Why do so many adults fail to get flu shots every year: Is flu vaccine hard to find? Does it take too much time to get one? Will it cost too much money? Will it make me sick? The answers to all these questions are no, no, no, and no. It seems like everyone is giving flu vaccine. If you don’t have a regular primary care doctor (seriously, you should), you can stop at a local pharmacy or (gasp) Doc-in-the Box and get one. (I’ve even seen them offered at gas stations: A flu shot in return for “fuel perks!”) Almost all insurance plans cover flu shots, and free vaccine is available for those who don’t have insurance. Finally — and I can’t say this strongly enough — you can’t get the flu from a flu shot!
No, I believe adults are afraid of the owwee. A shot hurts, we don’t like pain, and no one (my mommy) is going to make me! I think avoiding the pain of an injection is the overriding reason why adults don’t get flu shots (and may be why they don’t go to the doctor for regular check ups either). I also think some parents refuse vaccines for their kids for exactly the same reason, rather than the thoroughly discredited idea that vaccines cause autism (they don’t). Scott Gavura agrees:
The pain of vaccines can lead to anxiety, fear, and even nonadherence with vaccination schedules. Fear of needles and injections is not uncommon, it’s estimated that 10% of the population avoids vaccinations for this reason.
It’s remarkable how well infants and children pick up on the fears of their parents. When pediatricians recognize the personality trait of being “a worrier” in a patient, we usually just have to look at the other adult in the room to find the origin of that trait.
A lot (maybe all) of this is learned behavior. I’m positive every pediatrician has heard some variation of the following:
- “Uh oh, here comes the mean doctor (or nurse) with the shots!”
- “Uh oh, you’re going to get it now!”
- To a misbehaving child: “Do you want the doctor to give you a shot?”
- “If you don’t calm down, I’m going to leave this room and leave you alone with the doctor (and shot)!
- “Don’t be such a baby. It doesn’t hurt.” (Yes it does and statements like that raise kids’ BS detectors immediately.)
And probably the most common and least helpful comment of all:
- “You can give him a flu shot, but I don’t get one because” … (wait for it)… “I don’t believe in them.”
It’s very easy for parents to inadvertently (and older siblings purposely — ooh, they’re worse!) add to a child’s sense of anxiety regarding shots. They remember they get shots when they come to the office and they remember that shots hurt.
A 2010 Canadian review of 71 studies on the subject of reducing immunization pain in children resulted in some very helpful evidence-based guidelines. Gavura at Science-Based Medicine summarizes the first two recommendations for infants:
1. Does breastfeeding during vaccination reduce pain at the time of injection?
Yes. Breastfeeding has been shown to provide analgesic effects, possibly through the combination of holding, skin-to-skin contact, the sweetness of the milk, and the process of sucking. To reduce pain, breastfeeding mothers should be encouraged to breastfeed during the vaccination procedure. (Grade I-A)
2. Does administration of a sweet-tasting solution reduce pain at the time of injection?
Yes. Sweet oral solutions provide analgesiceffectsin infants, reducing signs of pain. Up to 12 months of age, infants who cannot be breastfed during vaccination may be administered a sweet-tasting solution during vaccination (Grade I-A). A simple formula is one packet/cube of sugar in two teaspoons (10 mL) of water. Place in the infant’s mouth with an oral syringe 1-2 minutes before injection. The process is well tolerated, and side effects, like coughing and gagging, are infrequent. Because of conflicting data, there is insufficient evidence to support this strategy in children older than 12 months.
Additional strategies for infants were shown to be less effective for infants, and these are summarized at Immunize BC here.
Tomorrow, we’ll discuss ways to minimize immunization pain in older children.
(Back Pat: Raymond O’Toole, M.D.)