Immunisations and Injections

Immunizations and Injections

Pain relief for immunizations, particularly multiple injections, requires a variety of different techniques.  Scroll down for recommendations from clinicians using Buzzy for shots.

HOW TO USE BUZZY FOR INJECTIONS OR IMMUNIZATIONS: Because there’s no risk of shrinking blood vessels, pain control is maximized by using Buzzy’s ice wings to cool/numb and vibration to desensitize the area directly for 30-60 seconds, then moving Buzzy just proximal (toward the head or spine) during the shot. When injections burn, the pain can be relieved by rubbing Buzzy’s cold and vibration over the area after the medicine is in.

 

Arm InjectionIdeally, a parent would put an arm around their child and hold Buzzy on the site for about 30 seconds before the shot.  Even with Buzzy there will be dull touch sensations (those are transmitted on different nerves that Buzzy doesn’t block), so use distraction questions or DistrACTION cards to entertain and pull attention away if the child  already has a needle phobia.  When the shot is ready, move the Buzzy up and keep pressing on the nearest bony surface to maximize vibration transmission. The little red dot in the picture to the left shows where the shot would go.  If multiple immunizations are being given, change out the cold packs so the sites each have 30 seconds of numbing.

Buzzy can also be placed in the palm of the nurse’s hand leaving fingers free to bunch up skin.

 

one-hand-buzzy-techFor children aged 4-6 who are getting multiple injections, distraction is a critical part. Use the Buzzy ice pack on the site, but consider using the vibration of Buzzy to play the “Elbow Game” as seen in this video:

Kids do best if they’re under-promised and Buzzy then over-performs.   Let children play and experiment with Buzzy to get used to the sensations before using it for shots, and reserve the distraction cards for if the elbow game isn’t feasible. Check out these extra options:

video on how to reduce the pain of vaccination in babies and downloadable vaccination pain management pocket guides (one for babies and one for children > 1 year). (by Dr. Anna Taddio)

video showing how sucrose and breastfeeding can be easily used to reduce pain from vaccination in babies (by Dr. Denise Harrison)

A really adorable video for parents in which a young child advises her mom on some simple things that parents can do—and shouldn’t do—to help make shots less stressful and painful. (by Dr. Christine Chambers)

You can also have children who are more scientifically oriented rate their own pain on a faces scale with shots now, experimenting with things like taking a cold drink of something sweet while getting the shot, or taking a cold drink of water, etc.  You can also let kids who have to get many shots try taking a sweet mystery drink right when you give the shot and trying to guess what it is as a distraction.  Then when they use Buzzy, they’ll be used to both abstracting herself a little from the process, and she’ll know that various techniques work better or don’t so she’ll appreciate how much Buzzy helps.

From one clinician in the field with 30 years of experience, here are some unedited suggestions:

  • Do you give simultaneous injections when a child needs mulitple immunizations?
    • Usually one nurse gives the immunizations. When parents request we can use 2 nurses to give them.
  • What specific comfort positions have you found to be conducive to administering mulitple immunizations at the same time?–
    • I’m especially interested in the 0-1 year old and 4-6 year old ages. We have found the best comfort position is in the parents lap. I will let the child choose the chair or table by themselves or mom/dads lap. They usually choose the parents lap. I explain if they sit by themselves they need to hold very very still and usually have parents hold their hands, sometimes we have them sit on their hands. We use this for ages 1-9 or older if they choose.  After they are in position, I explain BUZZY and ice wings, and how he works,(explain, we use him so you don’t notice the poke so much) get them in place, then let them choose a sound book to look at and we start reading. After BUZZY has been on about 2 minutes ,move BUZZY up higher on the thigh, instruct parent to hold wrists, crisscross on chest (especially the toddler age) so they don’t reach down and help and also give their child a big hug. Sometimes I have time to talk them about blowing during the pokes, that helps to relax the muscles also. When the nurse is done I ask the child to turn BUZZY off(to distract )Many times they are ready to go after that.  If they are still upset I will blow bubbles for them, then encourage them to blow bubbles and blow the hurt away. Sometimes we need to finish the book before I leave and I remind them to keep moving their legs by running, jumping and playing today to make their legs feel better. Also praise them for being so brave and holding still. Many times the nurse will be holding the child’s legs with their legs,  nurse sitting on chair, child’s back to Moms chest, I hold BUZZY and book while Mom holds wrists. Our nurses are very quick, we usually give 3-5 shots. Infants 0-12 months, I have been encouraging the nurses to let the parents hold their infants. We have just started using surcrose in the last couple of months, given about 2 minutes before immunizations. Explain to parents that holding their baby gives their child comfort and helps them cope with the pain and helps to build trust. We have also discuss that mom can breast feed if she would like. No one has done that yet. I have a few nurses that will ask me to distract with this age, I will use light wands, bubbles, sounds books, and sometimes BUZZY, letting child hold him. 10 -14 years old, BUZZY and ice wings usually works very well for this age. I will also use an I Spy book for distraction. They can choose to sit in parents lap or alone if they are still.  They also can choose to  use arms(if they are big) or legs.  I explain the same using more age appropriate language. I also will talk more to them about keeping their muscles loose and how they can do that and why it is important.
  • What is the most popular injection site when kids are getting multiple immunizations (arm or leg)?
    • Legs
  • Please share any other information or thoughts that you may find helpful to me!…
    • Any interesting distraction ideas, tips for educating parents or staff, etc. I don’t usually use the ice wings  for the 2,3 and some 4 year olds. You have to asses quickly with child and if they can tolerate it.  Regarding the light wands, I try to not let it out of my hands, when the child touches it I turn it on, then off when he lets go(he thinks he has made it go) cause and effect. Sometimes I have them blow at it, then turn it on so they think they are blowing it on.  We are honest with the kids about the pokes, they know they are getting them, letting know there are different ways of coping to make it better for them, some need to watch, some its better if they don’t. When they have a job to help the nurse it gives then some control, ex. Your job is to hold very still or blow, moms job is to give you a big hug and help you hold still. We have found parents can hold better when they hold the child’s wrist not hands and toddlers don’t twist their body as easily when the arms are crisscrossed. I have been a Child Life Specialist in the Hospital for 30 years and have moved to our Pediatric clinic the last couple of years.  It is a wonderful new learning experience! It has been exciting to see the changes in the nurses also. We went from holding the child down on the table, with 2-3 nurses to now nurses are blowing bubbles for their patients to help calm them in the weigh stations and getting books to distract them if I’m not available. They will also use BUZZY without me!  If a child has a hard time coming to the clinic I will suggest to the parents to do medical play with the children at home and explain how to do that. I have also been talking to the nurses about giving choices to the child when appropriate and when they don’t have choices and the language they use with that in mind.  I am interested in hearing what other programs do.

Kay Mjolsness, CCLS Sanford Childrens Hospital SW Pediatric Clinic Fargo, ND 58103