Short Wave - Shots Are Scary. But They Don't Have To Be.

Episode Date: March 27, 2024

According to the CDC, about one in four adults has a fear of needles. Many of those people say the phobia started when they were kids. For some people, the fear of needles is strong enough that they avoid getting important treatments, vaccines or tests. That poses a serious problem for public health. Researchers have helped develop a five step plan to help prevent what they call "needless pain" for kids getting injections or their blood drawn. Guest host Tom Dreisbach talks with Dr. Stefan Friedrichsdorf of UCSF Benioff Children's Hospitals, who works with a team to implement the plan at his own hospital. Friedrichsdorf told us some of the most important research on eliminating pain has come from researchers in Canada. Learn more about their work here. This episode was inspired by the reporting of our colleague April Dembosky, a journalist at member station KQED and KFF Health News. Read her digital story here.Got another question for a doctor? Email us at [e-mail]. See pcm.adswizz.com for information about our collection and use of personal data for sponsorship and to manage your podcast sponsorship preferences.NPR Privacy Policy

You're listening to Shortwave from NPR. Hey, shortwavers, I'm Tom Dreisbach. Now, normally I'm an investigative reporter here at NPR News, digging into secrets and things no one knows about. But today, I'm here to talk about something almost all of us have gone through at one point in our lives. Going to the doctor's office and getting your shots. Now, for a lot of folks, it's not a big problem. You know what the nurses sometimes say.

It's like a little pinch and you're done. And for little kids, do they? even remember the pain anyway? Well, Stefan Friedrichstdorf says, yeah, he remembers. Stefan grew up in Germany, and he remembers this one time when he was nine years old. You had to go to the doctor for an infected nail. Two surgeons were holding me down, and I was screaming at the top of my head when the one surgeon sat to the other. Do you think he can feel any pain? And the guy said, no. And may they burn in hell? That happened more than 40 years. ago. But that traumatic doctor's visit has really stuck with him. Now, Stefan Friedrichstorff is a doctor

himself, and he's a professor of pediatrics. He also leads a palliative care team with a nurse manager and child life specialist at UCSF Benioff Children's Hospitals, where they are trying to prevent what they call needless pain from shots. Now, growing up, I definitely had this fear. And when we recently asked if you did too, we heard from a lot of short waivers. I have a terrible fear of needles. I'm infamous for being heard in the lobby screaming by my brothers. Even talking about my needle phobia almost had me pass out behind the wheel. This has gotten in the way of my ability to get gender-confirming surgeries. This has resulted in 20 years of not going to the dentist. A lot of people get this fear of needles when they're young. Little kids especially get a lot of shots in the first couple

years of life, and if you've ever had to take your kid to get their shots, you probably know how tough it can be. And it's not just a matter of being scared. That fear can make it really hard to get treatments that have to be injected or get blood drawn to run various tests or get vaccines to protect you from diseases. And Stefan Friedrichstdorf says that is a serious problem for public health. I have personally taken care of five children who died of measles who were not vaccinated. Clearly children, teenagers, young adults and adults, are choosing to forego medical care.

They're choosing to forego medical care. They're choosing to forego. go healthcare, and that increases their mobility, the risk of becoming sick, and increase their mortality, the risk of dying. But there are doctors and researchers working on a plan to make it better. Today on the show, making the doctor's office less painful and less scary for kids so that as adults, we can take better care of ourselves and each other. You're listening to Shortwave from NPR. Hey, we are back in talking with Dr. Stefan Friedrichstorff about how to prevent kids from having

to go through needless pain from needles. And he told me a group of researchers over the last decade have helped come up with a step-by-step plan. We found that if you can offer five things to every child, every time, everywhere, whether it's in a children's hospital, in a doctor's office, and whether this is in high-income countries in the United States or low-income countries, like in the Philippines, where we are replicating this as well,

then you can pretty much completely eradicate or at least significantly decrease the pain and anxiety caused by needles. Let's go through those things one by one if we could. What is the first step to dealing with this problem? The single most important thing, the number one thing, is to apply numbing cream. Hmm. Topical anesthesia, which you can buy over-the-counter in any drugstore, is called 4% Lidecine cream. is available for a few dollars. And that is something which should be offered to any child. And how do you apply it before you get a shot? So you basically put a pea size drop on the skin.

So you have to check in with your clinician, whether it's vaccination or bladder or where exactly to put this. And then you apply some dressing. And it needs to be on for at least 30 minutes. And then can be taken off before the needle procedure, whether it's a leptor or vaccination or the insertion of an intravenous cannula. Wow. Okay. And how effective is it? Can you not feel the needle go in at all? Or is it still just sort of like a little mild pinch? Or what does it feel like? So pain is a funny thing, Tom, if I come over right now into your office and I hit as hard as I can on your leg and ask you, Tom, what's your pain number between zero and 10? You say, you know, that's probably an eight out of 10. That's a hard hit. Wow. That is a hard hit because I just gave you a bruise. And because your brain is in terms of, interpreting this painful procedure, me hitting you, as a threat, and therefore is going to make you very painful. Now, let's say that you and I play soccer or will play American football or dance ballet or whatever it is. And I accidentally run into you. I give you the same bruise, you may not even notice that. Interesting.

So the kicker is, and this is what sometimes people who criticize the numbing cream and say, well, it's not deep enough. The needle just goes much deeper is it's the expectation whether or not it's going to hurt. Interesting. So it almost seems like the numbing cream serves, well, I guess if you're old enough to understand what's happening, you can understand, oh, this is going to make the process better, and that actually does make the process better, even if it doesn't eliminate the pain totally. I mean, I had a lacto two days ago. I did put numbing cream on, and I did not feel anything. Okay. Well, let's go through two through five of your protocol then, and the protocol you and other

researchers have developed. What are those steps? So step two is do never, ever, ever, ever hold down a chart. So back in the old days, we were taught in medical school, in nursing school, that the best way to do vaccination on leptoral is to hold down children. And we now know this is completely utterly and wrong. When we actually ask children, what does it feel like when we hold you down for a painful procedure, they tell us that they feel ashamed, humiliated, powerless, and reporting having lost the right to control to his, her own body. So we now are using what we call comfort positioning. So for different ages, this is of course very different. So small babies younger than six months, we would use some swaddling. And for older children, we always recommend for them to sit

and upright and give them a choice. So toddlers very likely want to sit on their parents or their caregiver's lap. But under no circumstances, should we ever pin down a child, restrain them? Because clearly this increases the anxiety, as you and I remember when we were children. Mm-hmm. And three? Three is age-appropriate distraction. For little babies, there may be sort of like little spinning tools and blowing bubbles.

It's absolutely awesome. So that we have the lytocaine crept. the positioning, don't restrain kids, you have the distraction. What's next? So the next two are different for different ages. So for babies younger than 12 months, we should always, always, either of a sucrose, sugar water, or breastfeeding. Okay. And what is the last step? So for older children, meaning when they're able to talk to us, it is really important that we change the memory. And it's very important how they remember how the procedure. And it's very important how they remember how the procedure went.

So we have to think about whatever we're doing before, the Minipok, Ewing, and after. So before, we don't want to use negative words. We don't call it shots or needles or pain or hurt, but rather we ease it. Is it okay if we're going to do something?

You're going to be bothered for just a very brief moment. The story we tell ourselves about how something happened, it's important to frame that story in a more positive way, rather than focusing only on the pain. Correct. It's a very very self-fulfitting prophecy. And then doing the interaction, we don't say count to three. I mean, that's like the worst thing to do. Why is that? Why is that so bad?

If I'm standing in front of you and I'm going to hit you and give you a bruise, and I say, okay, I'm going to do this when I count to three, that doubles the impact. The anticipation. Correct. And then after, and this is the most important thing. This is the kicker. We want to change the memory. So immediately afterwards, after the procedure, we say, all done, I'd like you to choose a sticker from the goodie box. I'd like you to drink a zip of water. And then reframe the pain. We basically say something like, I'm so proud of you.

You did so well. Now, when you talk to other people in medicine about these five steps that you have helped to develop, what do they think? Do you encounter much skepticism from other physicians or nurses who are giving a lot of these shots? This is something child life specialists have been doing for 20 years. So they are our biggest supporters in implementing this. When we ask our own staff, and we have done this, we often find something like, you know, this is not a priority. Interesting. And when we dig deeper and actually ask, so why is this not a priority?

Half of our colleagues are telling us, it's just not a big deal. You know, it's just like pin them down. It's a one second pain and then it's done. And they don't anticipate how much fear the child has afterwards. And others are saying it's like, yes, it's a problem, but there's nothing we can do about it. Because you have to actually get the numbing cream on 30 minutes before. I was going to say, I could imagine a lot of doctors' offices say, well, that's another step in an already very busy schedule. How are we going to fit that in?

Right. And that is the thing. So how we did this is actually said, okay, you may offer this that parents or patients may put this on at home. Or you can actually say, okay, let's put the cream in when you're checked in. and often realistically it does take 30 minutes until the child sees the needle. So we actually found that it's not only easily doable. It actually did save time. Because if you don't need five adults to hold down a child for a blood draw or full of vaccination, you can actually see many more happier children in a shorter time. So it makes actually a life better.

It's much more effective. And it's a win, win, win for children and the stuff. So it sounds like, you know, given that getting shots, getting blood draws, are such a key part of keeping your own health, your child's health, and the public health protected. This is really important to find ways to make it a less stressful, less fear-filled experience. But it sounds like there might need to be a little bit of a culture change in certain parts of medicine in order to make that happen for people to take it seriously on a broad level. That is correct.

At the Bany of Children's Hospitals here in Oakland, San Francisco, we are now rolling this out system-wide going from unit to unit and actually implementing the numbing cream, the sugar water or breastfeeding, the not holding children down and praising and giving children choices.

But that's certainly something which a hospital leadership needs to embrace because we have so many competing priorities in healthcare that despite the fact that if you ask a child, what is the number one fear? What is the number one

one very is pain. Yeah. Well, Dr. Friedrichstorf, thank you so much for your time and for all your insights. Really appreciate it. Thank you so much for having me on the show, Tom. I love it. Now, before we head out, a big thank you to our colleague April Dembski at member station KQED and KFF Health News, who reported this story for NPR's appropriately named Shots blog. Also, a quick shout out to our Shortwave Plus listeners. We appreciate you. We also thank you for being a subscriber. Shortwave Plus helps support our show. And if you're a regular listener, we'd love for you to join so you can enjoy the show without sponsor interruptions.

You can find out more at plus.npr.org slash shortwave. This episode was produced by Margaret Serino and edited by our showrunner Rebecca Ramirez. Rebecca also checked the facts. Quasi Lee was the audio engineer. And special thanks to you, our listeners, for taking time to email us your personal stories about being afraid of needles for the story.

I'm Tom Dreisbach. Thanks for listening to Shortwave from NPR.