Needle Procedures: Let's Try to Do Better

Pediatr Nurs. 2019;45(1):5-6. 

In This Article

Abstract and Introduction


It is no secret to pediatric nurses that children do not like needles. For most children, the first exposure to a needle is when receiving routine immunizations. Children also encounter needles for blood draws, intravenous infusions, lumbar punctures, or wound suturing. A recent systematic review and meta-analysis revealed that most children exhibit needle fear, while prevalence ranged from 20% to 50% in adolescents and 20% to 30% in young adults (McLenon & Rogers, 2019).

The primary reason children dislike and/or fear needles is obvious: unless measures are taken, getting stuck with a needle hurts. Along with the trauma of the event, this pain and fear can contribute to the development of needle phobias, which can lead to immunization non-compliance, and reluctance to get flu shots and other potentially life-saving vaccines.

Taddio and colleagues (2012) surveyed a sample of parents (n=883) and children (n=1024) attending a public museum in Canada regarding needle fears and non-compliance with immunization due to needle fear. Of the groups, 24% of parents and 63% of children reported fear of needles, with 7% of parents and 8% of children saying this fear was the primary reason for immunization non-compliance.

Research suggests that a fear of injections develops around age 5 years and has a negative impact on vaccine compliance (Baxter, Cohen, Burton, Mohammer, & Lawson, 2017). A private pediatric practice asked parents and 10 to 12-year-olds to rate needle anxiety on a 100 mm visual analog scale. Their needle anxiety was compared to previous vaccination records, including number of vaccinations between ages 4 and 6 years (total and same-day maximum), and subsequent initiation of the human papillomavirus (HPV) vaccine through age 13 years. Of the 120 enrolled, 117 received preschool vaccinations between ages four and six years. Baxter and colleagues (2017) found that the likelihood of being in the upper quartile of fear 5 years later increased with each additional same-day injection but was not related to total lifetime or total 4- to 6-year injections. About a quarter of the children in the upper fear quartile began their HPV series comparted to 48% in the lower quartile.

Findings by Baxter and colleagues (2017) suggest reducing the number of injections in a single day as one way to reduce fear of needles. Other healthcare researchers and practitioners are addressing the primary reason behind the fear – the pain associated with needles.