Whether they are getting their flu vaccine or having routine blood work, taking your child to the doctor’s office for their shots is one of the most stressful events for both child and parent.

For children with Autism who may have difficulty coping in events that are out of routine, who may be non-verbal or who may have sensory needs, it can become even more difficult to help them feel calm around needles.

As a Child Life Specialist who is trained in providing appropriate procedural preparation and procedural support for children in medical settings, I wanted to share insight on best ways to prepare your child with Autism for their shots before, during and after the injection.

Although this blog post is specific to strategies for children with Autism, these techniques can be applied to all children. 

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Before the doctor’s visit

Prep: Providing developmentally appropriate prep before the doctor’s visit allows your child to know what to expect during their visit which can decrease anxiety and difficulty with transitions. Since our children with Autism are visual learners, try using the following visual supports:

A social story is a short narrative that helps walk your child through a social scenario that should use language and images that are appropriate and specific to your child. It is ideal if the images reflect how the actual doctor’s office looks, but anything that comes close should suffice. An example of a social story could be:

•  I am going to see the doctor so he can help me take care of my body better.
• When I get there, mommy will sign my name so the doctor knows I am here
• I will wait in the waiting area with mommy until the doctor is ready to see me. I can play a game with mommy while I wait or watch a video on my iPad.

It is also important to know when the right time is to talk to your child about their visit. If showing them the social story days before the appointment will help relieve their stress then it is best to start early. However, if talking to them too early causes more anxiety then you can read them the social story while in the waiting room or even right before the shot.

Visual Schedule: A visual schedule is helpful in illustrating what is going to happen throughout the day or during your child’s doctor visit. Be sure to use images that your child understands and is familiar with. The following is an example of a hypothetical visual schedule for getting a shot. 

Schedule a Pre-visit: For children who may lack the receptive communication skills to benefit from a procedural prep, try scheduling a pre-visit to get your child familiar with the environment, sounds and sights before the actual day of the visit.

Appointment time: To decrease wait time in an already stressful situation, try to schedule the appointment first thing in the morning, first thing after lunch or ask when the office is the lease busiest to ensure your child may not have to wait in anxiety for too long. Inform the medical staff that your child has Autism and may benefit from less time in the waiting room, which can be an overstimulating environment. You  may also request for staff who are familiar with working with children with Autism. 

Medical Play: Engaging in medical play aka ‘playing doctor‘ is a great way to help your child familiarize themselves with medical supplies that will be used during their visit. Using items that the child will most likely be seeing in the doctor’s office is a great way to familiarize your child with the medical tools, leading to a less stressful encounter. 

Some things to incorporate during medical play are alcohol pads (allowing your child to feel the coolness on their skin), a tourniquet (wrap it snugly around their arm), a toy needle, and band-aids. Having toys that resemble the actual items is ideal in helping your child with Autism better make the association when encountering the same tools in the doctor’s office. Be sure to explain the role of each tool during the play session as well: 

Tourniqet – helps the doctor and nurses see your veins better

Alcohol pad – keeps germs away

IV – straw that can give your arm a drink and/or medication.

Straight stick – a poke for your arm to help the doctors know how to better help your body. 

Playing with these items beforehand not only helps them to be familiar with the tools and their purpose but also helps them associate these items with joy and comfort.

Medical play also gives you insight as to how your child may be feeling about the visit. When your daughter tells her toy doll that the ‘the needle will only hurt a little’, that reflects her own understanding of  the injection. On the flip side, if she’s stabbing a needle in her doll’s arm that can reflect how she thinks a needle may feel. This gives parents an opportunity to address these feelings saying things like: “you will feel a pinch in your arm, but it will be quick to go away”.

Engage the senses: Children with Autism feel overstimulated quite easily by their environment, especially when they are not prepared for it. Let your child know what to expect at their doctor’s visit using all their senses (sight, smell, touch, sound and taste).

• The alcohol pad is a wet cloth to help clean your skin, it might feel a little cold. For non-verbal children, demonstrate through medical play by using cool wet pads.
• A saline flush, for example, which is a syringe of water that runs through the IV tubing to make sure it’s working may have a smell or taste when the water goes in the IV.  Some kids say the saline flush might smell or taste salty like ocean water. The flush may also make the body feel a little cold which is normal. Since our body is so warm, any liquid entering our body will make us feel a little cool.

Discuss strategies beforehand: Most kids prefer to look away during needles and surprisingly some kids do better when they look. Similarly, some kids prefer the nurses to count down before inserting the needle while others do not. It is good to have an idea of your child’s preferences. If your child prefers to look away, it may help to have distraction items at hand to help keep them looking away. And of course, always have them pick the distraction items beforehand  (when the doctor gives you the pinch, would you like to watch blue clues on the iPad or watch me play with a bubble wand). It can also help to give your child an item to squeeze in their hands during the time of the injection. You can ask your child beforehand if they would prefer to squeeze your hand or a stress ball.

During the Visit

Important items to bring: It is very important that your child is able to express his or her feelings before, during and after getting their shot so be sure to bring their communication device if they have one. It is also important to bring in any comfort items or sensory toys that helps your child feel calmer and more comfortable. Sensory items like a mouthing toy, a weighted lap pad, glow in the dark sticks, are all great options to help your child feel more relaxed. Familiar items like a special blanket or a teddy bear are also helpful to have.

Use Honest yet Appropriate language: Saying the needle won’t hurt is not fair and may lead to mistrust between the parent and child. Rather, you can say “you will feel a strong pinch but it’s quick to go away”. Use language that is honest without having a negative connotation. For example, instead of saying the blue tourniquet will squeeze your arm, you can say the blue tourniquet will give your arm a nice tight hug.

Talk about the after: It’s important to talk to your child about what your plans are after getting the shot. For some kids it’s so hard to think of the ‘after’ since their stress levels are so high. They may not be able to imagine the event being over but by making plans and talking about going through the Dunkin drive through for some munchkins reminds them that this stressful event will come to an end. 

First-Then visual board: For our non-verbal children, it may be helpful to use a visual chart such as a First-Then chart. This is great when letting your child know that after they do the first action (ie get their shot) then they’ll get to have a preferred item or activity (ie. ice cream). Insert any activity or prize that your child will be motivated to work for as the “Then” part of the chart.

An example of a First-Then visual chart: 

Comfort positions: Talk to the nurse beforehand about possible comfort positions for your little one so they can feel more comfortable being secured by you as opposed to potentially being held by other medical staff. The comfort of your embrace can be calming for your child and serve as a natural pain management.

Explicit instructions: It is natural for your child to be nervous and cry before and during their shot. Crying is a natural coping mechanism for children. Validate your child’s emotions, letting them know it is okay to cry and to feel nervous/scared. However, give your child explicit instructions on what they should be doing: “It’s okay to be scared, but it’s important that you hold still while we get our special straw or IV”. Be sure to acknowledge your child’s brave efforts when they are trying to do so: “I know you feel nervous, but you are doing an amazing job holding still while the doctor looks at your arm!”.

Give choices throughout: Children cope well with choices during times of stress. Giving them control over an unwanted situation can reduce difficult behaviors. Some choices you can offer are where to sit, choice of band-aid, activity to do after the injection, etc.

Put it in context: For some children, it may help to tell them that the smaller pain (or ouchie) from the needle will outweigh the more seriousness (or bigger ouchie) of getting sick. Putting this in context and helping your child make the association to activities they won’t miss out on can help: “The Doctor will give a flu shot to help you not get sick during the winter so you can spend more time at home playing apple to apples with your brothers”.

Masking the pain: For children who are having a difficult time coping with the pain of the injection, there are different tools available to help mask the pain such as Buzzy the Bee or a Freeze/Coolant spray.

• Buzzy the bee is a small vibrating device in the shape of a bee that tricks your body’s nervous system into feeling the vibration as opposed to the pain from the needle. Buzzy the bee also comes with a cold pack which provides additional distraction to your body’s nervous system, further masking the pain from the injection site. For more information on Buzzy the bee, you can check out the website: https://www.buzzy4shots.com.au/pages/how-does-buzzy-work
• A freeze spray or coolant spray is also used to counteract the feeling of pain during an injection. Spraying a freeze spray before the shot can temporarily cool the injection site to almost feel numb. This may feel different or uncomfortable for your child so always test a small area before deciding to use this method during the time of the injection. 

Deep breathing: Deep breathing is a great way to help your child feel calmer and more relaxed during stressful events. If your child is having a hard time taking deep breaths or may not have the receptive communication skills to understand what is being asked of them, you can have them take deep breaths by blowing bubbles, blowing at a pinwheel, playing dragon or pretending to blow out some birthday candles.

Guided Imagery: Guided imagery is another great non-pharmacological method for pain management. Help your child imagine their favorite activity, place or memory during the time of their injection to help ease their stress and divert their attention to more positive and pleasurable thoughts.

After the Shots

Rewarding their bravery: Be sure to reward your child for their bravery! Let your child pick out a prize beforehand to encourage motivation. As mentioned earlier, use a First-Then chart to better make the association that after their shot, they will earn their prize. 

Debrief: Always talk to your child about how the visit went, what they liked/what they didn’t, so you know how to better help them especially for future visits. Sometimes, their concerns could be mitigated right away (ex. if your child thinks they will get multiple pokes, you can let them know that an IV is usually a one time poke).

You can also have your child communicate their feelings using a visual emotion or pain scale. 

It is okay if your child cried a lot during the time of the shot. As mentioned earlier, crying is a healthy coping mechanism. What you do want to look out for is whether or not your child was able to return to baseline shortly after. As long as child returns to their baseline level of playfulness, you can feel reassured that they may not be as traumatized by the experience.

More Medical Play: To better understand how your child felt during their visit, you can assess their reaction during medical play (a child who says ‘don’t worry this will be a quick pinch’ when giving her doll a shot shows that this may be how she felt when she got her own injection. On the flip side, a child stabbing her doll while giving her a shot may be indicating how she thought the needle felt like. In that case, you can address those concerns in a safe space and talk about how to help ‘the doll’ feel less pain (would it help if I hold the dolly’s hand, give her buzzy, etc). 

Hope this post was helpful! If you have any questions, be sure to write it in the comment box or email me directly at madeha.ayub@seedsforspecialneeds.com

See you in my next post!