How can I help my toddler with her upcoming immunizations?

My one year old is due for more immunizations soon.  I was able to soothe her after her baby shots but now it's different story--she’s already unhappy with having her ears examined and her belly poked.  I feel like her next shots will be more difficult!

Yes, the whole experience of getting immunizations on most pediatric visits can be hard on parents as well as children.  Many parents avoid thinking about the likelihood that a well child visit will almost always include two or more immunizations, so they miss the opportunity to prepare themselves and their child. No wonder the experience can be upsetting for everyone!  Learning strategies to help your child cope is the smart way to go and will make you and your child feel stronger and more capable in the future. A baby or toddler who is afraid of "shots" can wind up with other fears of medical procedures, and may even become afraid of going to the doctor's office!

First, a few thoughts that may help put the experience in perspective. Shots are some of the least painful experiences your child will have.  Really.  If you allow your child any freedom, by the time he’s an active toddler he will have bumped his head hard at least once, and within a few years boast a collection of healed scrapes and bruises that come with healthy play and fun.  You will learn to comfort him with a hug, a kiss, some understanding words, and maybe a magical bandaid. You’ll take pride in his ability to shake it off and go back to play.  You wouldn’t (I hope) try to keep him from running and jumping. So why are shots, which are usually quick and limited, a source of so much anxiety?

My guess is that the big difference is that in regular daily life we don’t plan for our child to feel some pain.  We don’t drop our kids on their heads or push them down, or give them their colds and ear infections.  We feel responsible for giving comfort after the fact, but it doesn’t seem like it’s our fault that they feel that way.

Another reason why parents get upset about shots is because many of us have had experiences that taught us to be fearful.  In the past children were often taken out of a parent’s arms while the “shot” was “given”, or were told that it wouldn’t hurt, or perhaps were scolded for resisting.  For your child, things can be different.

We know a lot more now about helping children with unpleasant experiences than was known when you were a child.  Your toddler can learn to accept injections as brief “owees” that are just a fact of life, a short moment of not nice in the middle of a pleasant experience at a pediatric office. That’s important for your child’s health now and in the future, because the protection provided by immunizations is a key element in keeping children free of diseases and disabilities that used to be common.  A thoughtful parent can keep “shots” from being the awful experience you fear.

How to do that?  Much of the power is in your hands, and if you are lucky your pediatric clinicians will be on your side once you are there. 

Preparation:  Before your child goes for her appointment, find out for sure if an immunization is due.  It probably is, but checking the recommended schedule or with your child’s provider will help you know for sure. Think about keeping your own record, using the CDC form that gives you space to record your child’s developmental milestones and heights and weights as well: http://www.cdc.gov/vaccines/parents/downloads/milestones-tracker.pdf

Now, check in with what you know you need for yourself.  How can you be the best calm parent so that your toddler can feel calm as well?  Do you want to practice deep breathing?  pack a chocolate bar?  play soft music on your smart phone that brings a smile to your face?  To be the best for your child when she needs you, you have to attend to your own emotions.  Once you’ve done that, you can use these ideas to help your child:

•  First it’s important that a parent (no one else) hold a toddler in what  is called a position of comfort.  Almost always that will be sitting on a parent’s lap, facing in or out.  For many toddlers, the cozy yet firm restraint of having legs between a parent’s will help them stay still during injections.  That position also helps free your arms to both hold him and distract him. Don’t allow anyone to put your child flat on a table as this position is very upsetting to most toddlers and should only be used when restraint is medically necessary.

•  Distractions are an important part of helping children cope with an unpleasant procedure because it takes their focus away from what might bother and turns it towards something that gives them pleasure.  You already know how hard it is to get your child to give up something she likes--your car keys, your phone, her favorite toy.  Now you’ll use that natural focus to help her to not notice (as much) the shots. Pack your distraction tools in a special bag to take out a few minutes ahead of the immunizations, so that your child is already engaged. By the way, using this focused attention to help your child is a part of pediatric hypnosis and hypnotherapy that you can read about elsewhere on this site.

•  In the bag: toys that make noise and move, a comfort object such as a stuffed animal or blanket, any desirable parent possession (your key ring, your phone, maybe even an extra wallet preloaded with plastic cards.) If you have a helper (siblings are great for this) a great distraction is to blow bubbles so that your child’s interest is continuously captured.  

•  Keep talking (or singing) to give your child an additional way to use her senses. What you say is less important than the tone and rhythm of your voice, so don’t hesitate to repeat the Itsy Bitsy Spider and Old McDonald as many times as needed (and yes, there’s an app for that to help you).

•  Your child will almost always get more than one shot per visit, so keep up the distractions even if she is upset, because your steadiness is usually more comforting than starting and stopping the procedures. (Parents who want to reduce the number of injections per visit by taking their child in for immunizations every month sometimes find that getting two shots every month is much harder on the child than four shots every few months)

•  When the injections are over, you can stand up and move your toddler to distract her even more, or offer the kind of cuddle and soothing that you know works best for her.  Nursing, a pacifier, or sips of milk from a cup work well for many, but for some toddlers,  a change of position and a different toy, combined with your comforting voice, will be enough to signal “all done”!  

•  If you need to talk to your health care provider, that’s fine, but first focus on your child.  Remember that your comfort now is another type of immunization, protection against stress.  When a toddler can associate getting her parents’ comfort with her own distress, she is learning that you are the person she can turn to when she needs help.

And don’t forget to keep your own immunizations up to date!