Reducing the Pain and Anxiety of Needles

Needles are often needed to treat patients. They are used for immunizations, blood draws, starting IV (intravenous) lines, and stitches. Many children and adults are fearful (anxious) of needles. Distress related to needles is caused by a combination of pain and anxiety. If your child is anxious it can make the blood vessels narrow. This narrowing makes blood draws and IV line starts more difficult. Even one minor negative experience may lead to “pain memories.” These memories can affect coping and lead to avoidance later on.

We partner with you and your child to prevent and relieve pain as completely as possible. This includes the anxiety and pain related to needles. We use positioning, coping and numbing medicine together to address pain and distress during needle procedures. These strategies come from studies in which children and families taught us how to improve the quality of the experience.

• Help us assess your child’s pain. See our handout “Assessing Children’s Pain,” seattlechildrens.org/pdf/PE952.pdf.
• Do not tell your child “It won’t hurt.”
• Learn your child’s coping style and develop a plan to respond to possible fears.

This child likes to watch and learn about each step.

• Ask your provider to say aloud what they will be doing.
• Describe what your child may see, feel or smell.
• Involve your child as possible. Have them hold or place the Band-Aid or count during the procedure.
• Make a written plan together, with ideas of what will help your child. This will help your child feel a sense of control. Bring the plan with you, to share with the staff.

This child prefers to look away and focus on something else.

• Ask your provider if they have toys, books or bubbles available or have the child tell you a story, sing a song or watch a video for distraction.
• Engage your child with imagery. Ask them to focus on another place or time, including what they may see, feel, hear or smell.

This child likes to watch sometimes and to look away at other times. They may benefit from both approaches.

• Learn your own coping style (sensitizer or distractor). Recognize how this may match and influence your child’s coping.
• Help your child into a sitting or cradled position. To reduce distress, avoid laying your child down flat.
• Breastfeed your baby during the procedure. The sweet taste, sucking and skin-to-skin contact reduce pain.
• For babies up to 12 months who cannot breastfeed during the needle procedure, ask for a sweet-tasting solution to be given to your baby at the same time.
• For children older than 4 years having immunizations, offer to rub the skin near the needle site before and after the injection.
• Give older children and teens choices. Ask them how they would like to sit or who they would like to be in the room.

• LMX-4 or other 4% lidocaine creams may be used to numb the skin where the needle will be inserted. You do not need a prescription for these creams, as they may be bought over the counter at your pharmacy. It takes at least 30 minutes to work and is applied before the needle procedure and covered with plastic wrap. It can stay in place for up to 4 hours and still be affective. Talk to your health care provider about how to apply numbing cream at home. Check with your doctor first before giving any type of medicine to your child.
• J-tip is a device that delivers medicine (buffered lidocaine) into the top layers of the skin to numb the area where the needle will be inserted. It makes a ‘pop’ sound as it pushes the medicine into the skin with a strong puff of air. After 2 to 3 minutes the skin begins to feel numb. This product requires a prescription and is used by a healthcare provider.

Child Life specialists are members of your child’s healthcare team. They work with you and your child to help you relieve tension, express concerns and fears, and feel more in control about your hospital experience. Ask for more information about how to connect with this resource if your child needs additional tips for coping with pain and anxiety of needles.

All members of the team are committed to partner with you and your child to improve the quality of the experience with needles. Please let your child’s provider know if you have questions or feedback at any time.