How to prepare your kid for the Covid vaccine

There's a lot you can do to make the shot easier — and if your kid is terrified of needles, you should start now.

Welcome to Is My Kid the Asshole?, a newsletter from science journalist and author Melinda Wenner Moyer, which you can read more about here. If you like it, please subscribe and/or share this post with someone else who would too.

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Today I’m going to break from my usual format and address a timely question: What’s the best way to get kids ready for the Covid vaccine? Rumor has it, in the U.S., for kids 5 to 11, the shots will be available as soon as November 3 — that’s just eight days from now — and if your children are nervous around needles, you’ll definitely want to prepare them.

How much preparation you need, however, depends on your child and their state of mind. My 7-year-old is a legitimate needle-phobe: I can’t mention shots in passing without her crying, and her banshee screams have become infamous among the staff in our pediatrician’s office. About 5 to 10 percent of kids have severe needle phobia, and if you’re a parent to one, you know full well that it sucks.

However, after calling one of the world’s experts on the issue, Meghan McMurtry, a clinical child and adolescent psychologist who runs the Pediatric Pain, Health, and Communication Lab at the University of Guelph in Canada, I learned that kids like my daughter can in fact handle shots; they just need to develop the confidence to face their fear. The larger proportion of kids who have only mild to moderate needle fear — like my 10-year-old, who doesn’t particularly like needles, and is nervous about the vaccine, but is not losing sleep over it — still benefit from preparation, but much less.

I’ll warn you: There’s a lot of information in this newsletter. You don’t have to do everything that’s recommended here, of course, but I like to be thorough and provide options, in part because I think these strategies could be really, really useful to many families (and some are quite surprising). I’ve broken my recommendations down into two tracks. If your kid is like my son — not particularly fond of needles but also not seriously needle phobic — you should follow the simpler track one. If your kid is like my daughter and is seriously needle-phobic, you’ll want to scroll down and follow the more intensive track two.

TRACK ONE: KIDS WHO DON’T LOVE NEEDLES, BUT DON’T HAVE NIGHTMARES ABOUT THEM EITHER

First things first: Don’t spring the Covid vaccine on your kid. When parents don’t talk about medical procedures or just announce them on the day of, “that, actually, is harder on everybody,” McMurtry said.

You might start by talking about why they’ll be getting the vaccine, and why it’s so amazing — the fact that it helps your body fight off the coronavirus, and that it protects other people from getting sick, too. Get your kid excited about being inoculated!

Then move onto the day-of details, describing, to the degree that you can, what your child can expect. Who will take them? Where will they get it (if you know)? What will it be like? It might seem counterintuitive to have these detailed conversations, but McMurtry said it’s far better for kids to have a good idea of what’s going to happen. Otherwise, they fill in the gaps with their imagination, which is often way more scary than reality.

Should you tell your kid it’s going to hurt? Yes, kind of, if they ask. You don’t want to lie and assure them that it won’t hurt at all, because if what you’ve told them doesn’t match their experience, they’ll lose trust in you. McMurtry suggested saying something like this: Some kids say that it pinches and their arm is sore for a while afterwards. Other kids say it doesn't really bother them. But you know what, afterwards, you can tell me what it was like for you.

Then, come up with a plan for helping your kid manage fear and pain before, during and after the shot. McMurtry suggested talking about what you’re going to do to make the experience as comfortable as possible — what you (as a parent) are going to do, what they (as a kid) are going to do, and what you might ask the nurse to do. Give them choices, too: How do you want the nurse to tell you that the shot is about to start? What do you want to wear that will be comfortable and allow easy access to your upper arm?

Not sure what helps and what doesn’t? Here’s what the research suggests:

• Kids experience less pain when they’re sitting up during medical procedures rather than lying down, although there are exceptions: If your child really wants to lie down, by all means, let them, McMurtry said. Kids who become faint after shots are also better off lying down. (Here’s more info on how to prevent and manage needle-related fainting.)

• It’s not a great idea to repeatedly reassure your kid during a medical procedure, because that actually makes them more anxious rather than less. When we say things like you’re ok, or it’s alright, our kids sense that we’re saying this because we’re nervous, and that amps up their own fear, McMurtry said.

• Instead, distract your kids. Yes — distraction actually reduces pain. Ideally, you want to distract before and during the procedure. McMurtry said she lets her kids watch their iPads with noise-cancelling headphones so they can’t hear other children’s screams (heh). Maybe you download a favorite show or game for the procedure itself, so that it’s something rewarding and engrossing.

• Try to stay calm yourself. Kids look to us for cues on how to feel, so if we look nervous, they’ll be nervous.

• Numbing creams work. They’re available in drug stores and on Amazon. You’ll want to read the directions and probably apply it to your child’s upper arm before you leave the house.

• Other evidence-based pain-reducing products can help reduce needle pain, too, like The Buzzy (which has been shown to work in clinical trials).

• After the shot, talk about it with your child. Focus on and highlight what went well so that you help them form positive and accurate memories. (If kids form negative memories, McMurtry said, they tend to become more exaggerated over time, which doesn’t bode well for future appointments.) McMurtry takes a video of her son after he gets a shot so that she can show the video to him before the next procedure. She directs him by saying, Tell me what just happened. How did it go? Could we do anything to make it more comfortable? What would you tell yourself next time?

TRACK TWO: KIDS WHO HAVE BAD NEEDLE PHOBIA

If your kids are terrified of needles, you have your work cut out for you. If you merely follow track one, thinking that numbing creams and distraction will get your kid through the procedure, you’ll probably be in for a hellish appointment. For needle-phobic kids, pain management isn’t the central issue. It’s fear that’s the problem, McMurtry said. Before your needle-phobic kid even gets to the doctor’s appointment, their anxiety is through the roof, and no amount of numbing cream is going to help.

Yes, sure — you can ignore that fear and drag them to the office and hold them down when they freak out (I have, um, totally done this). But these experiences traumatize kids, which only feeds the fear, McMurtry explained. So if you have the time and inclination, it’s better to help your child learn to manage the fear before the day of the shot. Doing so is empowering for them, and it also means your child will grow up more willing to get medical care when they need it.

The best way to help kids overcome phobias is through what is called exposure therapy. When a child is afraid of needles, their fear is exaggerated — they are more afraid of needles than they rationally should be. With exposure therapy, people practice facing their exaggerated fears, so that they can discover that their fears are, in fact, exaggerated. We want them to gain the confidence “that what they're most afraid of isn't going to happen. Or if it does, they can survive it,” McMurtry explained.

Here is a step-by-step breakdown of how to do exposure therapy. Ideally, you’ll want to start this process a few weeks before your kid has to get their Covid shot. (If you want to read more, here’s a resource on exposure therapy that McMurtry shared with me. And here’s a story I wrote for The New York Times abut the time I used exposure therapy to help my daughter with a bee phobia.)

1. Explain what you’re planning to work on with your child, and get them on board. Maybe you tell them you’re going to work together every day to help them become less afraid of shots. You don’t want to force your kids to do this work, so to increase buy-in, consider buying small rewards or prizes that they’ll get after completing the work each day. Or, the prize could be that they get to choose what’s for dinner, or what movie they get to watch with you next weekend. (I’m not a big fan of rewards, as those who’ve read my book know. But rewards can be useful when kids really, really don’t want to do the thing you’re asking them to do.)

2. Ask your child to write out a list of all the things they’re afraid of when it comes to needles. This can include things like: talking about needles, seeing needles, seeing other people get shots or blood draws, driving by the doctor’s office, sitting in the waiting room of the doctor’s office, and of course, getting a shot. Then, have your child rank each fear from one to ten based on how scary it is, and rank all their needle fears from lowest to highest. This creates what McMurtry called the “fear hierarchy.”

3. Starting with the least scary thing on their list, begin exposing your child to that scenario. If their lowest fear on the list is “talking about needles,” then you’ll begin by having a session in which you talk about needles. It’s going to be hard for them, and they might resist — when we’re scared, we avoid. But avoidance only increases fear. And when kids are slowly exposed to an irrational fear, their fear wanes.

4. Once your child reports no longer being afraid of that particular fear, move up to the next fear in hierarchy. Go slowly, and don’t rush your kid — you only want to move up when they no longer feel scared of the thing you’re working on. (And yes, if “driving by the pediatrician’s office” is a fear, you really do need to drive by the pediatrician’s office over and over again.)

5. Work your way through the entire list until you get to the key fear you’re working towards: Getting the shot. You might think, well, but then they’re still going to freak out when they have to get the shot! But as McMurtry explained, the exposure process empowers them. Kids realize that they’ve survived and overcome all of the other fears on their list, so maybe they can get through the shot, too.

6. Move over to TRACK ONE: KIDS WHO DON’T LOVE NEEDLES, BUT DON’T HAVE NIGHTMARES ABOUT THEM EITHER, which provides tips and strategies for handling the shot on the day of.

What should you do if you’ve done all the exposure therapy steps but your child still loses their shit at the doctor’s appointment? McMurtry advised walking out rather than forcing your kid to get the shot, and then doing more exposure therapy before going back. Of course, this might not be possible (especially with emergency procedures) — and you, like me, may also really want your kid to get the Covid vaccine as soon as possible. So I get that you might not be willing to walk out and come back later. But McMurtry pointed out that if you do force your child to get the shot when they are kicking and screaming, it will be traumatic and will only serve to heighten their fear, so you end up back at square one (or worse) for the next shot. That might be a risk you’re willing to take, but just be aware that it exists.

Finally: Do your best to stay empathetic throughout this entire process. Your kid’s fear may seem totally irrational to you, but it’s a real fear nonetheless. And your child is not the problem — it’s their fear that’s the problem. So you don’t want to blame or shame your child for having big feelings. Instead, consider that you and your child are teaming up to fight and overcome their biggest fears.

Yesterday, I wrote a flu guide for The New York Times that answers a bunch of questions about flu season this year. It has some surprising info for parents, too! Tl;dr: Everybody please get your flu shot.

This week I’m on The Backwards Podcast with A.J. Juliani, talking about my book, connecting with kids, and homework.