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A man arrives with two young girls for his shot at the COVID-19 vaccination clinic at the Ontario Food Terminal in Toronto on May 11. The two girls did not get vaccinated as children are not yet approved for COVID-19 vaccines in Canada, but Health Canada’s decision to approve vaccines for children could come as early as this week.Frank Gunn/The Canadian Press

Be honest that it’s going to hurt, but not even for as long as it takes to count to 10. Save up that Netflix show they’re bingeing, to use as a distraction. Have them blow bubbles to prompt deep breaths. Buy ice cream afterward.

Health Canada’s decision to approve COVID-19 vaccines for children could come as early as this week. Fully vaccinating the country’s roughly 2.7 million five- to 11-year-olds will be key to ending the pandemic. According to Canada’s public-health officer, children under 12 now account for the largest proportion of new infections in the country.

As Canada prepares to roll out the most significant childhood mass vaccination campaign in a generation, making the process as pain-free as possible for those on the pointy ends of the needles will be important.

After all, the country needs kids to do it all over again a few weeks later.

As the COVID-19 vaccine for kids nears approval, Canadian parents wrestle with whether to vaccinate their children

The good news is that Canada is a world leader in the science of pediatric pain, the result of a multimillion-dollar investment by Ottawa between 2001 and 2017. Canadian researchers have produced evidence-based strategies for making needles easier for kids – before, during and after the shot.

“We don’t just know what to do,” said Dr. Rebecca Pillai Riddell, a clinical psychologist at York University and part of a team conducting the largest-ever long-term pain study of caregivers and infants during childhood immunizations. “We created the knowledge.”

Now we just have to use it. This is an anxious time for families, when the discourse around vaccine safety is particularly fraught – muddled with misinformation on social media. But even in ordinary times, a lot of kids would be dreading their vaccine visits.

According to Canadian research, about 60 per cent of children are afraid of needles. That’s much higher than the adult numbers, which studies put at between 14 per cent and 38 per cent. The lifetime prevalence of severe needle phobia, characterized by symptoms such as panic attacks, fainting spells and insomnia in anticipation of an appointment, is about 4 per cent. It’s often rooted in negative childhood experiences with vaccines.

“People think it is just a needle, it will be over soon, and it is not that big of a deal,” said Christine Chambers, a clinical psychologist and Canada Research Chair on Children’s Pain at Dalhousie University. “But for some people it is a big deal.”

Vaccine centres are already taking steps to make the process more positive. Some clinics in Canada have used therapy dogs. Toronto Public Health announced this week that its clinics will have “superhero selfie stations,” where kids will be encouraged to celebrate with pictures.

“We often only think about getting the child through the current procedure,” Dr. Chambers said. “We don’t think about setting it up so it is easier to get the child to the next procedure.”

In this case, the next vaccine isn’t a year or more away – it’s only weeks. Even in adults, turnout for second doses fell after the first. Parents already hesitant about vaccines might be less likely to bring their kids back again if the experience is too stressful the first time around.

The best case is for children to get vaccinated when they’re calm. Anxiety can create a memory of a vaccine being more painful than it was. Parents should start having age-appropriate conversations with their children now, Dr. Chambers said, even before appointments are officially booked. They can explain the purpose of the vaccine, talking it up as an opportunity – a chance to be protected from the virus and help life go back to normal.

Dr. Chambers suggested that parents ask their kids how far in advance they would like to know about their appointments, and what they think would help them feel more relaxed when they receive their shots. “Kids know themselves,” she said. Parents also need to be careful about passing on any of their own anxiety around getting needles, and be alert to junk science their kids might be seeing on social media.

On the day of a vaccine appointment, research shows that a number of strategies help to reduce anxiety, such as distracting a child with a TV show or game, or asking them to take deep breaths, or to tense and relax muscles as a way of practising mindfulness while the needle is administered. According to Dr. Chambers, the most effective pain-relieving approach is over-the-counter numbing cream or patches applied about an hour beforehand. They not only reduce the pinch feeling, but can also be psychologically reassuring for nervous children. “My kids refer to it as their magic cream,” Dr. Chambers said.

When children have severe needle phobia, Dr. Riddell recommends therapy. Fortunately, she said, phobias are often receptive to treatment in short periods of time. Dr. Riddell has counselled young children who panicked at the word “needle,” let alone the sight of one. The therapy involves teaching mindfulness exercises while desensitizing them in small steps – having them practise remaining calm while looking at pictures of needles, or during needle-free doctor visits. What needs to be avoided, Dr. Riddell said, is the kind of situation her team once captured on camera during their research: a young child screaming tearfully while her mom and a nurse restrained her to get the needle done.

That kind of scene carries risks, especially if other children in line are witnesses. Anxiety is contagious, said Steven Taylor, a clinical psychologist at the University of British Columbia, so clinics and schools should ensure that kids have privacy when they get their vaccines.

Dr. Taylor co-authored an October editorial in the Journal of Anxiety Disorders, which warned that a poor understanding of typical stress responses could increase vaccine hesitancy. For instance, he said, there have been cases of fainting spells that spread among children in classrooms after vaccines were administered – the type of mass stress incident that, if not properly addressed, could be misinterpreted as a safety issue with a vaccine itself.

Dr. Taylor suggested that public officials and parents play down the potential for adverse side effects, which are rare, and educate kids about how stress can cause physical symptoms. For instance, parents might compare the experience to how someone feels on the eve of a birthday party, to show children how being nervous, even about something positive, can upset someone’s stomach or make their heart pound.

“These are simple conversations,” he said. “But we need to know that stress can produce intense sensations that are harmless.”

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