I’m a practice nurse and I’ve been in the post for over a year now, and one of the things I’ve found difficult was doing the immunisations for the children. Babies are easier in a way because they don’t know what’s coming and you know they are going to cry but then they’ll forget about it. The preschool boosters are from 3 years and 4 months, so they will have an awareness of what’s going on and have strong opinions on it! It is also two injections, so after the first one is done they hate you and don’t want to sit still for the second. I wanted to gather together some of the tips I’ve gleaned from others and from my own experience so that other new practice nurses can easily find this resource, or I can point them in the right place. Obviously you need to have had the proper trainig to do the immunisations first, this is just for techniques to help the children have hopefully a better experience and improve their relationships with healthcare professionals. I also work in the UK so things may be different in other countries.
One of the debates is whether to prepare them or not. Is it better to have a well-prepared child who knows what is coming but may have heightened anxiety about the procedure, or is it better to have a child completely unaware but then will possibly have more pain and distrust of health professionals afterward? There is no clear-cut answer here, but evidence suggests a well-prepared child has better outcomes. The parent will know their child the best, so they will be the best judge. If a child is anxious and asking questions, it’s important to answer them honestly and give reassurance. If they ask about injections and whether they will hurt, for example, answer that it will sting for just a second, and Mum/Dad will be with you the whole time and we can have a treat afterward.
We as health professionals need to make sure the parents have all the information they need prior to the appointment so that they will give the child the correct information too. If you see them beforehand for anything else or see the parents, get them to prepare the child. Some nurses will mention preparation at the 12-month immunisation appointment. If you decide to go down that route, here are a few good resources to give or signpost to:
Dr. Ranj’s YouTube video on injections:
The NHS vaccination tips for parents
I like this leaflet from the NHS Ayrshire and Arran
NHS leaflet on immunisations from 2 years until primary school
Once we have the child in for their immunisation appointment, here is how we can alleviate anxiety and pain. Remember children are all different in their reactions, and you will hardly ever get one that is completely chilled, you are doing your best to make it better for them, and remember why you are doing it, to help protect them from serious disease.
Firstly, be welcoming and happy – it sounds basic, but a smile goes a long way. Treat them as the important ones, mention them by name and compliment their outfit or toy. If they have a particular TV or superhero character on display or with them as a toy, ask them about it and say it is your favourite too. Say that you have to ask Mum/Dad/Grandma some boring questions first and do your admin.
Here are some different approaches from UK practice nurses on how they do it:
I say “I am going to give you 2 vaccines here and here (point at the arms), it will b a bit stingy but I really need you to try your best to stay still to make sure we are all safe. I am going to show you how to give mummy a special cuddle to help you.” Then I ask adult to turn the child around facing them with the child’s arms wrapped round the back under the grown ups arms then I ask the adult to hold the top of the arm near the shoulder with 1 hand and near the elbow with the other then swap to do the other. Before I do the second one I always ask if the grown up is ready and warn them they the child may try and move more because they know what’s coming. Then quietly ask grown up if they are allowed a treat (I have a jar of sweets and chocolate coins hidden in the cupboard in case mum says no) and always give a sticker and lots of praise “oh my goodness I’m so proud of you, you can tell all your friends and family how brave you were and show them your sticker”!
I use a little doll that the children give pretend injections to (superpowers) and then the children choose and give the doll a sticker, before we do theirs. It works well 9 times out of 10!
I make big fuss of them from the beginning, get them to show me their muscles and exaggerate the WOW they’re hugeeee, then tell them how we’re going to make them even stronger to fight off all the germs. Then choose their stickers for when they’ve been super brave.
I speak to the child – make a joke – what a big boy/girl how old are you 10? 6? Then I say next year you will be going to big school and all the little boys and girls in your class have to have special medicine so they stay well and can play with their friends. I need to see your guns! In a minute I wil go 123 boop (touch the arm) and it will sting for a second but I have stickers, bubbles and a certificate. I also have a fuzzy on the wall for them to watch as ‘he moves.’
Bravery certificates, stickers, tell them how really grown up they are and how the medicine is really special and makes them big a strong. On occasion I’ve put nice pictures on my computer that they can look at to distract and also calming music. Generally if the parents are relaxed the children are too.
I explain to them what they need the magic medicine for and how it will make them big and strong. I Try and be really up beat. I tell them why I’m holding their arm etc, so I don’t freak them out. Sometimes get them to count to 5 with me.
I talk about how magic the medicine is and then very excitedly ask them if they can feel it working yet! Generally stops them becoming too upset.
Ask them to pick 2 superpowers
and watch their muscles grow like a superhero. Plus sticker & printed certificate to colour in at home.
I used to show them the syringe (not the needle) and ask if they could see the fairy dust/Spider-Man magic. Most kids could
. Then they had to be really brave to get the dust and see if they grew wings/webs with magic powers the next morning.
One to help them learn to read and one to help them learn to write. Works most times.
Stickers/certificates off Amazon. I used to dish out the £1 bears from IKEA but they stopped making them (we are a small practice and average about 2 preschoolers a week). I talk about the magic medicine that’s stops them getting very poorly and mum/dad giving them a super duper cuddle while I give it. I also give them the important job of checking whether their big boy/girl muscles have grown the next day. Seems to work
I wear flashing Oleg figures on my head to distract them plus on F12 there is a bravery certificate while on parents knee I jab while they reading their name. Explain to parents first of course and tell children 2 little sharp scratches.
Super hero stickers giving them some super powers seems to work for me
We’ve made a magic box at our surgery which can only be opened by children who had their magic medicine. It’s sparkly with stars on….and we don’t know what’s in it as we can’t open it. We then exaggerate how we can’t open the box. Once had the medicine we get them to tap and wave and the box and it then pops open. It’s got stickers and sweets in it (which we whisper permission from parents at the beginning) often works a treat for the pre schoolers.
Firstly child and parent preparation is essential I collar them at the 1 year imms and explain that they need to prep the child before the preschools as it will make it so much easier. If someone told me I was going to town for an ice cream but just calling in here first and a stranger attacked me with a needle I would be pretty pissed off so I can’t blame the kids if the parents haven’t prepped them! Secondly I go into “mr tumble mode” waving saying hello asking them about what they have on their jumper/coat/ doll etc to build bridges. thirdly I put their favourite tv show on the computer to keep them occupied whilst I talk to the parents, explain the imms, consent etc. finally once we have given the imms we go on an expedition to find my secret sticker draw to distract them and reward them. Doesn’t always work but it does a fair bit of the time.
I have a bag of mini chocolate buttons at the ready and stickers. Also do the ‘are you ready to get your super powers to fight off germs and prepare you for BIG school’
I talk about magic powers, ask them who their favourite cartoon characters are, get Google images up and get them to choose which power (picture they would like) with each injection I say which power it is, kids love it. Parents come back in saying they’ve not stopped talking about their magic powers.
Introductions first, then explain to the child why they are here, to be given a small injection that will help them grow up healthy and strong like their parents and then I offer to put a YouTube video on of their favourite programme…. firstly spend time guessing what that may be. Then talk to the parents about the vaccines while the child is distracted. Reward with stickers and high fives afterwards
I encourage kids to blow some bubbles afterwards. It can be a good distraction and helps to calm down a bit as they have to take some deep breaths! If they are too sad/cross to blow bubbles then I see if a parent wants to and we all get involved with popping them and trying to lighten the mood a bit
I use a combination of these suggestions, I prepare the parents and child if I see them before, then I say I’m going to give you two injections, one in each arm and I show them where, I say it is super hero juice and will help keep them healhy. I show them the stickers I have and make a big fuss of them when it’s done. I do it as quickly as possible with a 123 countdown.
You can order leaflets and stickers from the NHS for free if you’re a health professional, they have some cute bear stickers for kids and butterfly ones for adults too. Choose and order here. You need to register and have an NHS email. You can get free printable bravery certificates here. Amazon do some cheap bubbles to help you.
If you’re a practice nurse, how do you do your preschool boosters? I’d love to hear from you.
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