Injections are a necessary part of life for our children – from routine immunisations to blood tests, dental work or jabs for trips abroad. But some children with learning disabilities will not be able to rationalise that the small amount of pain is greatly outweighed by the benefits.
Needlephobia – an extreme, persistent and excessive fear of needles – is said to affect anywhere between 3.5 per cent and 10 per cent of the population, but it can be particularly associated with autistic spectrum disorder. Symptoms can be physical, psychological and behavioural. They include palpitations, shortness of breath and an increased heart rate and blood pressure. Even thinking about a procedure involving needles can trigger feelings of panic and an almost overwhelming desire to escape.
For parents whose children have needlephobia, routine medical and dental appointments can become a nightmare, the more so because complete avoidance is not possible. At some point their children will need an injection, so it is important to seek help.
The starting point, says chartered psychologist Nigel Blagg, is to look back through a child’s history and try to identify the factors that may have triggered the phobia in the first place and could potentially maintain and even exacerbate it. ‘Has the child ever had an injection and under what circumstances? Have they ever witnessed somebody having an injection, has anybody in their family got a problem with this and has it become a learned, acquired phobia because of the experiences of other members of the family? You need to do your homework,’ he says.
And parents may inadvertently be making things worse. ‘If the adult dealing with the child is highly anxious about the child’s behaviour and is very attentive to that and can’t be calm and reassuring, or provide the child with the kind of relaxed reassurance that they need, that might not help,’ he says.
Practical steps that minimise the discomfort of the procedure can make a big difference. ‘I would try a variety of tricks - elaborate forms of bribery and, best of all, anaesthetic cream,’ says Dr Richard Stevens, who practised as a GP for 30 years. ‘This does not remove the scary anticipation part but this can be reduced by being quick, not making the patient wait and not showing them the needle.’
Desensitisation and CBT
Desensitisation or behavioural exposure involves establishing all the fear-inducing factors and creating an anxiety hierarchy from them. Gradual and repeated exposure means that over time, the triggers lose their power to distress. ‘For a child, this might start, for example, with a toy needle or picture of a needle or a visit to a doctor’s surgery just to chat,’ says Blagg.
Cognitive Behavioural Therapy (CBT) works by finding ways of managing negative feelings and behaviour. It can be highly practical – injecting an orange to reassure a patient that the needle won’t break, for example – and even getting dental staff to use anaesthetic cream on their own mouths to demonstrate how effective it is.
For a case history treatment of a 13-year-old with severe needlephobia through CBT see https://pdfs.semanticscholar.org/7cfc/f581398c0ad0254e370617766fd90174c362.pdf
Clinical hypnotherapy uses deep relaxation and visualisation to help people cope better with phobia triggers and remain calm. While some healthcare professionals question how well it works, supporters say that this can be highly effective in helping them to manage their phobias.
Needle fears and autism
Social stories, role playing and modelling can all help to work through the child’s fears. For a template social story on blood tests see http://www.johnson-center.org/downloads/pdfs/blood-draw.pdf
For a case study on helping a 10-year-old autistic boy through his intense fear of blood tests see http://drkarenlevine.com/wp-content/uploads/2016/02/LevineASQ37Fall2013.pdf
Further information on needlephobia
Anxiety UK has an advice booklet on needlephobia