Helping Your Child Who Is Afraid of Needles 

These instructions are for caregivers of Children’s Hospital of Philadelphia (CHOP) patients who are afraid of the needles used to give medicines.

Anxiety related to medical procedures such as injections, infusions, or blood draws is known as procedural anxiety. This is common in children with medical conditions. Anxiety can become a problem if it affects the ability of your child to have the procedure. Procedural anxiety can start to build before the procedure and can continue after the procedure is finished.

Symptoms include sweating, change in breathing, irritability, shaking, increased heart rate, loss of appetite, inability to think or speak clearly, fear of fainting, and fear of losing control.

Some injectable medicines can cause nausea. Over time, children may become nauseous before the medicine is given. This is called anticipatory nausea. People respond to triggers, such as the sights, smells, or sounds of the medicine or the process of taking the medicine. For example, a child may become nauseous when they smell the alcohol swab before an injection. Anticipatory nausea can be worse in children who also have procedural anxiety.

How can I help my child?

Provide emotional support

• Allow your child to ask questions about the process to gain a sense of control and to know what to expect.

• Allow your child to make reasonable choices about things like where the injection will occur, who will administer it, and what kinds of distractions they want to use during the injection. 

• Discuss what will happen before the injection or infusion. This will help your child to know what to expect. 

• Ask your child’s healthcare team to suggest books and/or videos that may help to prepare your child for the procedure. 

• Involve a friend or family member for support. 

• Utilize rituals to keep children calm, such as singing a favorite song or giving the same type of special hug or kiss each time. 

• Remember that your goal is to help your child manage their fear. It may not disappear completely.

• Work with a child life specialist, therapist, or your child’s nurse to create a plan for the procedure. 

• Knowing what will happen before, during, and after the procedure can help reduce fears. Explain that the injection might feel like a pinch or a poke, but it usually lasts only for a moment. 

What do I say to my child about getting a needle?

• Be honest with your child. 

• Assure them that their fears are normal and nothing to be ashamed of.

• Choose your words carefully. 

  • Choose words that will make your child more comfortable. For example, replace words such as injection, needle, and blood draw with “poke” or “pinch”.

  • Explain why the medicine is helpful. “Everyone needs medicine or blood tests to stay healthy. Needles are never used as punishment for being bad.”

• Don't scold your child for being scared or crying. Being scared is a perfectly normal and healthy response.

• Explain to your child that it is okay to cry, but they must be still. Remind your child that things will go easier and faster if they hold still while the needle is being given.

  • Tell your child what to do instead of what not to do: “Keep your arm on the armrest” instead of “stop moving around.” 

Tips for giving an injection at home

• Try to find a private, calm, and quiet area to give the injection.

• Keep medicine, syringes, and supplies out of the reach of children. 

• Prepare the medicine before approaching your child. 

• Approach your child in a calm, but firm manner. 

• If your child is old enough to understand, explain why they need the medicine. You may need to explain this every time. 

• Use Comfort Holds 

  • Ask someone to hold your child while you insert the needle. 

  • Comfort holds are secure hugging holds that help your child feel safe and secure during medical procedures. When your child can remain calm and still, it helps prevent anyone from being injured during the procedure. 

  • You can find more information about comfort holds on our website https://www.chop.edu/centers-programs/child-life-education-and-creative-arts-therapy/prepare-your-child-visit-doctor/comfort-positioning-during-procedures

Create a Coping Toolkit

Creating a toolkit of coping strategies will help your child to feel prepared for getting a needle. Here are some examples of coping strategies: 

Ask about the different ways to administer the medicine (syringe or auto-injector pen) to find a preference (if both are covered by your insurance). Some patients prefer using an auto-injector pen, so they do not need to see the needle. Some prefer the syringe because they can control how fast they inject the medication.

Physical comfort: 

• Buzzy Bee: This device distracts your child by applying cold and vibration to the injection site. This also helps to reduce discomfort. You can learn more on their website:

  • https://paincarelabs.com/buzzy 

• ShotBlocker: This device uses blunt contact points to distract from the injection site. You can learn more on their website:

  • https://bionix.com/shotblocker.html 

• Use lidocaine numbing cream or ice to numb the skin before the injection numbing creams need to be applied to the skin and kept covered before the injection. Use plastic wrap instead of adhesive bandages to cover the cream. It can be uncomfortable to remove a sticky bandage.

• Allow medicine to come to room temperature to reduce the stinging sensation. Be sure to read the medicine instructions to understand how long it is allowed to be at room temperature.

• Let your child choose the injection site (some find the belly less painful).

Distract your child

• Watch TV or listen to music during the injection.

• Let them eat a popsicle.

• Play with a fidget spinner or squeeze a stress ball.

• Do deep breathing exercises.

• Do a fun dance before and after the procedure to help their body calm down.

Promote a sense of calm

• Help your child to imagine themselves in a happy place. Talk about what they see, smell, feel, hear, and taste while they are in this place.

• Do deep breaths with your child.

• Remind your child about their past successes to give them courage and boost their confidence.

Emotional support: 

• Encourage your child to share their feelings and concerns.

• Have a treat ready to give them afterwards.

• Use fun band-aids. 

• Have them hug a loved one or squeeze their hand for comfort during the procedure.

Helpful coping resources from our Integrative Health Team

• What is Aromatherapy? | Children's Hospital of Philadelphia (chop.edu)

• Acupressure and Acupressure Bands and Seeds | Children's Hospital of Philadelphia (chop.edu)

• Breathwork: Tools to Help with Stress: Breathwork | Children's Hospital of Philadelphia (chop.edu)

• Progressive Muscle Relaxation: Tools to Help with Stress: Progressive Muscle Relaxation | Children's Hospital of Philadelphia (chop.edu)

Reviewed November 2023 by Kerry Spichiger, DNP, CRNP; Melissa A. Lerman, MD, PhD, MSCE, Dori Abel, MD