Needle pokes, whether they are for vaccines, blood draws, or intravenous (IV) placement, can be negative experiences for children. Fortunately, there are research-supported strategies to promote child coping and comfort during pokes. These simple comfort measures may reduce pain and create a more comfortable experience for children during procedures. They may also prevent the development of significant fears or difficult behaviors in response to needles.
Distraction
Focusing on enjoyable and engaging activities can help quiet pain signals and make pokes feel more comfortable. Examples might include watching a favorite show or video, playing a game, engaging in conversation, or blowing bubbles. It may be helpful to allow the child to choose their preferred distraction.
Relaxation
Relaxation skills can help children feel calmer and more comfortable.
Have your child take slow and deep belly breaths in through their nose and out through their mouth.
Have your child tense up and then relax different muscles in their body. This is called progressive muscle relaxation.
Have your child imagine a place where they feel calm and safe. It can be a real or made-up place, depending on their preference.
Comfort Hold
Use a comfort hold to help your child feel secure and stay safe during the procedure, especially if they are fearful of pokes. Access the Comfort Hold Helping Hand for further information.
Topical Numbing
Apply a topical numbing cream before the poke to help reduce pain. Follow the product or provider’s instructions for how much to use and how long before the poke to apply it.
Sensory Intervention
Use a sensory device to promote comfort and reduce pain. Devices may use vibrating, cold, or bumpy sensations to block pain signals and support comfort. Refer to our Helping Hand for more information on these products.
Language
Coach caregivers and providers to use calm and encouraging language. Prepare the child by using developmentally-appropriate language to describe what will happen, how it might feel, and how the poke or procedure supports their health. Frame the experience honestly and positively, validate your child’s feelings, and encourage use of coping skills, like this example:
“You will get a poke in your arm with medicine to keep you healthy. There may be a pinch or pushing feeling for a few seconds. It feels different for everyone, but we will use skills to help you stay calm and comfortable. Let’s take some deep breaths and find a show to keep your mind on while we wait.”
Avoid use of emotional, apologetic, or dismissive language that may increase child distress level, such as “hurt,” “I’m sorry…” or “Don’t cry.”
Maintain Expectations and Choices
Maintain expectations to stay calm and safe during the procedure. Make a poke plan and offer the child appropriate choices to promote their sense of control, such as which arm, distracting activity, comfort hold, or coping skills will be used.
Positive Reinforcement
Recognize the child's coping and effort after the procedure with specific labeled praise (e.g., “Great job staying calm and safe during that poke”) or a tangible reward like a preferred activity, sweet treat, or toy as appropriate.
Sucrose, pacifier, or breastfeeding
Sucrose (sugar water) and non-nutritive sucking (such as using a pacifier) or breastfeeding can help reduce pain in infants ages 0–12 months. These strategies can also be combined with skin-to-skin contact to help comfort and calm your baby during painful procedures.
Learn more about helping your child cope with injections at home.
Dr. Alana Leever, PsyD, is a pediatric psychologist at Nationwide Children’s Hospital and clinical associate professor at the Ohio State University. She serves as the team psychologist to the Division of Rheumatology and specializes in supporting children and teens affected by rheumatic diseases.
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