National guideline aims to ease vaccination stress for children and families
Summary:
Recommendations include the SickKids-developed CARD system, giving families practical tools to reduce fear, anxiety and pain during vaccinations.
For many children, getting a vaccine is much more than a brief pinch. Needle fear, uncertainty about what will happen and unfamiliar surroundings can make the experience stressful for anyone, let alone young patients. Newly updated Canadian standards, published in the Canadian Medical Association Journal, aims to help.
The HELPinKids&Adults Clinical Practice Guideline, led by Dr. Anna Taddio at The Hospital for Sick Children (SickKids), brings together the latest evidence on how to reduce pain, fear and anxiety during vaccinations and give children and families practical ways to prepare.
These recommendations, updating guidelines published in 2015, encourage health-care providers, organizations, vaccine recipients and their support people to work together to make vaccinations more comfortable and less stressful.
New Comfort, Ask, Relax and Distract tool
One key element is the introduction of CARD™, a tool developed by SickKids in conjunction with the University of Toronto that stands for Comfort, Ask, Relax and Distract — an approach that helps families choose strategies that work best for them. It offers a host of tips, such as asking questions ahead of time, bringing a favourite item, listening to music and using a numbing cream.
"With CARD we move away from one-size-fits-all approaches because what comforts one child might be different from what comforts somebody else,” says Taddio, Senior Associate Scientist in the Child Health Evaluative Sciences program at SickKids and Professor at U of T’s Leslie Dan Faculty of Pharmacy.
Taddio says that reducing distress begins long before the needle poke itself. The sights, sounds and clinical environments (even in schools) can all provoke anxiety, but there are relatively simple methods to limit that fear.
The new guideline reflects growing evidence showing that someone's vaccination experience is shaped by a cluster of factors, from pain to fear and anxiety to a sense of losing control. Importantly, each can all influence how children and families feel in the moment — and their willingness to get vaccines in the future.
Dr. Meghan McMurtry, Professor of Psychology at the University of Guelph and a member of the guideline oversight committee, says one of the biggest lessons learned over the past decade is that vaccination support must be tailored to the individual. While past recommendations would prescribe specific strategies based on age, the new version emphasizes empowering vaccine recipients and their families to choose what works best for them.
“Not every strategy is going to work for the given person in front of you,” says McMurtry. “It’s so important for people to find personalized strategies and feel empowered to have choice and some control.”
A shared responsibility
Unlike earlier approaches that focused primarily on health-care providers, the guideline recognizes that creating a positive vaccination experience is a shared responsibility between health-care providers, clinics, support persons and vaccine recipients themselves. Recommendations are grouped by topics and tailored to different audiences.
"The guideline tells you what works, and CARD tells you how to do it," says Taddio. “When you give some of this control to the families and the kids, it takes that extra stress and burden off providers,” Taddio says. “Now we're working together.”
CARD has now been evaluated with more than 20,000 vaccine recipients and adopted in many vaccination settings, including schools, public health clinics and SickKids' own Nuclear Medicine department. Its inclusion in the updated national guideline reflects years of SickKids-led research that aims to improve vaccination experiences across Canada.
By giving children and families the knowledge and choice to decide what works best for them, CARD is an example of Precision Child Health, a movement at SickKids to individualize care for each unique child.
The CARD System
Comfort. Ask. Relax. Distract.
The SickKids-developed CARD system provides strategies that can be used to help cope before and during vaccinations or needle procedures.