Needle Phobia in Children and Youth
Fear of needles is very common in children and adults. All children get needles through their regular immunizations. Those with medical illnesses or problems will need to get even more needles for injections or blood work. Most children and adults are able to overcome their fears, and it does not stop them from getting necessary immunizations, injections or blood work.
But if the fear is so great that it stops that person from getting needles, then it may be a condition known as ‘needle phobia'.
According to the DSM-5 (Diagnostic Statistical Manual of Mental Disorders), a tool used by professionals for diagnosis, needle phobia is a type of specific phobia. Its main features include:
- Marked and persistent fear of needles that is excessive or unreasonable, cued by the presence or anticipation of needles.
- Exposure to needles almost invariably provokes immediate anxiety.
- Situations involving needles are avoided or are endured with intense anxiety or distress.
- The avoidance, fear and distress around needles interfere significantly with the person's life.
It can affect a person's medical health because it leads people to avoid getting proper health care. It can also cause significant social problems because immunizations or blood testing can be required for employment, getting health insurance, travel, education and marriage.
Needle phobia is relatively common with an estimated incidence of 5-9% in adults and children (Craske, Antony, & Barlow, 1997; Kleinknecht, 1987; Mark, 1988).
Needle phobia results from a combination of factors (Hamilton, 1995; Willemsen, 2002):
- Genetics. An unusually large percentage of those with needle phobia have relatives with needle phobia, which suggests a genetic basis for it. Indeed, from an evolutionary perspective, it is protective to be fearful of having your skin pierced, because that would make you more careful about avoiding cuts, bruises or injuries.
- Life events. People with needle phobias may have had a bad, painful needle in the past; or hearing or witnessing someone with a bad experience.
For those with needle phobia, a needle situation will activate their body's alarm system (i.e. autonomic nervous system), which leads to an increased heart rate and blood pressure. After this, the body compensates with the opposite -- a vasovagal reflex which causes a lowering of the heart rate and blood pressure. In some individuals, this vasovagal reflex is so extreme that the person may faint.
Prior to getting a needle
Explain to your child why s/he needs a needle. Knowledge is power. How would you feel if you just went to the doctor, and s/he just stuck you with a needle without an explanation? Make sure that you explain to your child why s/he needs needle(s). For younger children, demonstrate the process of getting a needle using a doll or toy animal.
If your child expresses fear, you might ask, "What is so scary about needles?" "What stops you from getting a needle?
Do give the child a sense of control. For example, if possible, you might offer:
- "Do you want me (or someone else) with you when you have the injection?"
- "Do you want to lie down/stand up/sit down?"
- "Do you want to know what is happening or would you rather not?"
Right before the needle
Do numb the skin in order to reduce or eliminate the pain of the needle prick. Ways to do this include:
- Using an anesthetic patch (like the EMLA [eutectic mixture of local anesthetics]TM Patch) or cream. They can be used on healthy, unbroken skin prior to getting a needle, or having blood taken (with a needle). Many clinics and hospitals will offer this. If they do not, you can still buy an EMLA patch from your pharmacy; just follow the instructions in the package.
- Applying an icepack to the skin before the injection.
During the needle
Distract the child. Consider distracting your child in some way, such as:
- Using a tablet or smart phone to play a video game or watch a video
- Playing with a noisy toy (with younger children)
- Blowing bubbles
Is the child an infant? Studies show that allowing the child to breastfeed before the needle, or giving them sugar solution to help reduce the pain of bloodwork.
Be a model for calmness for your child. If you have problems getting upset and tense with your child's needle, then find a way to deal with your own fears. If you have unresolved issues with needle phobia, then consider seeing a professional such as a psychologist to learn ways to overcome your own fear.
Don't restrain the child, or hold them down. This was done in the past, but makes it very frightening for the child. Instead, allow the child to sit upright on a parent's lap. Or with older children, sit beside a parent.
Making positive coping statements: a child with needle phobia may be having anxious thoughts such as "It's going to hurt"; "I can't cope with this!" Gently help the child with more positive statements, such as "I know you can cope with this. Come on, let's take a few deep breathes together... In through the nose, out with the mouth..."
Offer empathy if your child is upset. You might say, "I can see its not easy... Its okay if you need to cry... Here's a Kleenex... Let me hold your hand... Let's do some deep breathes..." Don't tease them, insult them or call them a crybaby.
After the needle
Positive reinforcement: You express gratitude, "Thank you for getting the needle. I'm so happy that you were able to do that."
Try the following for people who faint from their vasovagal reflex:
- Have the person lying down, or have their legs elevated while the needle is given.
- After the needle, the person should stay lying or sitting and only stand up gradually and slowly.
- Do ask the person to relax the 'needle arm', while tensing the muscles of the opposite arms, torso and legs.
- Don't get up suddenly after having a needle.
If your child's needle fears are not improving on their own, and if the fears are causing problems, it is best to seek professional help.
See your child's doctor, and also inform other health professionals such as nurses that may be involved in giving needles.
Doctors and nurses will be able to help with basic strategies. If those are not enough, then your child's doctor might recommend seeing a professional such as a psychologist. Some of the standard strategies used by psychologists include the following:
Exposure / Desensitization / Rehearsal: This involves practicing the whole process of getting a needle in a step-bystep approach.
The theory behind progressive exposure is that if your child is too scared to go to the doctor's and get a needle, then it's because that's too big a step for the child to handle. The solution is to break down the whole process into a series of smaller steps, and then go through one step at a time with the child. One such hierarchy might involve:
- With your child, get a children's book or video about needles or going to the doctor's office. Many pediatric hospitals also have websites with such information. Contact your local children's hospital for more information.
- With younger children, get a doctor's play set, and practice "playing doctor" or "playing nurse" and give each other needles. Have your child pretend to give you a needle, and give him/herself a needle. Or you might consider getting a doll so your child can give the doll a (pretend) needle.
With older children such as teenagers, mental health professionals (such as psychologists) may also use real needles in treating needle phobia, with steps such as:
- Looking at a needle
- Holding the needle
- Putting a needle next to one's skin, but without doing the injection -- note that this is not recommended for most children and youth and is only done with close supervision by a professional.
- Go to the doctor's office and just wait in the waiting room
- Go to the doctor's office, wait in the waiting room, and see the doctor, but without getting any needle.
- Go to the doctor's office, wait in the waiting room, see the doctor, and get the needle
Relaxation training: learning and practicing strategies that help keep one relaxed. This includes:
- Imagery: this is all about closing your eyes and imagining yourself in a soothing place, and/or being successful at getting a needle.
- Breathing exercises / Relaxation. When children get nervous, they may start breathing faster. You can help your child relax by encouraging your child to breathe slowly and deeply.
- Hypnosis: working with a professional trained in hypnosis (like a family doctor or psychologist), you learn how to reach a state of deep relaxation (i.e. a hypnotic state).
It is normal for many children to dislike needles. But if it's to the point where your child is refusing and/or too overwhelmed to have a needle, you might consider doing the following:
- Speak to your child's doctor
- Speak to your local pediatric hospital: Most children's hospitals have books, videos or other resources to help teach the importance of needles to children.
- Speak to a psychologist
Antony, Martin M., & Watling, Mark A. (2006). Overcoming medical phobias: How to conquer fear of blood, needles, doctors, and dentists. New Harbinger Publications.
Hamilton, James G. (1995). Needle phobia: a neglected diagnosis. Journal of Family Practice, 41:169-175.
Uman, L.S., Chambers C.T., McGrath, P.J., Kisely, S (2006). Psychological interventions for needle-related procedural pain and distress in children and adolescents. Cochrane Database of Systematic Reviews, issue 4, retrieved Dec 3, 2007 from http://mrw.interscience.wiley.com/ cochrane/clsysrev/articles/CD005179/frame.html
Willemsen, H., Chowdhury, U., Briscall, L. (2002). Needle phobia in children: a discussion of aetiology and treatment options. Child Psychology and Psychiatry, 7(4): 609-619.
Written by the eMentalHealth Team and Partners.
Information in this pamphlet is offered ‘as is' and is meant only to provide general information that supplements, but does not replace the information from your health provider. Always contact a qualified health professional for further information in your specific situation or circumstance.
You are free to copy and distribute this material in its entirety as long as 1) this material is not used in any way that suggests we endorse you or your use of the material, 2) this material is not used for commercial purposes (non-commercial), 3) this material is not altered in any way (no derivative works). View full license at http://creativecommons.org/licenses/by-nc-nd/2.5/ca/
Date of Last Revision: Oct 3, 2019