When Yousef Bishara, 11, was told the COVID-19 vaccine could be approved for children between the ages of 5 and 11 by the end of next week, he quickly glanced at his mother and uttered an excited ‘Oh yay! I didn’t know that.’
The sixth grader from Yarmouth County is excited at the prospect of finally getting vaccinated. A friend who recently turned 12 already had his first COVID-19 shot, and other friends preparing to celebrate their twelfth birthdays are eagerly awaiting their appointments.
Bishara can’t wait to join them.
“I was annoyed (before) because I couldn’t get it, and I wanted to get it,” he said.
His biggest concern is experiencing nausea after the vaccine like his father did, but he’s not remotely worried about getting the needles.
His mother, Renee Meuse Bishara, said she’ll be booking COVID-19 vaccination appointments for Yousef and his brother Nassim (who’s 8) as soon as they’re available.
“Where we live it’s pretty rural so I think that gives us a degree of comfort, but the last month has shown us that it’s everywhere and the numbers have really changed here,” Meuse Bishara said in an interview. “I guess there’s that comfort that as we learn to live with this or adjust to living with this, they’ll have a little more coverage.”
Last Friday, Canada’s chief medical adviser Dr. Supriya Sharam told reporters Health Canada is ‘actively continuing the review’ of the Pfizer vaccine for children between the ages of 5 to 11.” Sharam said regulators expect to announce a decision “in the next one to two weeks.”
As parents wait for the official green light on that approval, not all children are as enthusiastic — or as prepared — as Bishara.
The Halifax Examiner reached out to Dalhousie University professor and pediatric pain researcher Christine Chambers. Her research is based in the Centre for Pediatric Pain Research at the IWK Health Centre.
On Tuesday we spoke with Chambers, who is also scientific director of Solutions for Kids in Pain (SKIP), a national network aimed at improving children’s pain management. Her research interests also include pediatric and health psychology.
We asked Chambers how parents can best prepare their younger children — and themselves — when the vaccine is made available to that younger age cohort. Here is our conversation, edited for brevity and clarity.
Halifax Examiner (HE): How should parents prepare and talk to their children in this age group about the COVID-19 vaccine?
Christine Chambers (CC): I think it is really important for parents to have a calm, very neutral, positive conversation about what a great opportunity this is for kids, that it’s a chance to keep them safe and to keep others safe. One of the things that parents often struggle with is just actually taking their kid for a vaccination. No kid likes needles, no parent likes taking their kids for needles, and every time you tell a kid they have a doctor’s appointment, they almost always say, ‘Am I going to get a needle?’ It’s definitely top of mind, and so we really talked to parents about three ways of thinking about taking their kids in for vaccination.
HE: What are those three things they should be thinking about?
CC: What happens before, what happens during, and what happens after. Before, it’s just being very honest, using age-appropriate language, answering any questions that they might have, making sure that you tell them about it in advance. How far in advance really depends on your child, their temperament, how old they are. Sometimes parents get so nervous about taking their kids for needles that they don’t want to tell them, or they avoid telling them until they get there. And that really produces a lot of this kind of mistrust in the parent and in the health professional.
Then we talk about what to do when you are there. So there’s actually a cream that you can buy at the pharmacy that you can apply, it’s like a numbing cream, that you can put on your child’s arm if you wish before you go for the procedure. Research has shown that’s really effective. But there are also no cost ways to make it smoother. Distraction is key. So I always have my iPhone out with a YouTube video or a video game for kids to be distracted. Promote relaxation and encourage kids to take deep breaths, relaxing and tensing different muscle groups. These things work.
And then after the vaccination, really emphasizing what went well, giving them something to look forward to after. It’s really important because we know that this vaccine is two visits, right? You need the two doses. Often parents will wrestle their way through a vaccination and then feel like they don’t have to worry about it for a while. But in fact the second one’s going to come up fast, and so it’s really important that we make it as positive of an experience, really emphasize what went well, and set kids up for success.
HE: What are some of the things that you’re hearing from parents and families as they await approval of the vaccine for this age group?
CC: We’re hearing a lot of excitement from parents. Some nervousness, too. It’s normal to feel nervous, but we’re reassuring parents that a lot of research and a lot of analysis has gone into improving these vaccines, that they are safe for children. Some parents are saying, ‘Well, COVID doesn’t affect children as badly,’ or ‘Children are less likely to die from COVID.’ Well, 17 children in Canada have died from COVID.
I think the other thing I’m hearing from parents is some are worried they won’t be able to get their children there for a vaccination. Even some older kids who are eligible in the 12 to 17 year old cohort (parents are saying) ‘We took them for the first one, we had to hold them down. And now he’s refusing to go back and he’s not able to do basketball. He’s not able to do these other activities.’
We want to approach vaccination in a positive way for all kids. But some kids have developed a full-blown phobia. Needle fears are normal along a continuum, but for kids who’ve specifically developed needle phobia, they do benefit from a specialized treatment from a psychologist, an exposure-based therapy where you gradually introduce kids to feared stimuli and introduce coping skills.
So just letting parents know that there are some cases where your child’s anxiety is so significant that you might need some professional support and that there are psychologists who specialize in that treatment. Also, it’s very effective in a couple of sessions.
HE: What kind of tips or tricks do you have to help mitigate fear of needles for those who aren’t necessarily phobic but fearful?
CC: Besides distraction and having a plan, it’s really important for parents to keep their own anxiety in check. Some of our research has shown that when parents are anxious, it makes kids more anxious and actually causes the vaccination to hurt more than it would otherwise. So having a conversation. A lot of adults are afraid of needles, too. Be honest with yourself. If you have a partner who might be better suited to taking your children to get the vaccination, that’s a decision some people make. But even just making sure that our body language and the things that we’re saying are going to work to help kids.
One of the number one things parents do when their kids are having medical procedures is reassure them. They say things like ‘It’ll be over soon,’ ‘It’ll be OK.’ But research has shown that actually makes kids feel worse. (Instead) distract them using humour, give them suggestions on how to cope. Those types of things work. For parents it’s about getting them to distract and take attention away from the needle.
HE: You mentioned using the numbing cream earlier, but can you touch on some other ways parents can manage pain during the procedure and after?
CC: We often talk about the three P’s of pain management. There’s the pharmacological management, there’s the psychological management, and then there’s the physical management.
Most people have never heard of this numbing cream. There is a cost attached, so it is a barrier for some parents, although parents are used to buying things like Tylenol to make their children more comfortable. The research shows that it really does reduce pain, but some of my kids like it because it has a psychological benefit too. ‘I have my magic cream on.’ It makes them feel more powerful and more in control.
On the psychological side, our research has shown that it actually doesn’t matter what you distract your kid with. It could be a phone, a video, or it could be counting ceiling tiles, as long as they actually are distracted. And then the relaxation, encouraging deep breaths. Blowing bubbles is something that encourages deep breathing, having a pinwheel. Those types of things can promote breathing.
Also asking kids. Kids know themselves, and I think sometimes we don’t stop and say, ‘Listen, I’m going to be booking you for your COVID vaccination soon. How far in advance do you want me to tell you? What would be helpful for us to bring? What would you like to look forward to after?’ I’m a child psychologist, so I can say that bribes do work. We call them positive reinforcement.
On the physical side — these strategies are usually known by the vaccinator — but we know that being seated upright actually hurts less than if you’re lying down. It’s really important to tell the vaccinators if your child has had a history of anxiety. Let them know in advance. If there’s an opportunity to put a note in when you book the appointment, do that. If not, do it when you arrive.
There have been some (vaccine) clinics that have been advertised as specific to individuals with anxiety. I saw one that had therapy dogs, which is a great distraction. It’ll be interesting to see whether there are some more tailored approaches for kids and families who are experiencing more distress.
HE: Why is it important to acknowledge this distress?
CC: Some people tend to underplay the impact that needles have. They say ‘It’s just a needle. What’s the big deal?’ That’s great if that’s how you feel, but needles are a big deal to a lot of people. Part of the conversation is just normalizing it, putting a little time in in advance to plan ahead, being aware that all of these strategies that I’ve mentioned have been supported by decades of research. They are recommended in a clinical practice guideline.
Most people aren’t aware of them, which is interesting, and that’s why we at Solutions for Kids in Pain are trying to bridge that gap. There’s all this research and we want to make sure it’s put into practice. There are a lot of complex reasons why people choose not to get vaccinated, but pain and fear of needles is one of those reasons. It may not be the number one reason, but it’s definitely one of the reasons, and it’s an area where we have tons of research and really strong solutions. So it’s just great to connect parents with that information.
HE: What information and resources do you recommend parents consult as they’re thinking about this issue?
CC: Specific to preparing kids for needles, we have a website for SKIP called www.kidsinpain.ca. I also have my research website, www.itdoesnthavetohurt.ca, and we use #itdoesnthavetohurt on social media so that parents can find all the evidence-based information. Also Immunize Canada, the Canadian Paediatric Society, Health Canada and PHAC (Public Health Agency of Canada) once the approval comes forward will also be creating more resources and information for parents.
For parents it’s easy to fall down a social media rabbit hole, to be influenced by different YouTube videos or different content that people might be sharing. It’s really important just to stop, look at the source, and really, really rely on experts and credible organizations and credible information. All parents want to do the right thing for their kids, and we worry a lot about our kids, so looking to experts like myself and others for advice and input is really the way to go.
HE: How can parents work through their own fears and uncertainties about giving their younger children the COVID-19 vaccine?
CC: This point is such an interesting one because we’re all on edge. We’ve been living through this very stressful time for almost two years now, and what might have felt like a simpler decision two years ago feels more anxiety-ridden and more confusing.
I think part of it is just acknowledging that we’re all on edge. We’re all feeling more stressed these days, and that can make decision-making more challenging. I think really looking through the information very clearly about what the benefits are. Childhood immunizations and vaccinations are one of the most significant scientific discoveries, they have saved so many lives and we’re so fortunate that we have this solution. The benefits far outweigh the risks. If you’re nervous, though, talk to your health professional, talk to a pharmacist, ask people who are positioned to know the evidence and don’t rely on other folks who maybe don’t have the background or the expertise.