Vaccination pain management for children: Guidance for health care providers

On this page

• Overview
• Children under 3 years
• Children 3 to 17 years
• Children of all ages

Overview

Vaccination begins in infancy and plays an important role in keeping children healthy. Early experiences can influence how caregivers and children will respond to vaccination later on.

You can help make vaccinations a more positive experience by minimizing pain during vaccine injections. This can improve a child's comfort and experience. It can also help to build trust with caregivers and children and increase the likelihood of future vaccine acceptance.

There are a number of ways to make vaccine injections more comfortable for children and their caregivers.

Children under 3 years

• Discuss options ahead of time that require planning, such as topical anesthetic medications and sweet solutions (sucrose water).
• Be calm, positive and attentive to the child, and encourage the caregiver to do the same.
• Encourage breastfeeding before, during and after the vaccination.
  • Alternatively, a bottle or pacifier can be given.
• Provide physical comfort during vaccination by positioning the child on the caregiver's lap throughout the vaccination process for comfort.
  • The limb receiving the vaccine should be exposed.
• Skin to skin contact can be used by the caregiver for infants one month or younger.
• Suggest the caregiver use a distraction, such as toys or talking to the child.

Children 3 to 17 years

• Discuss options ahead of time that require planning, such as topical anesthetic medications and distraction items (toys, bubbles, games, music, videos or talking).
• Encourage caregivers to be present during vaccination to support the child.
• Be calm, positive and attentive to the child, and encourage the caregiver to do the same.
• Position the child upright during vaccination.
  • It may be necessary for younger children to be held by the caregiver in a supportive position to keep them comfortable and still.
• Encourage relaxation of the arm so that it is loose and jiggly like cooked spaghetti.
• Use and combine strategies to reduce pain and fear that meet the child's needs and preferences, such as:
  • distraction (electronic device, toys, games, music, talking or singing)
  • relaxation techniques (deep belly breathing)
  • topical anesthetic medications
• Use muscle tension for vaccine injections in children with a history of dizziness and fainting.

Children of all ages

• Combine coping strategies to help mitigate pain during vaccination.
• Educate caregivers and children about pain management strategies before and on the day of the appointment.
• Talk to caregivers and children about applying a topical anesthetic medication before the appointment.
• Answer questions or concerns that the child or their caregivers have about vaccination.
• Communicate using neutral language and do not use:
  • o words that elicit fear (e.g., the needle stings)
  • o repetitive reassurance (i.e., don't worry, it's okay, you'll be fine)
• Provide balanced information.
  • Do not promise the vaccination will not hurt or that everything is okay.
  • Describe sensations (e.g., pressure, pinch).
  • Invite the child to report on how they feel.
• Ask the child and caregivers about their preferences (e.g., Do you want to be distracted?).
  • Do not impose coping interventions such as distraction, as this may be counter to the coping strategy of individual children, increasing distress.
• Avoid aspiration before injection.
• Inject vaccines quickly.
• If giving multiple separate injections, start with the vaccine that causes the least amount of pain.

Ensuring that information about these strategies is shared using accessible plain language and communicating in a culturally safe manner, can help both children and caregivers have a positive experience with vaccination.

If a child has a high level of needle fear, consider referral to a mental health expert such as a psychologist. Treating needle fear can help children and caregivers accept vaccination and other needle procedures.

Related links

• Provincial and territorial routine and catch-up vaccination schedule for infants and children in Canada
• Canadian Immunization Guide: Techniques to decrease immunization injection pain
• Immunize Canada
  • Clinical practice guideline on management of vaccination pain (from birth to adulthood)
  • Immunization pain management (clinician focus)
  • Pain management during immunizations for children
  • CARD system: Coping with fear and anxiety (for parents and caregivers)
• CANVAX: Health worker training module: Managing pain during vaccine administration
• BC Centre for Disease Control: Communicable Disease Control Manual, Reducing Immunization Injection Pain (PDF)
• World Health Organization: Meeting of the Strategic Advisory Group of Experts on Immunization: Conclusions and recommendations reducing pain and distress at the time of vaccination (PDF)