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Many pediatricians don't take kids' pain seriously - particularly when it comes to ear infections and sore throats, writes Dr. Ralph Berberich in Pediatrics.
Wendi Fellner always nursed her baby daughter when she got her childhood immunizations, and that baby has grown into a 9-year-old who’s pretty fearless about shots.
But Fellner, who lives in Winter Park, Fla., will never forget her first -- and last -- visit to the office of a new pediatrician she tried when her daughter was four months old.
The nurse told her it was against the practice’s policy to allow moms to breastfeed babies while they were getting shots. Infants could choke on breast milk if they started crying from the shot, don’t you know?
In fact, the nurse went on, it was against policy for parents even to touch infants who were getting immunized. Liability issues, you know, she told Fellner. What if the parent jumped when the baby screamed?
Policy-schmolicy, Fellner thought. She persuaded the reluctant nurse to bend both of the rules and then quickly found another doctor for her daughter’s next checkup.
Pediatrician Ralph Berberich, who practices in Berkeley, Calif., has heard too many stories like that. Frustrated, Berberich and Dr. Neil Schechter, a pain doctor at Children’s Hospital Boston, wrote an article entitled “Pediatric Office Pain: Crying for Attention,” that will be published next month in Pediatrics. The journal posted the piece online Monday.
Many doctors, and their office staffs, don’t take kids’ pain seriously, Berberich told msnbc.com. They view shots as a rite of childhood that prepares them for a lifetime of doctor-inflicted pain.
“They don’t know that the literature shows there are indeed lasting consequences,” Berberich says. One in 10 adults is phobic about needles, he notes, and you can bet that fear stems from a heavy-handed doctor in childhood.
Even less attention is paid to pain from sore throats and ear infections, Berberich says. “Doctors are very afraid to put medications in the hands of parents and trust that they will know how to use them.”
Study: Sugar water helps newborns' pain
In 2009, Berberich reported in Pediatrics about a method to distract kids from shot pain. It involves a cooling spray on the site of the injection and a vibrating massager that meanders down the other arm.
When the massager reaches their elbow, children are told to say “elbow,” which makes them forget to say “ouch,” Berberich says.
While the method “is very successful,” it requires an extra nurse and perhaps a couple more minutes of time, he says. Ultimately, though, it saves time and money, because he doesn’t have to cajole frightened patients into letting him administer shots.
Parents can help, too. Recent research supports Fellner’s belief that breast milk might be the perfect pain reliever for infants. And, Berberich says, “If the parent says, ‘I would rather have my child in my lap, most pediatricians would agree.”
With toddlers own up; be honest. Don’t say the shot won’t hurt, but also don’t say it will hurt only a little. Best to say “I don’t know how it’s going to feel for you,” and change the subject to what treat you have planned for afterward.
In his practice, Berberich tops off children’s shots with a cookie.
What are your tips for helping your child get through a painful experience? Tell us on Facebook.
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I love my pediatric doc who told hilarious (at least to me) bathroom jokes. I never felt the shots.
How can you cry when the doctor is telling fart jokes? Even my mom was laughing!
My doctor just distraced me by talking to me.
But in reality, shots don't usually HURT. They just feel uncomfortable. A pressure that you aren't used to feeling. People get all worked up about getting a shot and manifest a pain that isn't really there.
Maybe that is your experience, Rado, and I am glad for you, but it most certainly isn't mine. I'm not phobic about shots. They don't scare me. They do hurt. What is the definition of pain if it is not "unusual discomfort?"
Everyone's experience and perception is different. A baby isn't going to get worked up about a shot, so if they start crying, it probably didn't feel so good.
It's unnecessarily cruel to strap babies down on "papoose" boards to insert an I.V. without prior numbing of the needle site. It can take multiple tries to place an I.V. needle into a chubby baby with tiny veins -- each attempt is terrifying and the baby's screams can be heard all over the clinic.
What about giving parents a small tube of EMLA cream to rub on the planned insertion site(s) beforehand and then aiming a cooling freeze at the site during the insertion? Babies who need I.V.'s may already be struggling with painful conditions, and pediatricians should do more to reduce the pain and panic.
I had a doctor that knew you just had to distract the kid for a split second and they wouldn't really notice the shot. The funniest thing was when he asked me to count to ten in German when I was getting my booster shot (and he didn't know that my parents were giving both my sister and me German lessons). I guess he was just trying to confuse me enough to distract me from the needle. When I actually started counting in German, he was so shocked he forgot to give me the shot. The look on my mom's face was priceless.
I think this is very true, in that the "pain" of a shot is far more psychological than physiological. I've seen a big tough guy who cut his finger nearly all the way off with a table saw with no more than a simple, "Ah, crap" have a serious freak-out when he was presented with the needle for the tetanus shot that followed.
Children typically look to the parents (especially mothers) on how to respond to pain. If a mother responds traumatically then the child is more likely to respond similarly. The worst thing in the world is for a parent to freak out, which is why many parents are often not promoted to be in the room for IV insertion. Distraction both before and after for the child is an excellent method for pain reduction. For younger children it's good to use something somewhat new and more shiny but also soft and older children something much more cognitive it better. For children who know how to count or know their ABC's have them say them backward. This actually even works well for adults. Try counting backward from 100 by 13's. The cookie or candy is a better reward for visiting the doctor and being a good patient. It is best given after the child has finished vs. right after a shot. Oh and don't have them hold their breath!!! unless absolutely needed for a procedure, as it elevates anxiety, which is what you are trying to reduce.
The nurses were always sweet to my babies when adminisering shots. I always held them, and afterwards the nurse took the time to distract them with a special toy and help them forget what just happened. They sent them home with a special sticker they got to choose.
When my daughter was 5, I she had finished all her childhood shots required for school, and the only thing left was the flu shot. I said she could decide for herself whether to get it (but of course I intended to have her choose yes), and so for weeks we discussed it. Every time she had the sniffles, I'd remind her that the flu is similar but much worse, and would she like to get a shot that is a quick pain, or possibly get the flu which is a little pain that lasts a long time? She thought about it for a long time, and finally told me she would like a flu shot. Since she totally owned the decision, in her mind, she was on her best behavior in the clinic. How can you complain about a decision you made, after all?
Our family doctor always said he wanted ''his '' babies to like him so Mom always held the baby while he gave the shot from behind.
I have always told my children that the shot will hurt, but just for a moment. They know what to expect, so it's not as scary for them. I wonder how parents who tell their kids it won't hurt respond to their child afterward when they ask "Mommy, why did you say it wouldn't hurt?". I think it's great that Mrs. Fellner stood up for her child and demanded that she be able to comfort him while he got shots. I don't know if it was the reporting or what Mrs. Fellner actually said, but I don't think breast milk relieves pain. It's the comfort and security the child feels when breastfeeding.
My son's doctor is so good that we sent my sister there for her son. We are allowed to hold him when he gets shots...in fact, if we weren't, I think I'd be looking for a new doctor.
Oh, so the cookie will wipe away the trauma? Good thing we have know-it-all parents and doctors to set us straight.
That's not exactly what it was saying nor was it the point. But glad to know your defenses are up and ready to detect offense at the slightest provocation. I'm sure you know best in all things.
Okay, so shots aren't the greatest thing in life, but trauma? Really? That seems to be a little bit of an exaggeration there.
@Tricycle Rabbit, Idk. I knew a person who avoided doctors for YEARS after a horrible needle experience.
I probably could have worded that better, but I meant in a general sense, most people don't get traumatized from shots. I don't doubt that it has happened to some people who've had bad experiences.
I'd get a shot in exchange for a cookie. Even a placebo. I bet you could get a kid to CHOOSE the shot if you told him it would end in a cookie.
Maybe stories re children should not allow comments.
Look at what the parents have to say here.
WHO are the children?
How about the pain baby boys feel when their genitals are cut apart? The pain of 1 million babies every year is ignored by money-hungry, unethical doctors. When are US doctors going to catch up with the rest of civilized societies and stop mutilating babies?
Join a growing movement for peace in our country and the world - say NO to male genital cutting aka circumcision.
I thought the article might mention that to. Having your penis sliced apart HAS to be agony but no one gives a crap. Oh well.
I don't really have an opinion on circumcision but I think it's a little unfair to say that the doctors are money hungry or describe it as cutting their genitals apart.
Doctors are doing a procedure currently not considered unethical in this country due to parent's demand and are not receiving exorbitant amounts of money for it either. Maybe they shouldn't but I think they and parents probably need to be convinced that the practice is harmful, not just called names and demonized.
Now days they basically put a clamp on that pinches the foreskin so the skin falls off on it's own over the course of a week or two. It's probably not pleasant but if it was terribly painful I doubt parent's would let their children obviously suffer (and infants have no trouble crying if they are displeased) over this time.
The doctors numb the area during circumcision, and it prevents the spread of diseases such as HIV. And this article is not about that.
There are different methods used to circumcise, and some babies definitely suffer great pain, although some don't seem to feel much. The procedure is occasionally botched or causes permanent problems later.
Elizabeth, it does not prevent the spread of HIV. Those studies showing it can HELP prevent the spread were done in Africa, which a completely different society than the U.S, and the results cannot be extrapolated to apply to the U.S. A circumcised male who has unprotected sex and is exposed to an STD can certainly still catch it, so this is not a valid reason in itself to subject a baby to the procedure. There are cases where it's needed later, but it's never needed as a preventative measure.
I think this article is about all procedures done on children that cause pain, and how that pain is viewed and handled. We clearly still have a long way to go as a society on this topic.
I think the reason they don't hand out cookies after circumcision is the patient's age. Most newborns can't properly chew and swallow a cookie, but children receiving vaccinations can. Otherwise I'd definitely agree that circumcision patients should get a cookie.
I agree w/ Kell on that one! If we are concerned about the way children respond to shots, shouldn't we be discussing the excruciating pain and trauma that is inflicted on brand new baby boys when they have their genitals cut? Seriously, 80% of OB's admit they don't give proper pain medication before CUTTING A CHILD's PENIS. Think about that for one second.
How many men do you know who's penises get hurt by the wind? And how many of these same men would volunteer to have a knife taken to their genitals without pain medication? I am going to bet 100% of men would kill anyone who strapped them down and cut their beloved penises w/o pain meds. The fact that this even takes place in a westernized, civilized country is absolutely abhorrent. Especially when all other civilized countries have nearly abandoned it, and Sweden, Denmark, Netherlands, Germany, Austria have all declared it a violation of human rights.
Say no to cirucmcision. It's painful, it's unnecessary, no medical organization ANYWHERE in the world recommends it, and it violates human rights to bodily integrity. His body, his choice.
If you are concerned about vaccinations, but you strapped your son down and had the most sensitive part of his penis cut off, well, a re-evaluation of you concern about pain levels is in order.
Boys deserve respect, and cutting genitals of babies is unethical beyond belief.
I agree completely. There is no excuse to do that to a little baby, who can't say "no". It's horrible. And parents are actually STUPID enough to believe that it's "cleaner" and "more attractive". They think that it's "just a little piece of skin", when in truth, the penis has MANY sensitive nerve endings that are vital to a healthy sex life/pleasure.
Number one: It IS possible to keep an intact penis clean, there is NO need to remove skin for cleanliness.
Number two: I don't care if it's more attractive or not...these parents are basically saying that they're sons are ugly if they are uncircumcised....@!$%# that. If a woman can't love a man enough to accept his penis the way it is, then she's not good enough for him. There's NOTHING ugly about an uncut penis.
Number three: You will damage nerves and sensitivity is you circumcise your son. Who are you (parents) to deny him that pleasure by cutting the skin off? Exactly
I think boys should be left uncut. And if they choose later in life to be circumcised, then at least it will be THEIR decision, and NOT their parents. At least it will be consensual. And that is how it needs to be. There ought to be a law against circumcising babies, since they cannot say "no', that way, the power and choice, is in the man's hands when he's older.
Circumcision might have made sense in places with lot of sand and dust, and shortage of water.
I don't care if it "makes sense" or not. It should be the individual's choice.
Personal choice. In my son's case, phymosis made it necessary. This subject always brings out heated discussion - just like breastfeeding, bike riding in the streets, and how immunizations cause autism.
It doesn't have to be heated. In certain cases, where a valid medical condion warrants it, then I can make an exception. If it is vital to the health of the child, then that's the one exception to the rule.
But aside from all that, parents should not be circumcising their babies for religious/cosmetic purposes.
When doing a clinical rotation as a student, I watched a surgeon do 10 circumcisions. The babies were lined up side by side and each was done in a couple of minutes. They were given Tylenol prior and several slept right through the circumcision. The others cried momentarily about as much as they did with the PKU stick. I think that it must be much much worse for an adult
Even if it is worse for an adult, I think it is wrong to do it on a little baby who has no say and is totally helpless.
At least adults are able to give consent, and it is not as big a deal as you're making it out to be.
Circumcision is done at an age when the infant does not remember the event or the pain. The brain is simply not wired up for it. For all intents and purposes, from the infant's perspective, it never happened. I don't see what big deal is then.
I agree it's sad how many babies are circumcised, but please do not spread false information. European countries have not declared it a violation of human rights. The Muslim and Jewish populations are allowed to have the procedure done there for religious reasons. In fact, Americans or anyone else living there who chooses it for their child can find a doctor to do it, but they must pay for it out-of-pocket. It's not illegal, is my point.
Just because they forget about it at a certain age, does not make the experience itself any less traumatizing....I heard a baby scream being circumcised.....I don't care what ANY of you say, you do NOT circumcise a baby. I do not care about the "wiring of the brain". ONLY if there is a medical condition that warrants it, do you circumcise children and THAT'S IT.
It does NOT matter if they forget about it, that doesn't change the fact that they HAD NO SAY in the altering of their bodies. I say it needs to be the choice of the individual, not the doctor or mommy and daddy....just because she gave birth to him, that doesn't necessarily give her total control over the newly SEPERATE BEING.
Therefore, parents need to say no to circumcision and let their sons decide for THEMSELVES when their older. Circumcison should be on the individual's own terms, not his parents'.
Trauma is really only trauma when it is remembered, if it's not remembered there's no psychological damage, and therefore, not trauma.
However, don't take this the wrong way, I agree with you on not circumcising infants, unless there is a medical need for it.
We don't let parents cut off the tips of a baby's fingers or toes just because it's for 'religious' or 'cosmetic' purposes.
I know babies who have been through much much worse that circumcision and are not traumatized in the least, everything from babies with brain surgery to toddlers with diabetes, and these children that I know have turned out just fine. I don't think trauma should be the issue. The biggest part of it is that it takes the decision away from the child (who will one day be an adult). Although I have never known personally a guy that longed to not be circumcised anymore, it is removing something from their body without consent. That being said, I am not sure if we would circumcise if we had a boy. I would leave that decision up to my husband as I don't have a penis.
if a 2 year old is raped by her uncle but doesn't remember it does that mean it never happened? research is showing even things that happen in the womb stay with us and are "remembered" by the body and brain for a lifetime. even if the conscious memory can't recall the violence it STILL HAPPENED and is stored in the cellular memory of a person.
and actually yes, several european countries state forced genital cutting is a violation of human rights. the netherlands last year said it is a violation of the child's autonomy. swedish doctors recently urged a ban on genital cutting for any reason. no medical associaton in the world recommends infant genital cutting.
please, there is NO MEDICAL REASON to cut a child's normal and healthy body. give your child the most peaceful beginning there is and leave their bodies alone.
That presumption is what allows the forced genital cutting of so many helpless, voiceless boys be cut every single day. The truth is, it's much worse for an infant who cannot express his pain levels, who is defecating on an open wound in diapers, and cannot receive adequate pain meds. Further, the penis is underdeveloped at birth and the foreskin is fused to the glans, like fingernails to their beds. In order to remove it a probe must be shoved between the two as the foreskin is then pried and then sliced from the glans. This is similar to having your fingernails cut off, without adequate pain medication, and 10K times WORSE because it's the genitals, not the fingers.
Most parents who circumcise anymore in the 21st Century, and aren't doing it for religious reasons, are greatly misinformed on the importance of the foreskin, its function in infancy and adulthood, and have NO IDEA what their sons are going through. Parents who are adequately educated on the harm done, the male anatomy, and respect their children's bodies don't cut their sons' genitals.
It is a human rights issue, and we will see this barbaric, archaic and harmful practice come to an end, which will be for the better of humanity and our sons and all of their sexual partners. After all, the foreskin makes sex even better than most Americans are experiencing it!
Also, another brand new baby died from a Jewish ritual where the mohel strokes the penis until it is erect, cuts the foreskin, and then sucks the blood off the wound. If that doesn't sound like sexual assault, I'm not sure what qualifies. This ritual has no place in our society any longer, especially when it is stealing the lives of precious little boys. You can read the article here
Look up Neurogenic Shock during infant circumcision.
Kell Bell, what does a 2 year old being raped by her uncle have to do with circumcision???
There are ways to do it without hurting a child, or making it worth the hurt. If it's a single injection, tell them to pinch their nose. Harder! Is that the best you can do???? Oops, we're done. But practice for next time, because I want to see you pinch that nose! Never had one that didn't giggle at me.
In the ER, if we were going to have to do something painful, I asked them if they had a job. Usually they would say something about having to pick up their toys. I would tell them that yes, that was their job at home, but did they have a job away from home that they got money for? Almost invariably they would laugh and say they were too little. I would tell them that at the hospital we gave even little kids jobs, and they were going to have a job that paid real money. I would fill both their hands with change, and tell them that their job was to hold the change tight under their hiney and hold really still. If they did that, they got to keep the money. If something hurt, they could yell as loud as they wanted, and if they asked me to I would help them yell, but they had to hold still. if they took their hands out or moved, I got my money back.
I have never gotten my money back, and generally they were so concentrated on holding still that they felt little or nothing, they said. I've never had to hold down or papoose a child who was old enough to know what money is, and it's something they learn pretty young.
When I was a child, my doctor was an old Norwegian who thought that if he pinched me really hard at the site of the shot that I wouldn't think the shot hurt so much. Needless to say, I became absolutely terrified of shots and had to be tricked into going to the doctor! I've never lied to my kids about shots. They hurt a bit but it doesn't last (at least not as long as the bruises from those pinches did). The truth works best and a treat on the way home does wonders.
Meh... it all depends on the kid. My 4 year old didn't even flinch when he got his. It's not like a fear of needles is a life threatening emergency. What, we're supposed to get through life without ever being afraid of anything now? Try getting pertussis, that's a lot more scary than a little needle poke.
My kids have stood quietly for shots since they were old enough to stand. I've also always given them a dose of a pain reliever before hand and since they were toddlers let them have a sucker while they had them. Some thing I read somewhere that having something sweet while they were having the shot minimized the pain. I'll always remember my 5 year old's comment though after he received his kindergarten shots. He was very stoic about the shots themselves and then when we were walking to the car told me, "Mom, that hurt worse than getting run over by a car!". No, he's never been run over. Guess the Tylenol and sucker didn't help as much as I'd thought.
Lawyers are the ones dictating how doctor should practice, that's the sad state of medicine in this country.
Kids needs to know that there are going to be things in life that hurt. If you protect them too much they'll never learn how to handle it.
"prepares them for a lifetime of doctor-inflicted pain" Would say that, that line of thought really would not encourage many people to go to a doctor. Is that what some doctors and staff really want to teach children that they need to be prepared for a lifetime of doctor-inflicted pain.
Kinda funny that on the one hand, they run an article claiming that childhood trauma is the likely cause of needle phobias, and on the very same day, they run an article about arachnophobics that says that research increasingly shows early childhood trauma has little or nothing to do with phobias.
Good grief, msnbc, make up your mind. Or at least cross-check your own "science" articles against one another to look for conflicting claims. Otherwise you end up looking pretty amateurish.
I agree that some drs, not all, ignore pain in children BUT I also would point out that vaccines are not necessary and can damage children as well. We have two injured children and will no longer vaccinate as it is too risky and studies show very little if any immunity due to vaccines.
While I cannot speak to the condition of your children, the rest of your statement is a flat out lie (which calls into question the truth of any statement you make). There are decades worth of hard data to contradict your wild claim.
It is worse as they get older. My 7 yo got a flu shot last month and he was babying that arm all evening (I can't get dressed - I can't move my arm, etc). Woke up the next a.m. and he had forgotten all about it. But when he was 5 and got a whole bunch, he was only upset until the sucker hit his mouth. What a whiner.
Tell the Moms to suck it up. You think he cares you went to a new doctor?
Way back in the old days, hypodermic needles looked terribly enormous. My parents had to restrain me every time I got a shot. I hated shots so badly that I kicked, cursed, bit and spat on the doctor, his assistant and everyone around. When time came for me to take my own children for their shots, I had to leave the room for fear of fainting right there... Bottom line: Shots hurt, and they are traumatizing!
The REAL bottom line is that dying from suffocation while being fully conscious during a tetanic seizure hurts a whole lot more than a tetanus shot ever will.
I have a lifelong phobia of getting shots/injections of any kind. It's not really the pain that gets me, idk what it is, but I have uncontrollable panic attacks any time I know that a needle is about to be puncturing my skin and injecting me. It's gotten to the point where I can't even have my blood pressure taken without getting antsy because I don't like having my circulation cut off, it reminds me of those horrid rubber bands they use to make your veins pop up.
I've always been naturally very thin w/tiny veins that ROLL, just my luck. When I went to get immunized for kindergarten the idiot nurse had to stick me like six times with a 'butterfly' and ever since then I have not been able to handle shots/iv's unless I'm seriously on death's doorstep. Hospitals ignore the term phobia as you just being a big baby and offer no sort of pain relief whatsoever no matter what your age. A incompetent nurse scarred me for life by not knowing when to get someone else who could actually administer a needle. I'm pregnant now and terrified of giving birth because there's no frikkin way I can allow an epidural into my spinal cord, so now I have to give birth w/virtually no pain options against my wishes.
To this day I cannot control my panic attacks anytime I have to get bloodwork done, and NO amount of looking away, distractions, or thinking about something else has EVER helped...this is a real life altering phobia and doctors/nurses should be trained in sensitivity, especially to children, to prevent more stories like mine.
I draw blood for a living and have for many years...I have seen a lot of needle phobia in my years...I have seen health care professionals that can dish it out but cant take it themselves...and believe me, there is always a traumatic event(s) that have taken place in that persons life ,(mostly when they were children) that have set them up for a lifetime of panic in the drs office when the needle is whipped out...I have seen grown men cry like little girls over it and isn't pretty...The human psyche is a curious thing, and I think this subject is worth paying attention to...
Thank you! Sometimes it seems like nobody understands...luckily for me my doc's office has a lady who is very understanding
Pediatricians tend to be politically correct lib tard idiots.Take your kids to a good family practice Doc.Has anyone ever read some of the political agendas The American Academy of Pediatrics put out? Simply put a bunch of left leaning radical idiots.
Adults who never outgrew the habit of calling people names more properly fit the label "tard" that you are tossing around. In other words, look in the mirror, and ask yourself why you, an adult, are acting like an adolescent at the back of a middle school bus. It could be that your brain isn't capable of anything else.
My son always laughed when he got his booster shots. Then, a resident, with an attending doctor, was told to insert a butterfly IV, poorly I might add. Stupid resident, even stupider doctor for allowing this to go on for 3 pricks until I demanded they stop.
Thankfully today, he has gotten over his fear...slowly. Children are not pincushions for inept medical personnel to learn on, makes you wonder who graduated this maladroit bungler.
I wish I could say this was my first and last experience with substandard practices by medical 'ha ha' professionals. There shouldn't be a pass-by-the-skin-of-your-teeth diploma when it comes to dealing with people's bodies.
I recall the first IV I started as a medical student. It was in a lovely, very ill, 13 year old who asked me straight up, "Is this your first IV?" I replied, "yes" to which she said "Oh, OK" and let me proceed. She knew I had to learn somehow, and that as long as I was honest with her, she was willing to be my "guinea pig". That was pver 20 years ago. She's long since dead, but in her short life she demonstrated that the wisdom of daughters can vastly exceed that of momGrandmas. She had other virtues as well, of course.
When you invent the perfect procedure simulator, or suddenly become competent in the medical field to the extent you can criticize those who work as hard at improving themselves as the resident you cited, do let me know.
There is a big difference between a 13yr old teenageer who knows in advance to expect potential mishaps and a small preschool aged child who is more sensitive to pain and doesn't expect the doctor to make mistakes. Practice may make perfect, and I applaud you for genuinely trying to learn, but don't act shocked and offended if something goes wrong and the child is traumatized...you stuck them, not the other way around