To Tell or Not To Tell

I am a firm believer of prepping the kids about doctor's visits and "pokeys". I explain everything to my 4 year-old daughter, sometimes too much, but she seems to get it. Maybe I should have taken it as a sign that she cried a bit when she got her DTaP, IPV, and PPD test just a couple of weeks ago. Removing the bandage? That was another fight in itself. Anyway, as we got closer to her next appointment to get her MMR, varicella, and H1N1 vaccines, I started telling her about the upcoming visit. She was not happy about it, but eventually agreed that this was important as long as she didn't need the finger prick again. My husband even played doctor/patient with her all weekend and focused on administering shots. Right before leaving the house, I let her choose a princess figurine to take with her. All seemed fine. She took a nap in the car and she didn't cling onto her booster seat when it was time to go in.

We walked into the examination room and waited. And waited. The vaccine nurse finally came in with her tray (after 15 minutes) and asked me to fill out paperwork and then hold her. I couldn't because I had my son on my lap. After shifting some weight around, I managed to put her on my lap, too. Then the nurse fussed about whether my daughter's shirt should be removed or should she attempt stretching the collar to reach her deltoid (arm muscle). There was more fuss about holding her down and that's when everything fell apart. I was asked to put my son down so I could hold her, but that wasn't going to happen. He doesn't like the office to begin with and he's in his separation anxiety phase again. The other nurse was called in to help hold her down. More fuss about my daughter's clothes occurred. All this time my daughter was screeching and kicking. Boy, she is STRONG! At last, she got an injection in one arm and, after more fuss and fighting, the other two in the other arm.

I don't doubt that the act of injecting into the arm was painful (though two were subcutaneous, or injections into the fat layer) but the anticipatory pain was really off the charts. The delay, the fuss, the insistence of holding her down were major contributing factors. An unfamiliar face can also be a detriment. Our former pediatrician actually administered all the immunizations and drew all the blood samples herself. That was probably why my daughter never ever cried when she got vaccines. All the immunizations were also given on one day without a problem.I also found the immunizer to be unfriendly. I don't remember if she tried to win my daughter over to begin with or not. She could have introduced herself in a friendly voice, tell her it will just be a pinch (or three), and ask if my daughter wanted me to hold her. We had talked about just holding her hand and having her look the other way. The process could have been much quicker. It also didn't help that my daughter forgot her princess in the car.

The bottom line? It is torturous to submit the child to the anticipatory pain twice; she was better off taking the pain of multiple injections on one day. If it weren't for the timing of her second H1N1 vaccine dose, I would have chosen to have all the vaccines given to her during one visit. She has not complained about any soreness. When I asked her if her arms hurt, she said, "no." I asked her what she was so scared of and she said that the pokeys hurt going in. Do I think she would have benefited from local topical anesthetics? Maybe, but that won't take away the anticipatory pain. Improving the external factors alone could have made experience better. Immunizers, please take note, it's not just about paperwork and injections. Make the experience more pleasant for the child (and caregiver) by being more efficient and not insist on having the child held down (unless necessary). Little things make a lot of difference. And I'm still going to tell them ahead of time what to expect.