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Npr. Hey.

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Everybody, it's Marielle. I'm

0:22

just pop in and for a minute here

0:24

because today are gonna hear from our friends

0:26

over at Npr Signs podcast short wave. They

0:28

did this great episode recently about shots the

0:31

kind you get the doctor's office. They're.

0:33

Scary for a lot of people, especially

0:35

for kids. But. There are things your

0:37

doctor's office can do and things you can

0:39

ask for to make it easier. Here's

0:41

the episode. His. Your

0:43

waivers. I'm Tom. Dries Buck now. Normally

0:46

have an investigative reporter here at Npr

0:48

News digging into secrets and things no

0:50

one knows about. But today I'm here

0:52

to talk about something almost all of

0:54

us have gone through at one point

0:56

in our lives going to the doctor's

0:58

office and getting your shots. Now for

1:00

a lot of folks, it's not a

1:02

big problem. You know the nurses sometimes

1:04

say like a little pinch and you're

1:06

done and for little kids do they

1:09

even remember the pain Anyway, while stuff

1:11

on Friedrichs to of says ah yeah

1:13

he. Remembers. Stefan grew up

1:15

in Germany and he remembers this one time

1:17

when he was nine years old he had

1:19

to go to the doctor for an infected

1:21

nail to certain swear holding a down and

1:23

I was screaming at the top of my

1:26

head when one certain set to the other

1:28

do think you can feel any pain and

1:30

the guy said no. And.

1:32

May they burn in hell. That.

1:36

Happened more than forty years ago,

1:38

but that dramatic doctor's visit has

1:40

really stuck with him now. Stuff

1:42

on Friedrichs Dorf is a doctor

1:44

himself, and he's a professor of

1:46

pediatrics. Also leads a palliative care

1:48

team with a nurse manager and

1:50

childlike specialist at U C S

1:52

F. Benioff Children's Hospitals where they

1:54

are trying to prevent what they

1:56

call needless pain from shots. A

1:58

growing up I death. That we had

2:00

this year and when we recently asked

2:03

if you did too, we heard from

2:05

a lot of short waivers. I have

2:07

a terrible fear of needles. I'm infamous

2:09

for being heard in the lobby screaming

2:11

by my brothers. Even talking about my

2:13

needle phobia almost had me pass out

2:15

behind the wheel distant cousin in the

2:18

way of my ability to get tenure,

2:20

confirming surgeries. This has resulted in twenty

2:22

years of not going to the dentist.

2:24

A lot of people get the sphere

2:26

of needles when they're young little kids,

2:28

especially get a lot of shots in

2:30

the first couple years of life. And

2:33

if you've ever had to take your

2:35

kid to get their shots, you probably

2:37

know how tough it can be. And

2:39

it's not just a matter of being

2:41

scared. That fear can make it really

2:43

hard to get treatments that have to

2:45

be injected or get blood drawn to

2:48

run various tests, or get vaccines to

2:50

protect you from diseases and stuff on.

2:52

Friedrichstrasse says that is a serious problem

2:54

for public health. I have prison to

2:56

detail sized certain who died of measles.

2:58

We're not vaccinated. Sleazy children,

3:00

teenagers, young adults and adults are

3:03

choosing to for goal medical care

3:05

that soothing to for go health

3:07

care and that increases their mobility.

3:09

The risk of becoming sick insists

3:11

a metallic seats the risk of

3:14

but there are doctors and researchers

3:16

working on a plan to make

3:18

it better. Today

3:21

on the cell making the doctor's office

3:23

less painful and less scary for kids

3:26

so that as adults, we can take

3:28

better care of ourselves and each other.

3:30

You're listening to short ways from Npr.

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5:38

we are back in talking with Dr.

5:40

Stefan Friedrichstorff about how to prevent kids

5:43

from having to go through needless pain

5:45

from needles. And he

5:47

told me a group of researchers over

5:49

the last decade have helped come up

5:51

with a step-by-step plan. We found that

5:54

if you can offer five things to

5:56

every child, every time, everywhere,

5:58

whether whether it's in children's hospital,

6:00

in the doctor's office, and whether

6:02

this is in high-income countries in

6:04

the United States or low-income countries

6:07

like in the Philippines where we

6:09

are replicating this as well, then

6:11

you can pretty much completely eradicate

6:14

or at least significantly decrease the pain

6:16

and anxiety caused by needle. Let's go

6:19

through those things one by one if

6:21

we could. What is the first step

6:23

to dealing with this problem? The single

6:26

most important thing, the number one thing,

6:29

is to apply numbing cream. Topical

6:32

anesthesia, which you can buy over the

6:35

counter in any drugstore, is called S

6:54

vaccine, whether it's vaccination or blood flow where

6:56

exactly to put this, and then you apply

6:58

some dressing. It needs to be on for

7:00

at least 30 minutes and then

7:03

can be taken off before the need

7:05

of procedure whether it's a lateral vaccination

7:07

or the insertion of an intravenous cannula.

7:11

Wow, okay. How effective is it? Can you not feel

7:13

the needle go in at all or is it still

7:15

just sort of like a little mild pinch or what

7:17

does it feel like? Pain is a funny thing, Tom.

7:19

If I come over right now into your office and

7:21

I hit you as hard as I can on your

7:23

leg and ask you, Tom, what's your pain number between

7:25

zero and 10? You say,

7:28

you know, that's probably an eight out of 10. That's

7:31

a hard hit. Wow. That is

7:33

a hard hit because I just gave you a bruise and

7:36

because your brain is interpreting this

7:38

painful procedure, me hitting you as

7:40

a threat and therefore it's going

7:43

to be very painful. Now,

7:45

let's say that you and I play

7:47

soccer or we play American football or

7:50

dance ballet or whatever it is and I

7:52

accidentally run into you and I give you

7:54

the same bruise, you may not even notice

7:56

that. Interesting. So the kicker

7:58

is, and this is what some people call it, the Sometimes people who

8:00

criticize the numbing cream and say, why it's

8:02

not deep enough, the needle just goes much

8:05

deeper, it's the expectation whether

8:07

or not it's going to hurt. Interesting.

8:09

So it almost seems like the numbing

8:11

cream serves, well, I guess if you're

8:13

old enough to understand what's happening, you

8:15

can understand, oh, this is going to

8:17

make the process better. And that actually

8:19

does make the process better, even if

8:21

it doesn't eliminate the pain totally. I

8:23

mean, I had a lab draw two

8:25

days ago. I did put numbing cream

8:27

on, and I did not feel anything.

8:30

OK. Well, let's go through two through five

8:32

of your protocol then. And the

8:34

protocol you and other researchers have developed, what

8:37

are those steps? So step two

8:39

is to never, ever, ever, ever

8:41

hold down a child. So

8:44

back in the old days, we were

8:46

taught in medical school, in nursing school,

8:48

that the best way to do vaccination

8:50

on a lab draw is to hold

8:52

down children. And we now

8:55

know this is completely utterly wrong.

8:58

When we actually ask children, what does it

9:00

feel like when we hold you down for

9:02

a painful procedure, they tell us that they

9:04

feel ashamed, humiliated,

9:07

powerless, and reporting having lost

9:09

the right to control to his or

9:11

her own body. So

9:14

we now are using what we call

9:16

comfort positioning. So for different

9:19

ages, this is, of course, very different.

9:21

So small babies younger

9:23

than six months, we would use some swaddling.

9:26

For older children, we always recommend for

9:28

them to sit them upright and give

9:30

them a choice. So toddlers very likely

9:33

want to sit on their parents or

9:35

their caregivers' lab. But under no circumstances

9:37

should we ever pin down a child

9:39

with spain then, because clearly this increases

9:42

the anxiety, as you and I remember

9:44

when we were children. And

9:47

three? Three is age-appropriate discussion.

9:50

For little babies, they're maybe sort

9:52

of like little spinning tools and

9:55

blowing bubbles is absolutely awesome. So

9:57

we have the lidocaine cream, the

10:00

Positioning, don't restrain kids, you have the

10:02

distraction, what's next? So the next two

10:04

are different ages. So

10:07

for babies younger than 12

10:09

months, we should always always

10:11

always either offer sucrose, sugar

10:13

water or breastfeeding. Okay,

10:16

and what is the last step?

10:18

So for older children, meaning when

10:20

they're able to talk to us,

10:22

it is really important that we

10:24

change the memory. And

10:26

it's very important how they remember how

10:28

the procedure went. So we have

10:30

to think about what are we doing before, the

10:33

nanopopes during and after.

10:35

So before we don't want to use negative

10:37

words, we don't call it shots or needles

10:39

or pain or hurt, but rather we ease

10:42

it. Is it okay if we're going to

10:44

do something, is it going to be bothered

10:46

for just a very brief moment? The

10:48

story we tell ourselves about how something

10:50

happened, it's important to frame that story

10:52

in a more positive way, rather than

10:54

focusing only on the pain. Correct, it's

10:57

a very self-fulfilling prophecy. And

10:59

then during the interaction, we don't say count

11:01

to three. I mean, that's like the worst

11:03

thing to do. Why is

11:05

that? Why is that so bad? If I'm standing in

11:07

front of you and I'm going to hit you and

11:09

give you a bruise, and I say, okay, I'm going

11:11

to do this when I count to three, that doubles

11:13

the impact. The anticipation. Correct. And then after,

11:16

and this is the most important thing, this is

11:18

the kicker, we want to change the memory. So

11:20

immediately afterwards, after the procedure, we

11:23

say, all done, I'd like you

11:25

to choose a sticker from the goodie box. I'd

11:27

like you to drink a sip of water. And

11:29

then reframe the pain. We basically say

11:31

something like, I'm so proud of you.

11:34

You did so well. Now, when

11:36

you talk to other people in medicine

11:38

about these five steps that you have

11:41

helped to develop, what

11:43

do they think? Do you encounter much skepticism

11:45

from other physicians or nurses who are giving

11:47

a lot of these shots? This is something

11:49

Child Life Specialists have been doing for 20

11:51

years. So they are our

11:54

biggest supporters in implementing this. When

11:57

we ask our own staff and we have to...

12:00

done this, we often find something

12:02

like, you know, this is not

12:04

a priority. Interesting. And when we

12:06

dig deep and actually ask, so

12:08

why is this not a priority?

12:10

Half of our colleagues are telling

12:12

us, it's just not a big

12:14

deal. You know, it's just like, pin them

12:16

down. It's a one second pain and then

12:18

it's done. And they don't anticipate

12:21

how much fear the

12:24

child has afterwards. And

12:26

others are saying it's like, yes, it's a problem. But

12:28

there's nothing we can do about it. Because

12:30

you have to actually get the numbing cream

12:32

on 30 minutes before. I was gonna say,

12:35

I would I could imagine a lot of

12:37

doctors offices say, well, that's another step in

12:39

an already very busy schedule. How are we

12:41

going to fit that in? Right. And that

12:43

is the thing. So how we did this

12:45

is actually said, Okay, you may offer this

12:47

that parents or patients may put this on

12:49

at home. Or you can actually

12:51

say, okay, let's put the cream and when

12:53

you're checked in, and often, realistically, it does

12:56

take 30 minutes until the child sees the

12:58

needle. So we actually found that it's

13:00

not only easily doable,

13:02

it actually did save time. Because if

13:05

you don't need five adults to hold

13:07

down a child for blood draw or

13:09

for vaccination, you can actually see many

13:11

more happier children in a shorter time.

13:13

So it makes your life better. It's

13:15

much more effective. And it's a win

13:18

win win for children and the staff.

13:20

So it sounds like, you know, given

13:22

that getting shots, getting blood draws are

13:24

such a key part of keeping your

13:26

own health, your child's health, and the

13:28

public health protected. This is

13:31

really important to find ways to make

13:33

it a less stressful, less fear filled

13:35

experience. But it sounds like there might

13:37

need to be a little bit of

13:40

a culture change in certain parts of

13:42

medicine in order to make that happen

13:44

for people to take it seriously on

13:46

a broad level. That is correct. At

13:49

the many of children's hospitals in Oakland,

13:51

San Francisco, we are now rolling this

13:53

out system wide and going from unit

13:55

to unit and actually implementing the numbing

13:57

cream, the sugar water of breastfeeding,

14:00

the not holding children

14:03

down and praising and

14:05

giving children choices. But

14:07

that's certainly something which a hospital

14:09

leadership needs to embrace because we

14:11

have so many competing priorities

14:15

in healthcare that despite

14:17

the fact that if you ask a child,

14:20

what is the number one fear? What is the

14:22

number one worry? It's pain.

14:25

Yeah. Well, Dr. Friedrichstorff, thank you

14:27

so much for your time and for all your

14:29

insights. Really appreciate it. Thank you so much

14:31

for having me on the show, Tom. I love you. Now,

14:38

before we head out, a big thank

14:40

you to our colleague April Domboski at

14:42

member station KQED and KFF Health News

14:44

who reported this story for NPR's appropriately

14:47

named shots blog. Also a

14:49

quick shout out to our shortwave plus listeners.

14:51

We appreciate you. We also thank you for

14:53

being a subscriber. We've plus

14:55

helps support our show. And if

14:58

you're a regular listener, we'd love

15:00

for you to join so you

15:02

can enjoy the show without sponsor

15:04

interruptions. To find out more at

15:06

plus dot npr.org/shortwave. This

15:08

episode was produced by Margaret Sereno and

15:10

edited by our showrunner, Rebecca Ramirez. Rebecca

15:13

also checked the facts. Quacy

15:15

Lee was the audio engineer and special thanks

15:17

to you, our listeners for taking time to

15:19

email us your personal stories about being afraid

15:22

of needles for the story. I'm Tom Driesbach.

15:24

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