Fear and pain are among the most common side effects of getting a shot, and a new clinical guideline says vaccination programs still are not routinely doing enough to prevent them. Published Sept. 21 in the Canadian Medical Association Journal, the guideline lays out 16 recommendations for reducing distress during vaccine injections, from breastfeeding infants during the shot to numbing creams and music for older children and adults.
The timing matters for U.S. families. Fall is the busiest season for flu shots, COVID vaccines, and back-to-school catch-up doses, and many parents brace for tears at the pediatrician’s office. The guideline’s message is that much of that distress is preventable with simple, low-cost steps.
It also matters beyond one appointment. According to the guideline, needle fear affects roughly 33% to 63% of children and 14% to 63% of adults, and pain and fear concerns influence about 10% of people to delay or refuse vaccination. Distress can also trigger dizziness or fainting, which can lead to injuries from falls.
Options Sorted by Age and Setting
The authors organized their advice into five categories they call the 5Ps: process, procedural, physical, pharmacologic, and psychological. Each category targets a different part of the vaccination visit, and vaccine recipients and caregivers are encouraged to choose the options that fit them best.
For babies 12 months and younger, the strongest advice is comfort through feeding. Breastfeeding, bottle-feeding, sweet-tasting liquids, or a pacifier during the injection can reduce pain, according to the CMAJ release on EurekAlert. Singing and toys can also help distract infants.
Topical anesthetics, the numbing creams or patches applied to the skin before a shot, are recommended for all ages. On the clinic side, the guideline recommends injecting without aspiration and using a rapid injection technique, and giving the least painful vaccine first when several are due.
For older children and adults, music is the distraction with the strongest support, and games, videos, and toys are also options, according to CIDRAP’s summary of the guideline. The authors also recommend planning coping strategies ahead of time using the CARD system, which stands for Comfort, Ask, Relax, Distract, and was developed by several of the guideline’s authors.
“Research shows there are effective ways to reduce distress,” said lead author Anna Taddio of the University of Toronto and The Hospital for Sick Children, adding that these strategies are still not routinely built into vaccination programs.
Strength of the Evidence Behind Each Tip
The guideline updates a 2015 version and was built using the GRADE method, a widely used system that rates how certain the evidence is and how strong each recommendation should be. The panel drew on five systematic reviews of randomized and quasi-randomized trials published through Jan. 31, 2025, and included vaccine recipients and support persons as voting members, according to a companion methods paper and the guideline itself.
Not every recommendation carries the same weight. Seven are strong recommendations, mostly backed by moderate to high certainty evidence, including multi-part education programs and feeding or pacifier use for infants. The other nine are conditional recommendations based on low or very low certainty evidence. Four of those favor certain approaches, such as reducing fear cues like visible needles, and five advise against others, including video or movie distraction for infants.
In plain terms, this is a clinical practice guideline built from reviews of controlled trials. It shows which comfort measures have the best support. It does not change which vaccines people should receive or when, and it was written for Canadian practice, though the strategies themselves are not country-specific.
The scope also has limits. The guideline does not cover severe needle fear that leads people to avoid care entirely. For that, the authors point to exposure-based therapy delivered by a mental health professional. People with developmental and intellectual disabilities were underrepresented in the underlying research.
Putting the Advice to Work at the Next Appointment
Parents can act on several recommendations without special equipment. Plan to breastfeed or bottle-feed an infant during the shot, and tell the nurse ahead of time. For toddlers and school-age children, bring a favorite toy or queue up music, and talk through the plan calmly beforehand rather than springing the shot as a surprise.
Numbing creams take planning. The products studied need to be applied about 20 to 60 minutes before the injection, depending on the product. Some are sold without a prescription in the United States, and families can ask a pharmacist or clinician which product fits a child’s age and how long to leave it on.
Adults with needle anxiety can use the same toolkit. Music, a numbing cream, and simply telling the vaccinator about the fear can make the visit easier. People with a history of fainting during shots should say so, since lying down and tensing large muscles can reduce symptoms.
Most reactions after a shot are mild. Soreness, redness, or a brief fever are common. Anyone who develops hives, swelling of the face or throat, or trouble breathing after a vaccine needs emergency care right away, which is one reason clinics may ask patients to wait a short time before leaving.
Cost is rarely a barrier to the simplest steps, since feeding, holding, distraction, and positioning are free. Families concerned about the price of numbing creams can ask whether the clinic stocks them.
The guideline’s authors hope clinics adopt these measures routinely rather than on request. Until that happens, families can ask for them directly. The takeaway is practical and reassuring: pain and fear during shots are common, but several proven strategies can make the experience easier for babies, children, and adults alike.
Key Questions Answered
What is the new guideline? It is a 2026 clinical practice guideline published in CMAJ with 16 recommendations for reducing pain and fear during vaccine injections across all ages.
What works best for babies? Breastfeeding, bottle-feeding, sweet-tasting liquids, or pacifiers during the shot are strongly recommended for infants 12 months and younger.
Are numbing creams recommended? Yes. Topical anesthetics are recommended for all ages, but the products studied need to be applied about 20 to 60 minutes before the injection.
Does distraction help? Yes. Music has the strongest support for older children and adults. The guideline advises against video or movie distraction for infants.
Does the guideline change vaccine schedules? No. It addresses comfort during vaccination, not which vaccines to get or when.
What if needle fear is severe? Severe needle fear falls outside this guideline. Exposure-based therapy with a mental health professional is the recommended approach.
When is a reaction after a shot an emergency? Hives, facial or throat swelling, or trouble breathing after a vaccine require emergency care immediately.
Published by Medicaldaily.com