Trypanophobia impacts. COVID-19 vaccine UAE: My child hates needles. How can we prepare for vaccinations?

Nobody really likes needles. Of all the hurdles there are to overcome in terms of the COVID-19 vaccine roll-out in the UAE and across the world, fear of being injected might seem like a minor one. But try saying that again when faced with a child who really, genuinely hates needles. When it comes to protecting the paediatric population with the COVID-19 vaccine – which is currently approved for children aged 3 years and upwards (Sinopharm) and for ages 5 and upwards (Pfizer) in the UAE– simply getting out of the car and into the vaccination clinic can be a huge hurdle in itself. The extreme fear of needles is a recognised medical condition called Trypanophobia: “an extreme fear of medical procedures involving injections or hypodermic needles.” A related fear—the fear of sharp objects—is called aichmophobia.

It matters because around 7% of adults with a fear of needles actively refuses vaccinations. The fear of needles in children is higher than that of adults, making the issue even more pressing.

With the announcement of the Abu Dhabi Blue Schools initiative – wherein schools are allowed to reduce COVID-19 precautionary restrictions to varying degrees depending on how many of its student and staff population are vaccinated – there is increasing encouragement for parents to protect their children against the SARS-CoV-2 virus through vaccination. As the implementation of the COVID vaccine for children gathers momentum in the UAE and around the world, this only looks set to increase further.

“We are lucky that the UAE provides the Sinopharm vaccine for children from the age of three,” says Dr Rania Ayat Hawayek Specialist Paediatrician, Medical Director & Owner at Circle Care Clinic in Dubai. “It was announced in November 2021 that the Pfizer Bio-N-tech vaccine had been given emergency-use approval on children from the age of five years upwards by the Ministry of Health. This is already happening in countries like the US and the UK, but providers in the UAE have not started implementing it as yet. I anticipate that this will perhaps come in within the next few weeks or months.”

So how do you help a child who hates needles? Whether it’s for a routine mandatory immunization, the annual flu jab, or the COVID-19 vaccine itself, here is your guide to helping your child prepare for vaccinations…

How common is it to have a fear of needles?

“Needle fear and needle phobia, sometimes called trypanophobia (From Greek, trypano – puncturing or piercing and phobos – fear) are both relatively common,” says Dr Ateeq Qureshi, Lead for Child and Adolescent Mental Health Service / Consultant Psychiatrist, Priory Wellbeing Centre, Abu Dhabi and Dubai. “The terms ‘needle fear’ and ‘needle phobia’ both describe anxiety associated with needles and situations where needles or injections are used. Needle phobia is more extreme and occurs less often than the generalized fear or anxiety associated with needles. Studies show the prevalence of needle fear to be 20-50% in children and adolescents, decreasing with age to about 20-30% in adults.”

 When does it turn from a simple dislike or fear to an actual phobia?

The difference between a fear and a phobia is in the degree of severity and the impact on the individual, explains Dr Qureshi. “Needle phobia is a psychiatric disorder that leads to extreme avoidance of not only having injections but often of even seeing injections and sometimes a physical response with an initial increase followed by sharp decrease in blood pressure, which can result in fainting.”

9 Ways to help a child who hates needles prepare for vaccinations

Make the build-up brief

Each child is different and you as a parent will know how your child will respond to the amount of information and how early it is given to them.  “But generally speaking, giving weeks of notice is simply going to build needless anxiety in the child,” says Dr Waleed Ahmed, Consultant Psychiatrist, Priory Wellbeing Centre Abu Dhabi, Dubai. “A day or two prior to the vaccination or other injection is a reasonable time frame.”

Find the bright side

Convey information about the procedure in a positive way, says Dr Ahmed, whether it’s through the language you choose to use, or the aspects you encourage them to focus on. “Using words like ‘a poke’, ‘a pinch’ or ‘a scratch’ rather than ‘a shot’ or ‘injection’ give the child a simple explanation of steps of the procedure they can expect. Explain why it is important for their health to take the vaccination.” Some children may benefit from a positive story about their favourite character getting their vaccination, or from role-playing the process in advance with themselves as the doctor and their toys as the patient. Reading a story book like  ‘The Berenstein Bears go to the Doctor’ can also help to demystify the process and take some of the fear away.

Acknowledge their feelings

Although it might be tempting to minimise and dismiss your child’s fear of needles in an effort to reassure them, this can increase a child’s anxiety, and create a lack of trust if your assurances that it won’t hurt turn out to be untrue. “As always, listen to your child’s concerns and encourage them to talk about their worries,” says Dr Ahmed. “It is usually unhelpful to dismiss your child’s concerns (unwittingly) and say that they shouldn’t worry or that it’s not that big a problem. Let them know that you understand their worries and are there to help them.  Acknowledge that there can be some pain and try to problem solve together what you can do to help on the day.”

Set the scene

It can help to inform the vaccination clinic beforehand that your child is worried, which enables them to prepare in advance. Talk to the health professional administering the injection  and explain that your child is anxious about getting a jab. If your child will be vaccinated in school then mention it in the consent forms so that the school clinic is aware of it.

Support them while it happens

During the procedure a few things can help, says Dr Ahmed. “Numbing creams can be used 30 minutes or so prior to the injection. Distractions like engaging them in a joke or something comical, giving them something to watch or play on a phone or tablet, etc. are also useful.  Some people benefit from having something vibrating along the skin close to the injection site to help dull the pain. If your child likes to be held, then there are different ways how you and your child can sit together so that you can comfort and keep them safe during the procedure.” Asking your child to engage in some relaxation techniques like deep breathing or mindfulness exercises may also help.

Keep your cool

It is important for the parent to remain calm and relaxed themselves and try not to get flustered in response to their child’s distress.  Take short breaks if things get very upsetting.  Think of a few positive, calming things to say to your child in advance.

Don’t trick them

Lying about the reason for visiting the hospital or clinic and springing it upon them in the last moment is likely to upset your child and increase her anxiety.  “This may also prove detrimental for future visits, as the child may generalize all visits to hospital as traumatic,” points out Dr Ahmed.

Don’t threaten

As frustrating as it can be, always aim for sympathy and connection with your child rather than disconnection, says Dr Ahmed. “Don’t use threats to force your child or use emotional blackmail to make them feel guilty for being upset or refusing to have it,” says Dr Ahmed.

Seek help from a professional

While all of the above can help a child who hates needles, if yours has a real phobia, he or she may benefit from professional help. Dr Ahmed says: “If your child’s problems are more complex and severe, a mental health professional can help with specific treatments like Cognitive Behaviour Therapy (CBT), and certain medications to help reduce the physical symptoms of anxiety, or help relax the child during the procedure.”

A final note: What if a parent is worried about giving the COVID-19 vaccine to their child?

Although vaccine hesitancy amongst parents is a huge topic in itself, Dr Rania from Circle Care Clinic has some words of reassurance for parents who may be concerned about the fact that the COVID-19 vaccines have been approved for emergency use. “Once a vaccine gets emergency use approval, that means that it has been put under strict trial conditions prior to that, with several hundreds or more volunteers put through a trial and the results studied. In the case of the Sinopharm vaccine, this was a trial that included almost 1000 children, and there were no reports of any worrying side effects. At the moment, I think we would worry more about the effects of COVID and long COVID rather than the effects of the vaccines that have been proven extremely successful at helping symptoms be mild and keeping hospitalisation rates at an all-time low since the very beginning of the pandemic.

“At the end of the day, vaccination is a parental choice. So depending on the family situation, the experiences of any specific family, the presence of vulnerable individuals within the household, each and every household, and each and every parent can then make the right choice for their children. If we have a fair percentage of children above the age of five vaccinated, it would make for a much safer school year ahead. So I for one am looking forward to the implementation of more vaccine choices for children under 12.”

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