“SHOTS”…..How Can I help my child be prepared?

They have names like Hib, DTP, HBV and MMR, but to most families they're simply called "shots." And often they're dreaded.

Linda K. Bausman, a nurse in pediatrics for 21 years at Mayo Clinic, Rochester, Minn., answers questions about helping children, and parents, cope with shots.

Oasis: Do some shots take longer to administer than others?

Bausman: Most of the required vaccines go pretty quickly — about 5 to 10 seconds for the actual injection. Penicillin injections may take a little longer because there's a larger volume of medication to inject, and the penicillin is thicker.

Oasis: Do some shots hurt more than others?

Bausman: Depending on the vaccine, some injections do hurt more than others. But we don't even get into that with kids. Children don't perceive the differences; they just know it's going to hurt.

By the way, it's not necessarily the needle stick that hurts. The vaccine actually may cause a burning sensation.

Oasis: How can I help my child manage the stress of getting a shot?

Bausman: The No. 1 thing is honesty. Children who know that they're going to get a shot generally do much better than children who aren't told in advance.

Next is preparation. I tell the child everything I'm going to do ahead of time: For example, 'Now I'm going to clean off your arm with a little alcohol.' `Now you're going to feel a little "owie."' Most of the time, children will do better if they know what to anticipate.

Oasis: So I can help at home by telling my child ahead of time.

Bausman: Yes. But don't do this a week ahead of time, because then children often worry about it. On the day of the appointment or right before you go in to the doctor's office, just say, 'Well, today you're going to get a shot.'

Oasis: How many of the details should I cover?

Bausman: Not many. I tell kids that they'll feel a little prick like a tiny bee sting, and that it's going to hurt only for a few seconds. I also say that kids need shots in order to go to school, and that we want kids to have shots so that they can stay healthy. I don't think parents need to go into much more detail than that.

But I always tell children that a shot does hurt a little. If parents say it isn't going to hurt at all, I say that actually it will — but we're going to make it easy for you, and it's not going to last very long.

Oasis: Besides honesty and preparation, are there any other techniques you use?

Bausman: Distraction helps. Sometimes I ask kids to blow out or whistle on my signal; I give the signal right before the injection. I'll also ask kids to count out loud with their parents. Usually by the time they count to five, I'm done.

Oasis: We've talked about the psychological aspect of shots. Can much be done to lessen the actual physical sensation of getting an injection?

Bausman: Not really. Some people ask about the EMLA skin cream. (EMLA stands for Eutectic Mixture of Local Anesthesia.) But this cream is used more to lessen sensation when we insert needles for IV (intravenous) therapy. When we're giving immunizations, we use a needle that goes an inch into muscle. The EMLA cream does not deaden sensation that deep, so the kids are going to feel the shot anyway. The EMLA cream also has to be applied 60 to 90 minutes before the injection.

Oasis: Do some kids, once they've had a shot, start to dread the next one?

Bausman: Yes. Sometimes when they come in for a shot, we have to force them to get up on the exam table. If I have a child who's really fighting a shot, we'll talk about it afterward: 'Now, I know you were really frightened, but did it hurt as much as you thought it was going to hurt?' Most often, kids say no. Then I'll say, 'Please remember that when you come in for your next shot.'

Of course, with some kids it doesn't make any difference what you say or do. They're basically upset, and there's not a lot that reasoning can do. You might just as well hold them and get the shot done.

Oasis: So in those rare cases when a child is out of control, the best thing to do is to hold the child down and proceed. This might call for bringing in another person to help?

Bausman: Yes, but I want to make sure that the parent is comfortable with this. I just say to the parent, 'I could get someone else to come help us,' and most parents will want to do that.

Now if I sense that a parent doesn't want me to be that assertive, then I will say, 'OK, why don't you talk to your child while I go out of the room? I'll come back when you think you're ready; just let me know.' Sometimes that works. But most of the time parents say, 'We've just got to get this done, or I'm going to be here all day!'

If a child is very upset, I don't rely on parents to hold their child. We find once we've inserted the needle that some parents may let go of the child. Then we don't have any control.

Oasis: Is there anything I can do right after a shot to help my child bring closure to the experience?

Bausman: Give reinforcement: 'Gee, you really did a good job.' Sometimes I'll add, 'It's fine to cry when it hurts, but you really held still for me.' So I offer a little praise and let kids pick out a sticker, and then they're out the door. Usually by the time they leave, kids are fine and back to their real job — learning and having fun