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I have no financial disclosures to report
 I will not be discussing off-label
medication or device use

Understand the importance of
needlestick pain for children and their
families
 Learn at least one new technique for
reducing needlestick pain that you can
implement with your next patient

www.cartoonistgroup.com

Kids and parents do!
(and you should too)
› Substantial source of distress
› Pain memories are cumulative
› 25% of adults have “needle-phobia”
› 10% of adults avoid recommended care as a
result
Pharmacological
Physical
Psychological
Procedural

Topicals (all ages)
› LMX (Lidocaine 4%)
› Apply 30 min prior to
injection, with clear cover
› Remove Tegaderm by
stretching corner

Sugar water (< 1 yr old)
› Sweet-ease
› 2 min prior to injection

Avoid
› Cold spray (vapocoolant)
› Tylenol/Motrin (until after)

Position of comfort (all
ages)
› In contact with parent
› Upright
› Secure

Sucking (infants)
› Initiate prior to
needlestick
› Breastfeeding or pacifier

Pressure/vibration
› Buzzy
Buzzy

Distraction
› One calm voice
› Rocking, cuddling,
singing
› Toys/objects if calm
(especially counting
games)

Belly breathing
› For nervous parents
› Expand belly for
count of 3
Behavioral Approaches to Anxiety and Pain Management for Pediatric Venous Access
http://pediatrics.aappublications.org/content/122/Supplement_3/S134/T1.expansion.html

Be quick about it!
› Aspiration is
unnecessary

Order injections
› Give most painful
shot last

Choosing site
› Know your success
rates
› Venipuncture vs.
heelstick

Taddio: http://immunize.ca/en/parents/pain.aspx
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Child/teen 0:00-01:39 (intro, 1:39)
Child/teen 02:55-04:40 (prepare child, 1:45)
Baby 01:24-04:40 (topicals, 3:16)
Baby 07:15-08:39 (hold upright, 1:24)
Child/teen 09:12-09:47 (privacy/out of sight, 0:35)
Child/teen 09:47-10:47 (rub skin, 1:00)
Child/teen 13:49-14:40 (distraction, 0:51)
Child/teen 15:47-16:46 (good example, 0:59)
Baby 11:53-12:08 (summary statement, 0:15)
Child/teen 19:12-19:33 (summary with teens, 0:21)
UCSF “elbow” http://vimeo.com/81836551
›
00:05 to 01:22 (example using rub/massage/distraction game, 1:17)

Needlestick pain…
› Is common
› Is scary for kids
› Has long-lasting and cumulative effects
› Can be reduced
› Is worth our effort – your patients will thank you!