The vaccines we administer are important and, while the last thing Dr. McAllister and Nurse Practitioner Jen want to do is cause pain to patients, let's face it: Shots hurt.

A number of parents ask if we will use numbing medications, but they are not a great choice. For example, an injection of lidocaine, which we commonly use when giving kids stitches, will numb the tissue but the lidocaine injection itself is more painful that the vaccine shot. Topical numbing medicines (like EMLA cream) do not work well and they only numb the skin and not the muscle that the vaccine is injected into. Lastly, since the pain is brief and site specific, common pain killers, like Tylenol and Motrin, do not help. There are, however, other techniques we use to minimize pain.

1. Speed: Getting the shots over quickly gets the pain over quickly. We encourage older children to sit in a parent's lap for the shots, but at the 2, 4, and 6 month visits it's best to have the patient lie on the table to speed the process.
2. Add Comfort: The anxiety in anticipation of the shot is often worse than the shot itself. Sitting in a parent's lap, talking or reading a story distracts the kid to relieve anxiety.
3. Alternate Sensation -- Cold: It is possible to fool the nervous system to decrease the pain sensation. We use alcohol to clean the skin before a shot which also cools the skin. When nerves are registering a "cold" sensation they cannot also register "pain". We sometimes will use a cold spray on a patients arm to "numb" it. The cold spray does not numb the skin but, rather, it intensifies the cold sensation.
4. Alternate Sensation - Pressure: Since nerves also differentiate pressure from pain, rubbing the shot site immediately after the injection stimulates the pressure sensation deactivating the pain sensation.
5. Address Anxiety: When it comes to physical pain, the physiological fear is far greater than the pain itself. When a child obsessively asks if they are going to get a shot at the doctor's office, the best answer to give is that you do not know and will have to ask the doctor. We prefer to deliver the bad news to your child at the appropriate time in the visit.  

Parents can help a lot to minimize pain as well. Try not to get too anxious about the vaccines; your child will know if you are worried about the shots. Focus on other aspects of the visit like how excited you are to see how tall they are or how well their eyes work. Other techniques with proven results include:

• Touch soothingly and talk or sing softly
• Make eye contact as you smile at your child
• Hold your child on your lap
• Help your child take deep breaths and slowly blow out the pain
• Use a hand puppet to distract your child
• Point out posters or objects in the room
• Tell a story or have your child tell you one
• Allow your child to cry

Someday we may be able to deliver more vaccines without needles (like the FluMist nasal spray vaccine) but for now most of the vaccines are given by injection. In order to protect ourselves and our children from serious illnesses, we need to endure a little pain.