Psychosocial management of fear of needles in children
Authors: FUNG ELIZABETH 
Published: March 2009

Objectives : Children often perceive invasive medical procedures, such as repetitive blood work, injection and venipuncture, with fear and anxiety. Commonly, the management of such fear is through reassurance, comfort and distraction. A survey of HTC social workers was conducted to determine the following: (i) In addition to ‘talking therapy’, when indicated, what adjunctive techniques are used to support patients and parents during these procedures? (ii) What developmentally appropriate anxiety and pain reduction techniques are recommended? (iii) What training needs are identified?Methods : Questionnaires were e‐mailed to 109 haemophilia social workers in the US listed in the CDC directory. All respondents were assured of confidentiality and anonymity, unless self‐identified. The survey consisted of 14 questions, mainly closed‐ended. Nominal and Likert‐like scales were used.Results : Twenty‐nine social workers completed the survey (27% participation). Twenty‐six (93%) of respondents think sensory and kinesthetic techniques are more effective with children 5 years and under. Ages 6 and up are excellent in utilizing their own active imagination through guided imagery, relaxation or hypnosis to manage their fears and anxieties. Most frequently used management techniques are ranked as follows:Demographics HTC sites of social work participants #1. Deep breathing exercise tied in withPlaying with an interesting toy.# 2. Watching TV/video programme tied in withPromise of a reward afterward.#3. Guided imagery/hypnosis.#4. Other distraction techniques.Conclusions:  Selection of technique for specific child is based on the assessment of many individual and environmental factors. Creative use of developmentally appropriate sensory solutions can effectively alleviate a child's anxiety and fear of a painful procedure. It helps to build a developing sense of coping, self‐calming and soothing ability. It is observed, when parents learn to relax, they are more effective in supporting their children's coping ability. It is empowering both parents and children, an incredible boost to one's sense of confidence, when children are able to manage painful medical procedures. Data suggest the following age‐appropriate guidelines:The social work respondents indicated three areas of needs for advanced professional training: relaxation/hypnosis (38%), guided imagery (31%) and music therapy (27%). The effectiveness of these techniques could be assessed by parental feedback in future studies.  Demographics

HTC sites of social work participants

Paediatric
Adult
Combined paediatric & adult

10
2
17

34%
7%
59%

Total respondents = 29

Stages of Development and Use of Adjunctive Techniques

0–1 years
Distraction by bubble blowing, sensory toys, light‐up toys and comfort hold

1–6 years
Distraction (see above), pop‐up/I Spy books, playing with interesting toy, promise of a reward afterwards, breathing game.

6–10 years
Distraction by diversion conversation/creative story telling, deep breathing, watching TV/video programme, guided imagery, relaxation/hypnosis

10 years +
Distraction, listening to music, guided imagery, relaxation/hypnosis