As some of you may know, a big part of my job as a Registered Nurse is to do well baby vaccine appointments (as well as see people across the entire life span for other vaccinations – I also do a lot of other stuff, but that’s a topic for another post) since I work in the family health setting.

I know how stressful these appointments can be for parents. Since I became a mother, I also now understand it. If you’re choosing to vaccinate your children, this post is for you – this is not a post to pass judgment on anyone because I don’t believe that an “attack” stance works well to educate parents (or people in general) on why vaccines work. However, I am always more than happy to discuss the benefits of vaccines, vaccine schedules, and preventative health measures (and I imagine your provider is too – so if you have questions/concerns you should bring them up with them!).

The intention of this post is to provide information to parents who are planning to have their children vaccinated and maybe feel a bit nervous about the whole process, or are looking for ways to help support their child during/before/after their appointment.

*Disclaimer: This blog is intended for informational purposes only. The information on this blog should not be used as a substitute to medical advice or medical treatment. As always, your Primary Care Provider, a doctor, or another health professional is your best resource for specific questions and medical advice. If you believe you or a loved one are experiencing a medical emergency, please contact 911.*

A Couple Quick Facts About Immunizations

• Vaccines prevent ~2 to 3 million deaths per year
• Most vaccines are about 90%+ effective at protecting against vaccine preventable diseases (such as the ones listed below)
  • Routine childhood immunizations help protect against several diseases such as: Tetanus, Diphtheria, Pertussis (whooping cough), Polio, Hib, Meningitis, pneumococcal diseases (such as pneumonia), Measles, Mumps, Rubella, Varicella (chicken pox), and Rotavirus
• Routine childhood immunizations take place at 2, 4, and 6 months; 1 year; 15 and 18 months; and 4-6 years (they are then followed by the school-age immunizations)
• They are safe – vaccines go through rigorous clinical trials before they are released for public use; each lot or batch of vaccines is also tested to ensure it is safe for use (your provider is also doing their own checks before administering any vaccines to you or your child); public health and/or government drug agencies also do regular inspections of anywhere that makes AND/or administers vaccines to make sure they are being stored properly, made safely, and so on; there is also a reporting system in both the US and Canada to track adverse events
• They are a heavily studied area – there is lots of research on vaccines (some reliable, others not so much – that’s why it’s important to know how to find reliable resources) – along with the clinical trials, these help to make sure they are safe, reliable, and effective (among other things)

Now, here is some info that can help you prepare for an upcoming immunization appointment:

Step one: Don’t panic. Prepare yourself.

That’s right – this is the biggest and most important step to making your child’s vaccination appointment run smoothly. Babies and children can sense stress in their parents – and it can impact them. So if you’re stressed about the appointment and you’re showing this, it’s possible that your baby or child may echo this response. This makes the whole experience more difficult for both of you.

Obviously, we can’t always control the stress and anxiety we feel – but you can make a mindful effort to try and manage it beforehand by doing things like educating yourself, talking to your provider about how these appointments go (a good time to bring it up might be at a newborn discharge appointment, for example), and preparing yourself as much as you can to be a good support person for your child, like you always are!

As a new mom, I know it’s easier said than done. I felt a lot of anxiety going into Maggie’s two-month appointment even though I know exactly how these things work. That’s why it’s also a good idea to…

Have a support person with you to help (and I know this is hard during COVID, so I’ll offer some alternative suggestions).

You don’t have to do this and right now you may not be able to even bring your partner, which is incredibly difficult and I am sorry for that. I do know a lot of parents who take their children alone often though and if it’s any comfort – know that they do just fine.

If you can bring someone with you and you want to – it is a good option, especially with a very young baby. At the 2-month appointment you may still be physically recovering from birth in many ways (or you may be recovering beyond that too), and it’s nice to have someone to help you out a bit. It’s also just nice to have an extra pair of hands for your stress levels and mental health during the appointment – especially if you feel particularly worried or nervous.

If you have a partner, family member, or support person who is pretty level-headed they are a great option – but it’s whoever you feel would be the best resource for you.

Since during these times, only 1 parent + child is often allowed, you may have to stick it out on your own. But you’re not totally alone – your healthcare staff are there to support you in anyway you need. Again – even this is hard for us right now since we can’t interact with babies and families the way we used to, but sometimes just having someone to talk to before, during, and after is a huge comfort. I know I always make an effort to gauge parents preparedness and comfort before I vaccinate a child – because then I can determine how much time I need to provide them with the type of support they need. Don’t be afraid to be honest with your provider or nurse about needing more support during the appointment.

Pain Management Tips

Distraction is your friend.

An office or a nurse will have their own way of distracting a baby or young child during these appointments – anything can work. Don’t underestimate the power of distraction. I can tell you that I have given a one-year-old three vaccines before without tears because the dancing dinosaur in our office is that good.

Other things I’ve seen work – mom/dad talking/singing/dancing/distracting-anyway-they-can; bubbles (used these a lot in the paediatric clinic I did my preceptorship in); and for children who are a bit older, iPads/tablets with a favourite show or song playing (some research shows that this method helps parents to have a better experience too, since it gives them comfort that their child is in less distress – however a recent review showed that videos may not decrease pain but that musical distraction is more effective).

That same review found that breathing (such as having the child blow the bubbles, using a pinwheel, or having them just follow cues to breathe) is also effective for pain reduction. Grab a pinwheel or small bottle of bubbles, or other similar device at the dollar store before you hit up your appointment!

If you breastfeed, try nursing during or after; or use a pacifier!

Breastfeeding is an often underused form of pain management during immunization appointments. However, research shows that it is effective – more-so than the use of sucrose. From my personal experience, I find that either feeding during or immediately after is the most effective, depending on the baby.

If you don’t breastfeed – pacifiers work too. They may reduce the amount of crying during/after the procedure, especially at that first 2 month vaccine appointment. However, pacifiers may not be as useful at the 4+ month appointments.

I mentioned sucrose too, which is commonly used in hospital on the postpartum unit for venipuncture for baby – however, research is conflicted over how long sucrose is actually effective for in regards to pain management. As baby grows older, it doesn’t seem to as effective, however more research is needed to determine when the effect on pain management decreases. I do not use it for babies in clinic – partly because we don’t have it, but also because distraction or breastfeeding works best at 2+ months from my personal experience. However every baby is different! Trial and error may be needed.

Another option for non-breastfeeding mothers or for a dad/loved one is to just hold baby during the vaccines. Touch is comfort. Your provider can help you to position your baby so that they are comfortable, safe, and so that the vaccines can be easily given. Skin to skin contact is even better for your babes under one.

Provider Tip: Sitting up positions are more comfortable and have been shown to cause less distress in children than laying down positions!

What about anesthetic creams or numbing patches?

I have a lot of parents ask about these options for pain reduction for their child. There are topical anesthetics that are safe for babies such as EMLA.

Studies show that they do seem to help with distress reduction for injections. There is also currently no evidence to suggest that they have any adverse effects in regards to the intended immune response from the vaccine.

If you are going to use them, you can apply them just before you head to your clinic (30 mins or so), but follow the instructions or guidance from your provider and/or pharmacist.

Provider Tip: It is great to be able to provide these options in clinic for patients! Especially if waits are usually a bit longer (which between entrance to clinic – to appointment – to vaccines they generally have a bit of time).

Things That Are Good to Know

Where the vaccines will be administered.

Generally, from 2-6 months, vaccines are administered in the vastus lateralis muscle or the outer third of the quadricep. I know the schedule is or can be slightly different in the US and in some other provinces, however in Ontario specifically at 2 and 4 months baby will receive one needle in each leg, plus the Rotavirus oral vaccine. At 6 months, it is only one needle and the Rotavirus dose orally (it used to stop at 4 months, but Rotateq is given in 3 doses – till 6 months).

At the 1 year appointment, this shifts to the needles being administered in the deltoid and the back of the arm for the live vaccines such as MMR (Measles, Mumps, Rubella; it does not go into the muscle but the subcutaneous layer between the skin and the muscle). Sometimes, if there are multiple vaccines (like baby is also getting the flu shot at this time for example), one will still be given in the leg. This is a document from Alberta Health Services but it very clearly illustrates where the injections will go – and though the schedule may be slightly different for you depending on where you are, it will give you a basic understanding of what to expect at your appointment.

Why is it important to know this? So you can know where and how to hold your baby – a nurse/provider may help you with this and provide specific guidance too. It’s just good to be prepared – it also lets you know where to look when you take baby home, especially with live vaccines such as MMR where post-immunization rashes are possible.

Contrary to popular belief, you should not give medication like Tylenol prior to the appointment.

Some people do this to prevent fevers or febrile seizures (which I talked more about in my post on fever misconceptions), or just to reduce pain. Giving ibuprofen (Advil/Motrin) or acetaminophen (Tylenol) before or too soon after can actually reduce the effect of the vaccine. There is a good explanation of how this happens here.

There is currently no evidence supporting the idea that either of these drugs have any benefit if given prior to the vaccines. The pain management tips I discussed above are more supported by evidence (as you can see by the studies I’ve linked), and in following with current Canadian and American recommendations. However, you should discuss this with your provider & see what their specific recommendations are.

After an appointment, acetaminophen can safely be given for pain/irritability or fever (ibuprofen when baby is >6 months old) – follow the recommendations regarding timing, dosage, and fevers-to-treat guidelines from your healthcare provider. They will either discuss this with you at your appointment or send you home with this information.

What can I expect after an immunization appointment?

Reactions to childhood vaccines are usually very minimal and easy to deal with. Immediately after the immunizations are given, you and your child will usually have to wait 15-20 minutes in office to be monitored to make sure there is no major reaction (~1 in a million dose occurrence). Once you go home, a few things can be expected or would not be considered uncommon reactions:

• Irritability/fussiness – this is common, though it depends on the baby. More napping (especially at 2+4 month appointments) that day, more cuddling, more eating (or less is also common) may all happen as a result.
• Injection site swelling, tenderness, redness – just like after you get a shot, this type of reaction is common. That is why I said it was important to know where your child gets their needles – so you can monitor the area. Major swelling of the limb is less common (1 in 30 children) but has been seen with the Tetanus combination vaccine (also known as DTaP).
• Low Fever – can happen – follow the recommendations from your provider regarding medication + dosage, as well as any guidance on a temperature can be treated at home vs. a temperature that may be high and require further attention
• Rash – with MMR and the chickenpox (varicella) vaccine, this can occur at the injection site and it can be delayed. It is usually a very mild rash – if you notice something like this, contact your provider for further guidance or follow the guidance they give you at the appointment.

There are other possible minor reactions that can be found on information sheets for each vaccine, but these are generally the most commonly reported.

Anaphylactic reactions (severe reactions) usually occur very shortly after the vaccine is given. They are rare.

When Should I Contact 911 or Seek Care?

Follow the advice and guidance of your provider! If you are EVER worried – call them, 911 in an emergency, or call a service like Telehealth (or equivalent where you are) if your provider is not available but you don’t think it is an emergency.

If your child is having trouble breathing, loss of consciousness or severe weakness, facial swelling, or you think they may be in an emergency situation – call 911.

Seattle Children’s provides a good list of when to call 911 vs. when to seek care from ER/urgent care vs. problems that may be able to be assessed the next day (your provider should also give you this info and you should follow their guidance first and foremost). However – you are the parent and you know your child best. If something seems wrong, don’t feel guilty for seeking guidance or care.

Anything else I should know?

• Bring your child’s immunization record with you to the appointment (if you remember) – if you forget, just bring it to your next one so it can be updated (I personally forgot mine at the 4 month one so – it happens!)
• Be familiar with the schedule for vaccines – if you are late coming in or miss an appointment, it can be rescheduled (talk to your provider)
  • Canadian recommendations (please see your provinces as well)
  • US recommendations (please see your states as well)
• Discuss any concerns or questions you have with your provider – as always, they are your most reliable/trustworthy source for information. There is a lot of information on the internet that is not reliable – be weary and aware of this as you read through the internet.

Hope this is helpful!