Offer limited choices. For children who like to take part in their own diabetes management, parents may find it helpful to set a clear limit on what choices are available rather than posing broad questions such as, “Where do you want to put the shot today?” Instead, allow your child to choose one of only two possible injection sites or fingers.
Work quickly. All choices should be offered and discussions finished before the injection or blood glucose monitoring supplies are out of their storage place. Adults should avoid engaging in lengthy negotiations with their child once the syringe or lancet is out and ready to be used. Looking at the syringe or lancet while discussing its use often creates more anticipatory anxiety.
Use distraction. Distraction is the most practical and effective tool families can use to minimize pain and distress for children. The use of cognitive distraction and touch distraction is based on the theory that cognitive activities and stimulation of the skin by stroking, rubbing, or applying pressure create impulses that travel to the brain and spinal cord quickly and interrupt the pain impulses that travel through the same pathways, reducing pain perception. Several recent studies suggest that both cognitive and touch distraction may be quite effective in reducing pain during immunization injections.
Cognitive distraction activities include blowing bubbles or a party-blower, squeezing on a soft ball, searching for specific items in a colorful photo or in the room, doing simple math equations out loud, counting, or saying the alphabet. Touch and pressure distraction may be helpful for children who are too upset to effectively engage in a cognitive activity during injections. The easiest way to use this technique is to apply pressure to the injection site with the thumb for 10 seconds just prior to the injection. People often use this technique in reverse when they experience pain. For example, a person bumps his shin and immediately rubs the injury to reduce the pain.
Another technique involves gently stroking the skin within an inch of the injection site as the insulin is being administered, using the fingers that are not being used to pinch up the skin. This may take some coordination and practice. If a second person is available to assist with injections, he can softly stroke the skin near the site as the injection is given. There is also a small, plastic device available called the ShotBlocker that helps create pressure distraction around the injection site.
Reduce pain where possible. Families may seek the advice of their medical team in choosing the smallest, shortest needles and lancets for their child. Some children may also find comfort in icing the skin for 10–20 seconds prior to injections. This can help by desensitizing the receptors in the surface of the skin.
Help older kids, too. Be available to support school-age and adolescent children as they become more competent at completing diabetes management tasks independently. Older children may still experience some anxiety or discomfort around diabetes tasks. Children are more likely to engage in coping behaviors with an adult acting as a coach than they might on their own.
Follow-up and support
Fear and distress over needles are appropriate responses to the management of diabetes for many children. In most cases, parental efforts to reduce anxiety and improve coping will be sufficient. However, some situations merit closer attention by a mental health professional, such as if a child frequently remains upset for more than 10 minutes after an injection or fingerstick. Similarly, if insulin is not being properly administered or there is great difficulty in following the blood glucose monitoring schedule recommended by your health-care team due to your child’s distress, seek immediate support from your child’s diabetes care team.