Help for shot phobia

Q: My young toddler is needle phobic. Help!

A: Vaccines are incredibly important for all children. They prevent life-threatening or debilitating infections; decrease illness and comorbid conditions; and challenge our immune systems to weather disease exposure throughout life, regardless of where we might travel.

Most vaccines do require an injection, however. Many children and grownups are concerned about the pain of the injection with vaccines or are even needle phobic. Unfortunately, some let this fear get in the way of receiving these precious vaccines. 

Lidocaine 4% — an over-the-counter local anesthetic — can help decrease pain caused by injections or needle sticks. It numbs the skin from the surface to a few millimeters below. In order to be effective at numbing the skin, lidocaine must be applied in a relatively thick layer, about a quarter to half-dollar in size, for 30 minutes before the injection. 

Unless parents know exactly where the vaccines will be administered, it shouldn’t be applied before arriving for a clinic visit. Often parents don’t know if vaccines will be given in arms or legs, what spot on the arms or legs, and are unaware that some vaccines are given in different extremities from one another. 

Lidocaine must also not be accidentally eaten or brushed into eyes by the child, both of which are difficult for an adult to prevent, especially if toddlers are in the backseat of the car while parents drive to appointments. Though placement of lidocaine during the clinic visit may extend the length of the clinic appointment (by 30 minutes or more), it’s the safest and most effective way to use it. 

It’s important to recognize that lidocaine will not take all discomfort away since vaccines are typically delivered into the muscle. Although the skin may have less pain with the injection, your child will still experience some discomfort when the vaccine is delivered. 

Other modalities, such as distraction, are pivotal in decreasing both the child’s and parent’s anxiety — and subsequently pain — associated with injections. If parents are visibly anxious while their child is about to receive a vaccine, children pick up on that, and the pain of the injection is heightened. 

Distraction is a wonderful way for both parents and their children to focus on something other than the injection itself. For example, parents can distract toddlers by cuddling them, reading with them or blowing bubbles together during the injections. 

Dr. Gigi Chawla is a board-certified pediatrician and the senior medical director of primary care at Children’s Hospitals and Clinics of Minnesota. Send questions to

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For more on proven techniques to decrease the pain associated with needle sticks and injections, please see