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Review Opens Bag of Tricks for Reducing Pain from Children’s Shot

interventions and hypnosis, said Uman, a doctoral student in clinical psychology.

Distraction can be as simple as having the child count or listen to a story or music while getting the shot. For example, a very young child can be distracted by blowing soap bubbles, Uman said.

Distraction could also include having a television for the child to watch or a video game handy, said Lynne Gerson Maxwell, M.D., associate professor of anesthesiology at the University of Pennsylvania. It can also be far more low-tech. Some anesthesiologists do magic tricks to keep their young patients attention off the needle. "I sing to kids when I put them asleep," she added.

"Cognitive-behavioral interventions are those aimed at targeting thoughts (cognitions) and behaviors. They are designed to help the child develop and apply coping skills in order to manage the pain and distress," Maxwell said. The health professional can explain what will happen so that the child knows what to expect, and also encourage the child to use a distraction during the procedure.

Many of the techniques do not require much training on the part of doctors or nurses and can be easily implemented, Uman said. Hypnosis requires more training, but it has been taught to children in as little as one or two sessions plus some practice time.

"Hypnosis is a skill that the children can then take home with them and use again during other subsequent procedures," Uman said. "Furthermore, the evidence shows that hypnosis is effective in reducing both pain and distress during needle procedures, specifically during more invasive ones such as bone marrow aspirations and lumbar punctures."

Although topical anesthetics can help reduce the pain of a shot, they often need to be applied in advance. In contrast, the majority of psychological interventions can be used quickly and easily and do not need much advance preparation, Uman said.

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