Injection-related Fear Associated with Routine Immunization

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Written by noreastermedical
On January 18, 2022

Injection-related Fear Associated with Routine Immunization

Injection-related Fear Associated with Routine Immunization

The pediatric population is subjected to needles in different encounters: the first needle encounter is during routine immunizations for most children. Other encounters include lumbar punctures and IV line insertion. Routine immunization among the pediatric population is crucial to prevent measles, mumps, pneumococcal pneumonia, and tuberculosis. Immunization-associated needle pain is the most prevalent cause of iatrogenic pain in childhood. It not only cause distress among children but also leads to distress among parents and nurses.

In addition, routine immunization of multiple injections during a single visit can increase pain and fear associated with injections. This shows that ongoing injections are a major cause of distress among children and parents. Additionally, some vaccinations such as the pentavalent given at 6,10, and 14 weeks can lead to pain at the injection site following the procedure, thereby leading to needle-associated fear among the children.

According to McLenon et al. (2019), children’s fear of injection is related to the actual injection rather than needle sticks. The fear of pain can lead to non-compliance with vaccination recommendations and preprocedural anxiety in childhood, which can persist in adulthood, affecting about 10% of the adults (Taddio et al., 2012). Because it creates avoidance behavior in an attempt to eliminate exposure to the needle, it is of essence to reduce the distress associated with injections to help prevent lasting phobia among the pediatric population. About 25 % of adults have needle fear, which developed mainly in early childhood (Taddio et al., 2012).

Needle phobia is an anxiety disorder and can be either trypanophobia or belenophobia. The former refers to the fear of sharp things, while the latter refers to the fear of blood or needles injection. In a study, children between the age of 6 and 17 reported fear of the needle. In this study, increased pain intensity was associated with routine immunization (McLenon et., (2019). There is a decreased fear of needles with increasing age, attributed to increased emotional regulation processes. Children who suffer from vaso-vagal needle phobia have an autonomic overreaction to needles (Cook, 2016). In the sight of a needle, they have an increased heart rate and blood pressure, creating significant distress associated with crying or fainting.

Needle-associated fear in children is related to psychological symptoms, including anxiety due to the preoccupation with the thought of the pain. Children who are more anxious during routine immunization procedures are likely to have more intense pain than less anxious children. Some children have resistive needle disorder and are likely to become combative and difficult during immunizations. They are likely to pull away during the injection or verbalize their resistance. Maternal anxiety also contributes to increased distress among children during routine immunizations. There is a positive relationship between observed pain rating by mothers and the rate of child distress (Taddio et al., 2012). However, there is a need for a parent to be there during injection procedures because they help reassure children, making them feel better.

Nurses and other clinician professionals should acknowledge the positive and negative and negative emotions expressed by children during immunization procedures. Literature that focuses on addressing needle-related pain emphasizes on the use of breastfeeding reassurance, distraction techniques, and topical analgesics. Topical analgesics such as EMLA have to be applied 20-60 minutes before the injection. In the first year of life, breastfeeding has been shown to promote analgesic effects. The mother should breastfeed the child before the immunization procedure and continue feeding the child during the procedure. There are no reported adverse consequences of breastfeeding during vaccine injections, such as spitting up and gagging: hence it is recommended (Orenius et al., 2018).

In addition, giving a sweet-tasting solution such as sucrose to the children in the non-breastfeeding age group can reduce pain during injection. Although the best position for vaccination in children is not known, restraining children can create more distress and fear. In a study, lying in a supine position was associated with increased pain compared to those who were in an upright position (Taddio et al., 2012). Parents are advised to hold their children close, reducing anxiety and consequently the perception of pain. However, the strategies lack consistent benefit in improving pain outcomes. Hence reducing the sensitivity of nociceptors would be crucial in reducing  Nurses also experience distress when administering vaccines to children who fear and combat needle injections, which calls for the need to incorporate intervention methods to reduce the fear of needles.

Exocool is a revolutionary device that reduces the pain associated with injections; hence its application in the pediatric during routine immunization is of the essence. Creating a positive needle experience decreases needle fear and promotes a trusting relationship between the health care provider and the patient. Cryo numbing is an effective strategy of mitigating injection pain in patients: it acts by numbing neurons at the injection site at – 9 degrees Celsius. The device only takes about 4-6 seconds to numb neurons in a person with sensitive skin and about 8-10 seconds in someone with normal skin.

Exocool is non-invasive, and it has no chemical; hence it does not cause hypersensitivity reactions because the tip of the device is made from aluminum alloy, which is ideal for all skin types. Pain relief is enhanced when the clinicians combine different strategies to minimize pain. Since injection-related anxiety can be psychological, the child fears the idea of injections even when there is no physical pain; clinicians can include other distraction strategies and Exocool to mitigate the fear of injections.



Cook, L. S. (2016) Needle phobia. Journal of Infusion Nursing 39(5): 273–279.

McLenon, J., & Rogers, M. A. (2019). The fear of needles: A systematic review and meta‐analysis. Journal of advanced nursing, 75(1), 30-42.

Orenius, T., LicPsych, Säilä, H., Mikola, K., & Ristolainen, L. (2018). Fear of injections and needle phobia among children and adolescents: an overview of psychological, behavioral, and contextual factors. SAGE Open Nursing, 4, 2377960818759442.

Taddio, A., Ipp, M., Thivakaran, S., Jamal, A., Parikh, C., Smart, S., Katz, J. (2012) Survey of the prevalence of immunization non-compliance due to needle fears in children and adults. Vaccine 30(32): 4807–4812.