The Nerve of It

Myths and Truths about Immunization Pain in Children

Myths and Truths about Immunization Pain as defined by "Inadequate Pain Management during Routine Childhood Immunizations: The Nerve of It"; Clinical Therapeutics/Volume 31, Supplement B, 2009; Anna Taddio et al., University of Toronto.

Myth and Truths of Pain Management in Children



The effects of pain can last a lifetime. Untreated pain can leave a permanent scar, or imprint, on the nervous system that changes how children respond to pain in the future. It also leads to fears of needles, doctors, and nurses.

It only hurts for a minute; there are no long-term effects.

The nervous system forms permanent memories of pain in infancy. Children also learn to associate the doctor or nurse with pain in infancy. Children fear of doctors and nurses at a young age. Parents are present at immunizations performed in early infancy and recall the pain their children experienced. They are less likely to adhere to immunization schedules because of it.

Most immunizations happen when kids are infants, and they don’t remember the pain.

More than 90% of toddlers and 50% of primary school-aged children exhibit severe distress during immunization. Even children who do not appear to be distressed may have considerable distress.

This is not an issue for most kids.

For children, procedures involving a needle puncture are viewed as one of the most frightening and painful health-related events. The most common question a child asks when entering a doctor’s office is “Am I getting a shot today?” Children are preoccupied by needle pain.

It’s only a needle.

Adopting a child-focused approach to immunization will allow vaccinators to open their minds to an alternative method of immunization that does not involve distress for children, parents, or themselves. If pain management is practiced with every injection, children will learn to manage pain, remain calm during procedures, and develop trusting relationships with health care professionals. It also saves time because children will be more cooperative.

I give a lot of injections; I just want to get it over with quickly.

Getting shots is stressful for everyone—the child, the parent, and the health care worker performing the injection. At least 5% to 10% of parents delay immunization or don’t have their children immunized because of pain. Fears develop because of a negative past experience with receiving injections, but can be avoided if proper pain management strategies are used every time. Parents can be trained to use pain-relieving techniques that will minimize their child’s fear about getting shots.

The problem is that hysterical parents are causing their child to have fears about getting shots. It is all psychological.

Parents have little information about how to manage pain during immunization. Health care providers have the opportunity to fill this knowledge gap.

Pain management is the parent’s problem.

When pain management is practiced routinely, it does not have to add extra time to the procedure. Parents and children can read about pain management beforehand, and measures can be put in place to mitigate pain during immunization.

We need to immunize quickly; we don’t have time for all this pain management stuff.

Up to 25% of adults are estimated to have a considerable fear of needles. Approximately 1 of every 10 people develops a needle phobia, usually in childhood, as a consequence of a negative experience with needles. This is common enough that everyone knows someone with a needle phobia. Fear of needles leads to avoidance of preventive and therapeutic health care measures in childhood and adulthood, which negatively impacts health.

Fear of shots is the only long-term effect of immunizations, and it is rare.

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