.
- The shot will be given.
How to advocate for your child:
Ask your team if your child can have numbing cream prior to the shots. Ice and vibration with a tool like Buzzy(TM), can help with pain management and distraction.
PICC Line
What is it:
Inserting a thin, flexible tube into a vein that connects to the large central veins close to the heart.
Why is it happening?
Your child’s care team needs access to a strong vein to give medicine, fluids or to take blood for a certain period of time. A specialized PICC line nurse will complete this procedure, either at the bedside, in a treatment room, or in the operating room.
What is the sequence of events?
- An ultrasound will be used on your child’s arm to find the vein.
- The nurse will likely mark the vein with a marker.
- Anyone in the room will wear a hat and mask.
- A sterile field will be set up (this takes a long time and all materials will be opened for easy access). The nurse will check again with an ultrasound machine.
- The nurse will clean the arm for minutes, and wait for the arm to dry entirely.
- A small poke will be injected into the site to numb the site.
- A tube will be inserted with a needle.
- The nurse will likely use the ultrasound or another piece of technology to ensure it is in the right spot.
- The nurse will remove a wire that put the tube in place.
- The nurse will secure the tube with a PICC line bandage.
How can I advocate for my child?
This procedure can take a long time, so if you can help your child find something relaxing to do like watching a movie or listening to music, that is extremely helpful. Remain steady and calm for your child. Stay at the head of the bed and provide your child with comforting, soothing support. If you sense your child is getting anxious and unable to remain still, ask your team about ways to support them with medicine, if necessary.
You’ve got this!
Fear and anxiety are part of every day life at any age. Recognizing when these feelings are more likely to occur, such as visits that require needle pokes and having a plan of action to deal with those feelings can help. Following these tips can help make a frightening experience a little more pleasant for everyone.
For more products and activities to help prepare your kid for a needle poke, check out our shop.
Katie Taylor is certified child life specialist, podcast host and CEO + Founder Child Life On Call, and a Piper+Enza expert contributor.
