This video provides an overview of vaccine anxiety in children and tips for how to support them in a clinic setting. There is a special focus on children who have also experienced trauma and/or parental substance misuse. This information is presented by Melony Williams, LCMHC, from TLC Family Resource Center in Claremont, NH and Torie Miele, MS CCLS, Child Life Specialist at the Children's Hospital at Dartmouth Hitchcock in Lebanon, NH.
Presenters
Melony Williams, LCMHC and Torie Miele, MS CCLS
About our presenters:
Melony Williams is the Clinical Supervisor for TLC Family Resource Center in Claremont, NH. She is an experienced Mental Health Counselor who specializes in working with young children and their families and families who have experienced trauma, loss or grief. She provides direct client care individually and in groups, supervises home visitors who work for the TLC Family Resource Center, and provides consultation to community providers.
Torie Miele is a Certified Child Life Specialist at the Children’s Hospital at Dartmouth Hitchcock. She works with children and families in the hospital to help them cope with medical and other difficult life experiences. She focuses on the mental, emotional, and social needs of each individual child and family and provides guidance through knowledge of child development, therapeutic play techniques, and family centered care.
Learning Outcome(s)
At the conclusion of this learning activity, participants, with knowledge of the effect that previous trauma (such as witnessing parental substance misuse) may impact a child’s presentation in a clinical setting, will be able to describe at least two strategies to reduce anxiety for children in preparation for receiving injections.
Disclosure
In accordance with the disclosure policy of Dartmouth-Hitchcock/Geisel School of Medicine at Dartmouth as well as standards set forth by the Accreditation Council on Continuing Medical Education and the Nursing Continuing Education Council standards set forth by the American Nurses Credentialing Center Commission on Accreditation, continuing medical education and nursing education activity director(s), planning committee member(s), speaker(s), author(s) or anyone in a position to control the content have been asked to disclose any financial relationship* they have to a commercial interest (any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on patients). Such disclosure is not intended to suggest or condone bias in any presentation, but is elicited to provide participants with information that might be of potential importance to their evaluation of a given activity.
The Activity Director(s), planning committee member(s), speaker(s), author(s) or anyone in a position to control the content have reported NO financial interest or relationship* with various companies. There were no individuals in a position to control the content that refused to disclose.
*A “financial interest or relationship" refers to an equity position, receipt of royalties, consultantship, funding by a research grant, receiving honoraria for educational services elsewhere, or to any other relationship to a company that provides sufficient reason for disclosure, in keeping with the spirit of the stated policy.
Bibliographic Material
Resources
- Help Eliminate Pain in Kids and Adults (HELP)- ways to make vaccinations less painful
- CARD: Comfort, Ask, Relax, Distract
- Info for parents, kids, providers
- Longer webinar available: Reducing Pain and Fear: Integrating evidence into routine immunization practice
- AAP Toolkit for TIC
- AAP Guidance on Supporting Emotional and Behavioral Health Needs of Children during Covid-19
- AAP Guidance on Support Child Welfare Involved Families during Covid-19
- General information for vaccinations with children:
- Vaccine Administration
- Administering Vaccines
- 2011 Video “The Family Experience with Primary Care” – what it’s like for children with mental illness and their families interfacing with primary care providers- NAMI
For PARENTS:
- https://www.cdc.gov/vaccines/parents/visit/
- 9 Things You Can Do For You And Your Baby
- Mirror and Match: De-escalation techniques
- Meg Foundation for Pain
- 7 Tips to Help Your Child Overcome a Fear of Shots
- Helping the Child Who is Afraid of Vaccines
- Addressing Vaccination Anxiety in Children
- Parents can Help Reduce Pain and Anxiety from Vaccinations
Medical Trauma Resources:
- NCTSN
- Pediatric Medical Traumatic Stress Toolkit for Health Care Providers
- Health Care Toolbox, from Center for Pediatric Traumatic Stress (CPTS)
Resources for Mental Health:
- Children's Mental Health: Depression
- Anxiety Disorders in Children
- SAMHSA’s Guidance for a Trauma Informed Approach
Where to purchase items:
- Buzzy
- Shot Blockers
- Stress balls and other fidgets
- Comfort position posters - Rainbow Comfort Measures from Rainbow Babies and Children's Hospital
Contact: Lissy Zaremba MA, CCLS;
Clinical Educator, Family and Child Life Services
[email protected]
Phone: (216) 844-1353
Journal Articles:
- McMurtry, C.M., Taddio, A., Noel, M., Antony, M.M., Chambers, C.T., Asmundson, G.J., Pillai Riddell, R., Shah, V., MacDonald, N.E., Rogers, J., Bucci, L.M., Mousmanis, P., Lang, E., Halperin, S., Bowles, S., Halpert, C., Ipp, M., Rieder, M.J., Robson, K., … Scott, J. (2016). Exposure-based interventions for management of individuals with high levels of needle fear across the lifespan: A clinical practice guideline and call for further research. Cognitive Behavioral Therapy, 45(3), 217-35. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4867871/
- Ahmadpour, N., Weatherall, A. D., Menezes, M., Yoo, S., Hong, H., & Wong, G. (2020). Synthesizing multiple stakeholder perspectives on using virtual reality to improve the periprocedural experience in children and adolescents: Survey study. Journal of Medical Internet Research, 22(7), e19752. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7395245/
- McMurtry C. M. (2020). Managing immunization stress-related response: A contributor to sustaining trust in vaccines. Canada communicable disease report, 46(6), 210–218. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7343055/
- World Health Organization. (2019). Immunization stress-related response: A manual for program managers and health professionals to prevent, identify and respond to stress-related responses following immunization. Geneva (CH): World Health Organization. https://www.who.int/publications/i/item/978-92-4-151594-8
- Sørensen, K., Skirbekk, H., Kvarstein, G., & Wøien, H. (2020). Children's fear of needle injections: a qualitative study of training sessions for children with rheumatic diseases before home administration. Pediatric Rheumatology Online Journal, 18(1), 13. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7007654/
- Felitti, V.J., & Anda, R.F. (2014). The Lifelong Effects of Adverse Childhood Experiences. In Chadwick’s Child Maltreatment: Sexual Abuse and Psychological Maltreatment, (Vol. 2, pp. 203-216). St. Louis, MO: STM Learning, Inc.
- Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., et al (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) study. American Journal of Preventive Medicine, 14, 245-258.
- Merrick, M.T., Ford, D.C., Ports, K.A., & Guinn, A.S. (2018). Prevalence of adverse childhood experiences from the 2011-2014 Behavioral Risk Factor Surveillance System in 23 states. JAMA Pediatrics, 172, E1-E7. doi:10.1001/jamapediatrics.2018.2537
- Substance Abuse and Mental Health Services Administration. (2014). SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach. HHS Publication No. (SMA) 14-4884. Rockville, MD: Substance Abuse and Mental Health Services Administration.
