More and more countries around the world are opening their vaccination campaigns up to children as the global battle against the COVID-19 pandemic ensues.

The annual flu shot is recommended for everyone 6 months and older around this time of the year, according to the U.S. Centers for Disease Control and Prevention. This is in addition to a variety of immunizations given throughout childhood to protect against potentially life-threatening illnesses.

While getting a shot can be nerve-wracking for many kids, as well as their parents and caregivers, medical experts say certain strategies and coping mechanisms can minimize a child’s anxiety and pain.

Applying some of these techniques can improve the vaccination experience in the moment as well as arm children with long-term skills to help them handle difficult or scary medical procedures throughout life, said Jennie Ott, director of child life and family education at University of Chicago Medicine.

“It’s very anxiety-provoking, but there’s so much parents can feel empowered to do,” she said. “We’re really setting a long-term foundation for children’s experiences with health care encounters.”

Here are 12 tips on how adults can help calm a child and ease their pain during vaccinations.

1. Make a plan
Talk ahead of time about the upcoming immunization, relay what the child can expect during the appointment, and allow them to ask questions, Ott said.

Going over various coping strategies beforehand can also help prepare children and give them a greater sense of autonomy, she said.

“What I would encourage parents to do is work with their child to come up with a plan,” she said. “Talking to them about their vaccine is going to be a critical piece in this.”

That might mean deciding to bring comforting or distracting items, like a favorite television show on a tablet, soothing music, a security blanket, a favorite stuffed animal or a stress ball.

2. Offer choices
This could include decisions about which comfort items to bring to the appointment, if the child would like to squeeze your hand or count during the injection. Kids might also have a preference of looking away during the shot or watching the process.

Sometimes adults are inclined to automatically tell children to look away, but for some kids this can spur “a huge sense of loss of control,” Ott said.

Children can also make decisions about how they’d like to be positioned during the shot, from sitting in a parent’s lap to holding a caregiver’s hand to being embraced.

Experts stress that these choices should be realistic; for instance, refusing to get the vaccine altogether isn’t an option.

3. Don’t lie
This can erode trust between the caregiver and child. Experts say to avoid statements like “you’re not getting a vaccine today” or “you won’t feel it at all.”

“We always talk about making sure we’re truthful with children,” Ott said.

4. Apply numbing agents to the injection site
Topical anesthetics like lidocaine creams or cold sprays can be applied to the skin at the injection site prior to the shot to reduce pain, said Dr. Diana Bottari, a pain specialist with Advocate Aurora Health. She says hemorrhoid cream can also work to numb the area.

But Bottari added that the decision to use a numbing agent can depend on the child’s preference; for example, some kids might dislike the sensation of cold from a spray.

5. Use pain-minimizing devices
There’s the ShotBlocker, a small plastic disc with prickly bumps on one side that’s pressed against the skin during the shot, which confuses the body’s nerves and distracts from the injection.

Bottari added that scratching the skin near the injection site – like on the child’s shoulder – can have a similar effect.

There are also Buzzy vibrating cold packs, devices shaped like ladybugs or bees that use cold temperature and vibration to reduce pain during vaccinations.

6. Validate the child’s feelings
Avoid statements like “it’s just a shot” or telling kids not to cry.

Medical experts say nervousness is a natural reaction to needles and injections, and adults can acknowledge discomfort from the vaccine.

“We say all the time: Feelings are for feeling, not for fixing,” said Becca Mitsos, a certified child life specialist at Ann & Robert H. Lurie Children’s Hospital in Chicago. “Crying is OK. It’s communication. It’s OK to share how you feel.”

Reaffirm that you’ll be there for your child during the injection, and you’ll get through it together, she said.

“Making it clear that they’re not going to have to go through it alone is important for kids of any age,” Mitsos said.

Ott added that praising a child afterward with statements like “you did it” or “I’m so proud of you for doing it” can also help.

“That verbal praise at the end is huge,” she said.

7. Adults should try and stay calm
Shots can make parents and guardians nervous, too. Ott advised grown-ups to try to keep their own anxiety in check, because it can exacerbate the emotions of their children.

“A lot of children pick up on parental anxiety,” she said. “We encourage parents to be as calm as they can and really be that sense of support for their child.”

8. Don't make the kid wait
Sometimes getting the vaccine at the start of a visit helps. If the shot is part of longer appointment with a medical provider, asking the clinician to perform the vaccination first might minimize a buildup of anxiety during the visit, Bottari said.

9. Blow bubbles
Taking slow, deep breaths can be calming, as opposed to the shallow, fast breathing often spurred by anxiety. Bottari suggested bringing bubble solution to the appointment and having the child blow bubbles during the injection, to facilitate deep breathing as well as another method of distraction.

10. What about babies
For babies, feed them during vaccination. While research on COVID-19 vaccines for children under 5 is still underway and little kids aren’t expected to be eligible in the near future, infants get various immunizations at birth and certain milestones, and babies 6 months and older should get the annual flu shot, according to the CDC.

Bottari recommends nursing or bottle-feeding infants before and during vaccinations. When infants suck, their bodies release calming endorphins that reduce pain, she said. Another strategy is to give a baby a pacifier dipped in sugar water, a solution of 1 teaspoon white sugar mixed with 2 teaspoons distilled water, she said.

She added that babies and children should be held in a comforting manner, but never held down or overpowered. Minimizing pain and anxiety during infant vaccinations can be critical because it sets the stage for future encounters with needles and injections, Bottari said.

“It’s really important to start when they’re babies because that needle fear does start when they’re very young,” she said.

11. Needle phobia
For children with needle phobia, sometimes therapy can help. Most kids – and even many adults – dislike getting shots and experience heightened anxiety during immunizations.

But some suffer from needle phobia, a persistent and deep-seated fear of medical procedures involving needles or injections that goes beyond the typical unease. For those cases, psychologists can provide exposure therapy, helping patients conquer their fears through incrementally difficult exposures to needles, injections and other situations that induce the phobia, according to the American Psychological Association.

12. Side effects
Prepare for potential side effects afterward. Following the COVID-19 vaccine, some patients report soreness at the injection site as well as short-term fatigue, fever, chills and other side effects.

Mitsos encourages parents and kids to plan ahead for these possible side effects. That might mean asking children if they’d prefer applying heat or cold to a sore arm, or asking what movies or books they’d like if they feel sick for a little in the aftermath. Packing a bag in advance with stuffed animals, books or other activities can help too, she said.

“There’s research about how If you have an awareness of what might be uncomfortable, your perceived discomfort is lower if you’re prepared for it,” she said. “The perception of pain or discomfort is significantly lessened when you’re prepared for that pain or discomfort.”

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