Ep 117: How to reduce fear and anxiety around vaccines? with Jody Thomas, CEO of Meg Foundation for pain

Jody Thomas, a clinical health psychologist and CEO of the Meg Foundation for pain, discusses strategies  to reduce fear and anxiety around needles in children.  Many children are affected by anxiety around vaccinations, and the Meg Foundation offers support to families to help.  She provides practical advice for parents to prepare their children for vaccinations, including creating a plan, using positive language, and considering other techniques such as utilizing numbing cream and vibration.  The conversation also highlights the efficiency and improved patient experience that can be achieved by implementing these techniques.  Check out the printable poke plan and other helpful resources on the Meg Foundation website. 

Takeaways

• Fear and anxiety around needles can significantly impact vaccination rates and healthcare decisions.
• Parents can help reduce fear by creating a plan, using positive language, and other strategies.
• Healthcare providers play a crucial role in supporting families and can offer strategies such as comfort positioning and giving choices.
• Empowering children in healthcare and addressing fear early can have long-term positive effects on their healthcare experiences.
• Spreading the message of effective pain management techniques to pediatricians and parents is crucial for improving the overall experience of children receiving medical care.

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Transcript

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Hi everybody, I'm Dr. Jessica Hochman, paediatrician, and mom of three. On this podcast I like to talk about various paediatric health topics, sharing my knowledge not only as a doctor, but also as a parent. Ultimately, my hope is that when it comes to your children's health, you feel more confident, worry less, and enjoy your parenting experience as much as possible. Does your child show signs of fear and anxiety when it comes to getting their vaccinations? Well, if so, this episode is just for you. Today, I talked to Jody Thomas. She's the CEO of Max foundation for pain, and she shares many tips on how to make getting vaccines easier for kids. Max foundation for pain is an incredible resource, I highly recommend checking out their website. There are all sorts of great videos and lots of information to help prepare you and your child for their vaccinations. And also as a quick reminder, before we get started, if you're enjoying this podcast, you can help support ask Dr. Jessica by giving it a five star rating by subscribing so you don't miss a new episode. And also, it really helps spread the word when you share episodes with friends. For all of you who are doing this, thank you so much. And lastly, I'm going to take a two week break during the holidays. So I will be back after the new year. I'm excited to see you back in 2024. I have some great episodes planned for you. Now on to my talk with Jodi Thomas, Jodi Thomas, thank you so much for coming on this podcast, I have to tell you, I could talk about your line of work all day long. I am so interested in what you're doing. And I can't wait to spread the message to help reduce fear and anxiety around needles and kids. Well, I'm completely thrilled to be here. Thank you so much for having me. And I love talking to anyone who loves to talk about pain as much as I do. I want to tell you how I found out about you. So I'm a general paediatrician. And a lot of my day is spent counselling families on vaccines and giving vaccines. And I have a child in our office who has been very fearful of getting shots. And it's always a difficult visit for them. And this last visit, he came in and he was very calm. And he told the nurses when he was ready to get his shots, and everything went really smoothly. And the mother completely attributed this change in what she learned from you from Meg's Poke Plan. And so I first want to start off this interview by thanking you because you really changed the entire experience for this family, in our office and around getting vaccinations. And it's all because of your plan and your plan to help reduce fear and anxiety around shots for kids. So thank you so much. Oh, my gosh, thank you that story makes my heart very, very happy. And that's exactly why we do what we do. So that is could not be more exciting to me. And that's when I said the mother said to me, you should really look it up next pope plan. And so I did. And that's when I got really excited because I'm hoping that by talking to you here, hopefully we can spread this message to more and more families. Because what you say is completely correct that why should we be in pain if we don't have to? Exactly. Well, that's what our mission and goal is, is to reach as many kids and families to really empower them with the tools and information they need to create a really good experience for not only that child, but let's be real as parents, we know that our experience is completely determined by how they're feeling as well. So really benefits all involved. It's true. My husband always says he's happy for me to be in charge of giving the vaccines for our kids. He wants to know that they're getting shots, but he he wants nothing to do with it. He doesn't want to be here. He doesn't want to see them feel uncomfortable or that they're going to be in pain. And so myself as the paediatrician that's sort of been my realm as the parent, but I'm sure a lot of parents or I know a lot of parents agree with him. They they want their kids vaccinated, but they don't want to see them face any sort of discomfort. You're 100% Correct. And the research would back you up. And as matter of fact, that is such a profound source of anxiety and fear for parents, that even pre COVID. One in 12 parents in North America would tell you, they're not going to vaccinate their child, not because of an anti Vax stance, but because they don't want to deal with the freak out around the needle. And that is millions of children. And so the impact on their health is huge. The impact on public health is massive. And not only that is if we're not going to get that vaccine then what does that mean about that blood test? What does that mean about coming in for that good preventative care that we all want as medical providers and you as a paediatrician and frankly want them feeling good about coming in and seeing you that you're not the scary lady who gives shots. You're their awesome doctor who helps them stay healthy and strong. And honestly, I'm actually surprised that that number isn't Higher One and 12 sounds low for my experience. Well, that's the ones who just don't come in at all. The numbers are pretty staggering. So 63% of kids 50% of There's teens and adolescents. And one in four adults have enough needle anxiety and fear to change their health care decisions. Wow. So that's the impact on their individual health and public health is huge. Wow, that's really crazy when you think about it, because obviously, we want people to feel comfortable the doctor, hopefully we're doing well by them helping their health improve. So that's scary, that fear of needles, something as quick as getting a vaccine would be so fearful to them that they would change the course of their health care. Exactly. Well, and what we know even scarier to me is that those early experiences completely determine how they feel about healthcare into adulthood. So everyone listening can think of that adult that they have that relative, they have that quote, unquote, doesn't do doctors, right. They don't go in, they don't want to go. And the implications are huge. So it's not only about those kids developing that fear, but again, those that that 13 year old, who, it's a lot harder to hold down. You know, it's, as they get older, it's harder to force them, which is why forcing them from the beginning is such a bad idea. Because we get bigger and stronger, everyone, we have more opinions. And so the more we're putting that in a place of empowerment for those kids, the better not only right now, but for those years and years and years to come. And that becomes we play the long game, as we like to say, How did you come about being the spokesperson to help make vaccines more comfortable for kids? Well, I am a clinical health psychologist by training. So I specialise in medical illness and trauma and pain. But I really got involved when actually was in a really bad car accident when I was in high school, and then ended up in the hospital for a long time. And so became intimately familiar with kind of the challenges of being in a place like that. And so, in college, I started volunteering and children's hospitals, that turned into grad school. And that turned into this being my whole life. But when I first started working on particular oncology units was where I first started working. And realising despite the fact these kids were dealing with these major huge chronic illnesses. The most distressing things to them day to day, was the procedures and the pokes. And frankly, I got tired of having this picture in my head all the time of this 27 year old girl whose woman who's sitting on my couch, and we're talking about her experiences, she had survived cancer in her teens. But then there's really crippled by anxiety and PTSD and fear from everything she'd been through. And she just looked at me and goes, where the hell were you when I was going through treatment? And the truth is, she had a point, right? If I tell people all the time, and that's really the mission, the foundation is you don't need me, you just need what I know. And we can give that to you and your patient being a great example of that. And so when you have these kids dealing with major chronic illnesses, but those experiences with vaccines are what, you know, most kids, that's our first experience with medical procedures. And that's their first memories of the doctor. And I have to tell you, if I think about what's the hardest part of my job in terms of seeing patients hands down as a paediatrician, it's giving vaccines, you know, when I'm seeing patients, I can hear kids crying in the other rooms, I'm constantly talking to kids trying to make them more comfortable with the vaccine they're gonna get. And I wish I could take that away from them that fear and anxiety away from them. A lot of times, I'll walk into a room a child's quiet, and I know that's what they're thinking about. Yeah. And it starts from a very young age, it starts even after a year, I can tell kids are scared of me, because they know the vaccines are coming. Yeah. And that's heartbreaking. I mean, that, to me is a big part of the motivation for my work. And our work too, is, you know, we love providers, you guys have the most important job that I can think of and but it is the most stressful part is to sit here and be like, I have to cause this child pain. And I don't want these kids to be afraid of me. And so that's such a big part. It's why we have so many tools on our website for providers and what we can do and how we can incorporate into workflows and care. Because that especially in a time when physician burnout and medical provider burnout is so high, they're just never felt than in the last few years more important to be able to support providers to make their job less stressful and causing kids pain is definitely a massive part of that stress. So first let's let me let's get into this a little bit. So tell parents that are listening. What can they do to help lessen fear around shots for kids, there's just something that they can do at home before they come in to see me under percent and I love that you are talking about before they come to see you because the vast majority of that of the problem with the anxiety and fear around needles and pain is the fact that of what happens before they even enter your office is that anticipatory fear and anxiety. So the one thing that I can tell you that is the mistake that most parents make is not telling their kid that there's a shot until they're pulling into the parking lot. And the motivation is pure the motivation, and they will say is, well, I don't want my kid to get anxious about it. And so the example will often give us a look and want you to think of most important work meeting you've ever had in your life. But no one tells you what's going to happen until two minutes before, okay? No, it's not, we've just doomed everyone to failure. So instead, it's not about avoiding that, that anxiety, it's about giving them a way to cope with it and figure it out. And so your patient that you gave at the beginning of this is the greatest example, they came in with a plan. They came in knowing what they want to do, whenever we have a challenge, we just need to have a way of dealing with it. So what parents can do is make that plan as home. That's why the MEG foundation site exists. So you get on there, we have a bunch of tools, we have the Poke Plan, you mentioned even had interactive tech, like the supermag poke planner that takes kids through the various options they have for different skills and strategies, lets them make a personalised plan. And that plan is then emailed to the parent along with the tools and resources they need to make that plan happen. We also have a planning tool, both a teen Poke Plan, and then a planner called the Take Control App for teenagers. And we even have hack the VAX, which is a site for parents because again, that 50 That 25% of adults who are scared, they then are in the position of supporting their kid, we don't want that to go generationally. Because we know that the biggest predictor of a child's distress during that procedure that poke is the parents distress. And so sometimes we'll say like, Are you blaming me? I'm like, No, I'm congratulating you on having a good healthy attachment to your child. And it's good. I want them to care how you think and feel. But we need to take that and, and go with it right. And to really empower ourselves that the more we can go in feeling prepped and prepared, the better it's going to go no matter what happens. So there are a bunch of strategies that we can plan for and use. So parents really have to put themselves in a good headspace before they talk to their kids about shots. It sounds like so that they can't detect any of our anxiety. Exactly. We need to fake it till we make it if we need to. But that's also being able to acknowledge that being like, Yeah, I used to be scared about needles too. But then I figured out all these different ways. And I know it can feel scary, or I know in the past, it has been difficult. But now we are going to make we're going to find all of these different ways that you can feel more comfortable and more in control when we go see Dr. Jessica. Okay, so this is great advice. So just to summarise for kids that are old enough to understand parents advice, before they come in to see the doctor, would you say like a day or two before? Yeah, exactly a couple of days. Yeah, I'd say give it like two or three days. So they have the chance to think about it, come back talk to you about it, we practice if they're little. And again, I want to say that little kids can understand this too, like two, three years old, we can be playing it out. This is where we give pokes to our stuffed animals. We give mom and dad a poke, we practice our comfort positioning, we've talked about it, and mom and dad used to give all this positive positive language around this is going to be great. I can't wait to see you be so brave and strong. This is going to be wonderful. Because we also want to think about the language that we're using. So instead of saying we have to go to the doctor and get a shot, how much different does it sound to say, hey, we get to go to the doctor and get magic medicine that keeps us healthy and strong. sounds so much better. Right? You're like, Okay, we got to get a poke to make that happen. So let's talk about all the ways that we can make that poke feel better or not even feel it at all. We've got all these different tricks, let's figure out which tricks you want to use. I love that so much. Because it's true. I feel like the messaging is more like you have to get it to go to school. You have to get this shot. And that what the way you describe it sounds so much better. Yeah. And it's accurate. That's the thing. We're not lying, right? Like that's the thing when people like, Oh, do you want me to lie and say it's not going to hurt? I'm like, No, we don't lie. But the truth is, is we all have had the experience of getting a shot that you don't even feel right and especially and that's without any the strategies on board. So it bothers us a lot, but it doesn't hurt necessarily. And so being able to just be really, really honest, like providers and parents asked me all the time like well What am I supposed to say if they asked what's going to hurt? In my advice, I assume that you know what, it might bother you a little, it might bother you a lot, it might not bother you at all. But we have all these different ways that we're going to do to help you feel better. Let's talk about all the different ways that you can choose to help yourself feel better when we do it. And I usually tell kids to that it's worse in our heads, we can build it up as being a much worse experience and much more powerful, uncomfortable experience in our own heads. And then in actuality, it's never as bad. And so constantly reminding that to children. And I hope it helps, because I really do believe it. Yeah, no, and it is true. But our expectations, you hit on something that's so important that our expectations and that experience, define it, as America is really, really cool research, that what we say after that a poke, determines their memory of that experience, and their expectations moving forward. And those expectations determine their future pain experiences for like decades. It's pretty crazy. It's super interesting. We have a video on the website that we called framing the story that coaches parents on what to say on that car ride home, from that vaccine appointment, that can completely determine how those next appointments go. So it's really cool. And it's all about just highlighting the positive. And talking about what went well, and reinforcing the good coping, they did, no matter what happened. So it's an all this again, it's not that hard. It's not complicated, doesn't take a lot of time. It's not expensive. It's just about learning a few tricks, as we like to say, Okay, so from the parents, and we have to fake it till we make it. We're going to have a plan ahead of time. We're going to use a lot of positive language. Yeah. Now. So that's good for the older kids. Now, what about for the littler kids? What about for the younger ones? Because they they come in feeling anxious before they can speak? So for those kids. Do you have any suggestions for parents? Yes. So one of the most powerful things we can do is start from moment one from birth, using good strategies, because that parents anxiety comes with those newborn appointments like those new moms, like there's no one, myself included, you know, even a child psychologist and knew a lot of children and did this. And again, it's just anxiety producing to be that new mom. But knowing that we do things like breastfeeding during a poke is the most powerful thing we can do. You have the sucking and the the skin to skin and the contact with mom. So that beautiful flood of oxytocin. So there's a lot and the number one thing there often is providers telling parents not to breastfeed during a poke. They're like, Oh, that they're going to associate with pain. Totally not true. They're going to choke on the milk. Also not true. We can't get a good safe position for the child unless we hold them down flat. Also untrue we have things like comfort positioning, so fun moment one, and even if you're not breastfeeding, skin to skin, if possible is best. Comfort positioning, holding that child is going to absolutely be your best bet distraction, extremely powerful. And for the little littles even glucose, pacifiers, so literally sugar water on a pacifier 30 seconds before and 30 seconds after undoes a stunning amount of the damage. So my daughter, for instance, was a NICU baby, she was born at 33 weeks. We have a crazy amount of data on the fact that those you know our newborns are not done cooking, their neurological systems are not done cooking. And when we damage those neurological systems by not using pain management around procedures, we actually increase rates of the risk of depression, anxiety, chronic pain, and their pain sensitivity for their lifetime. And what is really nice is that very simple interventions, like the glucose pacifier and breastfeeding during pokes can completely undo that risk. So it's so so weird to people that that simple of intervention can be that powerful that that research has been redone over and over and over again, because it's almost hard to believe that that simple intervention can help but it also helps Mom and Dad know okay, I can hold them, I can pat them and we can do the natural mom thing of like that rocking that really does help them keep calm and that their whole neurological system is different. So we can also use numbing cream on full term infants. We can use numbing cream on those littles like that six month shot year and 18 months. That going with numbing cream and telling kids that this is this is also a magic cream that helps you not feel a poke. And that expectation is Totally different. But numbing cream is one of the least use and most effective. It is a number one best practice recommendation by the World Health Organisation the American Academy of Paediatrics every major health, paediatric and pain org in the world would recommend the use of numbing cream, topical anaesthetic, and you can get that over the counter. Now, it used to be hard meant like this burden on the paediatrician to prescribe and do and pick up and whatever. Now you can order it on Amazon for 12 bucks, or pin just so parents know what the name of it is, what is it called just a general, topical lidocaine, there's dirt. Yeah, typical topical lidocaine, there's a bunch of different versions, we actually have a guide on our website, and also a video explaining how it works. It's really not that hard to get it all at 4% is kind of our minimum 5% is best if possible for the 5% lidocaine. And what we recommend, because usually the challenge with that from the provider end is it takes it can take a little bit to work. Yes, but the truth is, is if they put it on in your waiting room, by the time they're weighed and measured and get through the rest of your appointment, we have 2030 minutes anyway, so you're fine. But it also usually has about a two hour window two to three hours of efficacy. So they could put that on at home. Put on a big fat bandaid or saran wrap around that leg or that arm. And it's totally good to go. And it becomes a security blanket of sorts, right? We can walk into that appointment feeling like Oh, I'm covered. I'm good. I've got my numbing cream on. I know Dr. Jessica is gonna ask me about all the things that I wanted to do to make it better. And she gets explained to me how cool it is that this cream on my skin makes it so I don't have to feel the Poke. That's great. There's a couple of things you said that really blew my mind here because I feel like I've been taught wrong. I was taught that we should not let kids breastfeed while they're getting their vaccines, because as you mentioned, they said that a child might associate breastfeeding with pain. So immediately after the vaccines put them to the breast but not during the vaccines. And also there was a point that maybe it'd be harder for nurses should have mommy breastfeeding at the same time. What if the baby bites the nipple as a reaction when they're getting their vaccines? And it might be a liability to the paediatrician. So for all these reasons, I was taught not to do it. But what you're saying makes so much sense to me. There's no way that a quack vaccination would negatively impact how much a baby enjoys breastfeeding just doesn't make any sense. Exactly. It doesn't. And you're this is the most common thing you were undoubtedly literally taught that every like so many providers were taught that despite the fact that there's just research upon research upon a research that's wholly untrue. And it's just one of the very persistent myths around pain and pain management, that keep good practice from happening. Because you're you're certainly not alone. You're unfortunately in that regard. And really good company. I'm just thinking Babies love being held by their mothers being breastfed, it's a fun thing to do. Why not do that and distract them while they're getting their Pokes 100% It's the most comforting thing we can do. It's primal. And it's primal. For us as a parent, like the biggest trauma in those first appointments regarding pain is for the parent who's freaking out that their kid is being held down flat on their back and stabbed and they're screaming, and we feel like we're failing as a parent and as a mom. And that's that trauma that we're bringing in. So when you're like, even those kids who can't talk or anxious, I'm like, Mom is anxious. No kid is picking up on it. And they know, like everyone's walking into that appointment with dread. And I don't want them to walk in with dread, I want them to go and excited to see you and to tell them about what's going on. Right. So with a comfort positioning of a kid, because that's the other concern, we get asked that all the time, there are really effective way. So we actually have a couple of different guides on our site, one is longer for providers, and one is shorter. So the quick and dirty version, as we call it for comfort positioning because we agree kids should never ever be held down for medical procedures they should and there's massive research that it causes medical trauma. That said, of course, we need kids safe and still right we need that baby to be still we need that three year old to be still so we can safely give them that needle. But there are ways so there are really good guides we have on our site that showed you show providers how to do it and show providers how to coach parents in use your elbow to keep those legs and you your call your cradling the head are the different options that there are so everyone can feel like they are keeping the kids still in safe because we want providers to feel like they're able to give this safely to it's not about just letting it go. Alright, that's really helpful because I agree I don't like holding kids down. In fact, I won't do it. But some parents will ask us to their kids are upset and they just want to get it done and will ask us to hold their kid And then, because the parents are asking we do that doesn't happen very often, but it feels really uncomfortable. Yeah. And that thing I just want everyone to like, listen to our gut, right? And we're like, God, this feels bad. And you're like, yes. This is not the thing we need to be doing. But we need to find a way to get this done. Because we agree, we want that poke done. We want everyone safe. Gay vaccines go Better Living Through Chemistry and public health. Good. That win win win for everybody. Absolutely. No, and I and I'm so appreciative that you taught me about the Lidocaine being now available over the counter. Because when I first started practising as a paediatrician, sometimes parents would call me and ask me to call them in a prescription for it. And you're right, that's a little bit of a, I don't want to say it's an annoyance because we want to do everything we can to help families. But if every family called and asked for a written prescription before their vaccines, that's a burden on the paediatrician, which would be to say that, but I'm so happy to hear that it's now over the counter. Yeah, absolutely. It was it was a major game changer because of course, it just it the question is workflow, right? Like you are extremely busy, you're not sitting around your office in the day going, gee, Whatever shall I do to fill the time, right? And so we want to make things fit into a workflow and fill into the flow for busy parents who are trying to get in and out. And for paediatricians, who are trying to see as many kids as possible to keep them all healthy and safe. Now, what can I do as a paediatrician and what can I teach to the nurses here, and my staff here to help make the experience better for families? Because I hear what you're saying, and I love it. I want to implement as much as I can. The reality is, sometimes when kids take a long time to tell us it's okay to give the shots. It's really hard when we have such a busy day and the nurses can't spend too long waiting. What's your advice there? Can the nurse say to the family, for example, take your time we'll come back after the next patient or what should we do as a paediatric office. It's an excellent point. And that's because that's what we really want. So everything like we do, we have in mind not only that family, but the but the paediatrician and that office, because you have lots of people we don't have all the time in the world. And in a lot of ways, letting that kid sit there and let their anxiety rise and rise and rise is actually counterproductive. So that is where that plan coming in. becomes extremely important. So then we go in and quick. The anticipatory anxiety is usually our biggest enemy. So as paediatricians, if you have kids who you know, have a history of a lot of anxiety, then what we want to do is make an appointment where we know they can get in and out and done. Okay, so sitting in that waiting room with anxiety building and the freaking out and and all this is going to be not good for anyone involved. And so these are kids from a practice perspective, a great we want to do you guys first thing in the morning. So we know we can get you in and out and there's not a lot of waiting. We want to have everything prepped. So like even during COVID When vaccines were so important, and parents were, you know, obviously incredibly, incredibly worried about their kid getting vaccinated, but we're dealing with so much anxiety. We did a lot of planning around this. So even when we talk about vaccine clinics, it's okay so we want kids who are really anxious to be just sitting in the car watching their iPad or watching a video so distraction so on those things, we have vibration, which we can get into if you would like distraction comfort positioning, having a plan numbing cream, that that distraction not only needs to happen during that poke, but before the Poke as much as I am in the battle and as a psychologist and like less screens, please no screens, please. This is not the time to restrict. This is free for all yes. So when we are sitting there waiting in the car and on the way when that thing might be oh my gosh, this is intimate getting a poke. Is this gonna happen? This is when we're sitting there watching Peppa Pig or bluey or hilarious America's Funniest Home Videos or whatever your teenager wants to because let's not forget they are also struggling, that anticipatory anxiety and ask them so as paediatricians. One of the most powerful thing as providers, thing we can do is offer choice. Action is the enemy of anxiety and the more power and control we can give appropriately, the better. So hey, do you want to do your posts at the beginning of the visit instead of the end? So we can just get it over with and be done. Great. Do you want us to have it ready when you come in? So when we're walking in, we're sitting there being like great. I understand you got a plan. Excellent. Want to sit on mom's lap? Wonderful. You are numbing cream on how wonderful great we have a busy bee here. So we can do vibration if you want to to. Oh which video you're you're watching bluey. I love blue. That's amazing. Great. Boom, boom, boom, we're done. That was incredible. I'm so impressed. You did great job. Wonderful. Now let's go tell me more about fill in the blank all your other well child visit things that you have to find now move on and just move on. So but giving that choice which arm do we want the pokin? Which videos we want to watch during? Do you want to sit on mom's lap or dad's lap? Do we want to which position do you want to have? What reward are you getting after? Oh my gosh, ice cream. Excellent. What's your favourite ice cream? My favourite ice cream is this. Oh, look, we're done already. That's amazing. I'm so excited. You know what your paediatrician I can't say ice cream every day. But ice cream seems great ice cream day to day. Right? That that pattern all of a sudden we are done. I love that because we feel like so anxiety comes when we can't control the future when we feel like we're out of control. So yes, feeling like we're in control making those decisions left to right arm. When it's going to happen. I could see how that reduces anxiety. It does. And it becomes the false choice. I mean, it's a real choice. But it's not Do you want to get a shot or not? Because the answer that is going to be no. This is like you know the toddler putting on his shoes do you want to put Do you want to get your coat on before after you put on your shoes, but we're putting on our coat and our shoes. That becomes that any single thing it gives power and control. They don't have the power and control over deciding over that poke. But the moment we give them power and control over anything else, the better it's going to go. This is so helpful. I have to tell you my oldest child, she's now 13. She has severe anxiety over vaccines. And she's been really excited for me to interview you. I told her all about the topic she can't wait to learn. She really genuinely was so excited this morning. And I told her today was the day is going to interview you. And learning from you has been so helpful because I thought for example I did it did her a favour because last winter, I brought a flu vaccine to our home. And I thought oh, this is going to make it better. It won't be in the medical office. And it ended up the night went on so long before I actually gave her her vaccine because she was so nervous. She got so worked up, you know, let's say wanted to give her the vaccine at 6pm. Yeah, her mind just got out of control it just slowly and surely got worse and worse and worse. And then I think it took a couple of hours until she was finally ready for me to give her the vaccine. I think where we really I can see where we made a mistake. I didn't have a plan ahead of time. Yeah, and I mean, again, it's all sounds good, right? Like, okay, we'll have all this time, it'll be relaxed. But the truth is that larger window of uncertainty becomes its own source of stress, right. And we need that that brain cannot get too far out of control. Yeah, okay. And it's important, especially, first of all, I'm so excited to be able to have all the ways to help your daughter. And I really would love her to check out our take control app, I think she'd great because it really is about specialty. And I love those 13 year olds, because we really want them to be developing their voice within health care, right, we really want them to be the ones starting to advocate for themselves and communicating with their doctors directly. So they go in with this really positive relationship with their doctor and healthcare and feel like they have a voice in it. And I'll tell you two, she's one of these kids where, from the age of four, she finished her primary vaccines, and she knew that there were more vaccines to be given at 11 years old before Middle School. And we started freaking out that yes, I mean, it was years on her mind, oh my goodness, I'm getting closer and closer to 11. And I feel so bad that the weight of the vaccines was on her brain for years until she turned the dreaded age of 11 when she had more vaccinations. So this is so I have to tell you just from a personal level from from a professional level, I really love what you're doing. Thank you so much. We it's your thank you because you're doing such a great job of illustrating to us like why this is such a passion project. For us. This isn't just about a few difficult moments in the doctor's office. It's everything else that happens next. And we want these kids to be able to be like, Okay, I've got this. Yeah. Is it fun that? No, I don't ask you to like getting a poke. I just don't want it to be the thing that determines anything. So as I tell parents, look, there's a lot of decisions we have to make regarding our children and health care. I don't want fear making that decision for you. Fear should never make a decision for us. And I don't want fear making your daughter's decisions like when she's like okay, do you need a more COVID Booster? Do we want HPV vaccine? Do we want a flu shot? Do we need to do that blood test that we should do to figure out this weird infection that you're having that it is that yes, that is good. That's what's my doctors recommending? Not oh my god, how am I going to handle this? And as they get older, this shame factor comes in. Okay, because the researchers also too Tell us for the kid for the parent and the provider between about 11 and 13. We've decided that Nope, this is not cute anymore. And they just need to quote suck it up. Yeah, okay. And we can suck it up, make sure I can pick Yeah, difference happening. 100%, right, we get your like, if you can sit here and you can to handle the responsibility of having the phone and you can clean your own laundry, and you can do this and you can handle the shot. And I was like, I would like to introduce you to the 25% of the adult population that cannot. So it's this is trauma. Okay, that's what I must remember, this is trauma, it is not logical. It's like it's not logical. I'm like, of course, it's not the end, I would say I've had a lot of instances, I can think of where parents just back out of the vaccine, they said that they'll say, You know what, I'd rather my kid get the flu, I'd rather take the chance that they might get the flu this year and deal with that then deal with this situation right now where they're so worked up and anxious over the vaccine 100% Like, and this happens, like, during the COVID vaccine rollout, we did a lot of work with like HHS and the Surgeon General's office and I was lucky enough to be a trusted messenger for there we can do this campaign, is it we know that vaccine uptake would have been improved by at least 10% in the adults, if we could address anxiety, needle anxiety and fear 10% In adults, so let's think about how that translates to kids. And so we know that parents aren't getting vaccines, because they just want to deal. And again, my fear is it's not about that flu vaccine that year. What happens when they're 25? What happens when they're 45? And I want them to walk in being like, here's my health issue, not Oh, my God, I don't want to tell her because she might think I need a blood test. Or she might need I need a shot. And I don't want to tell her that. What No. And there are so many ways, and especially especially as kids get older, vibration is a really powerful strategy. There's a device called bezzie B, which is specially designed for this, you have that fantastic. You know what I read about it, there was a New York Times New York Times article maybe 10 years ago, yeah, I came out promoting it as a way to distract from vaccines, we do have it, we don't end up using it that much. Because we found it was kind of troublesome for someone to figure out how to hold it, and then someone else to give the vaccines if you have so I do. We have lovely, amazing. We have some videos about it on the site, we have a quick tip thing on the site about it, but one of the most powerful things we can do. So basically, it explained to everyone who's listening, it's simply vibration. So it turns out that to experience pain, a signal has to reach our brain pain actually happens in our brain. And so this is basically just the fact that that signal has to go from wherever that pain is to our brain. And when we hold the vibration on the nerves and that area, we're basically creating a traffic jam of signals. And so that other pain signal just doesn't get through. That's the basic premise. It's very simple, it's immediate. And you can demonstrate how it works, which becomes really powerful with a 13 year olds who are scared, is you can put that on and you can show be like, hey, no vibration, I scratched your skin with a pen cap or a paperclip, you noticed that sensation. I put on that vibration, leave it on for 30 seconds to a minute, and I do that same stimulation with the pen cap or whatever. It feels different. And like yeah, it does, because your skin literally doesn't feel the same way. But what we can do is we involve the parents to give the parents the job of holding that on. It gives them something productive and helpful to do. And so they feel more calm, and it frees the staff up to be able to do what they need to do. And so it gives the staff an ability to go Hey, Mom, Hey, Dad, I want you to hold that right here. Yep, it's gonna hold right there. We're gonna put it right over the spot for 30 seconds, and you're gonna lift it up, I am going to sit here and wipe we might wonderful alcohol swab, and we are all ready to go check that out. Isn't it amazing? Feels weird, doesn't it? I know you can't feel it. Crazy. Oh, we're done. At first when you say oh, it's going to take an extra minute. I'm thinking, Okay, this is going to add a lot of a lot more time to my my my already busy day, which is going to be practical. But then honestly, I think about the amount of kids where it takes such a long time to make the vaccines happen. That I'll bet if you implement this, across the board, the day overall is so much easier and smoother. And you probably don't waste that much more time. I hate to say waste time, but you probably don't spend that much time. No, and the data would support yours. So I'm all about the data. I'm all about the science and what we know for some gorgeous research because that's the number one thing because providers like I don't have the time to do all this. And I was like the truth is you don't have time to not it doesn't take that much more especially that's why all of our tools are digital so they can be sent without appointment reminder or that you have to come in so they're coming in with a plan so it reduces the burden on you to explain everything because they already know because they washed everything, right. And you're just coming in being like, Oh, great. You already have your cream on. Wonderful. You want to use bezzie today. Cool. I'm so glad you know how to use it. Here you go. Wonderful. You're going to sit on mom's lap, we're not going to have a large discussion about x 30. No. And the truth is, what you don't have time for is the kids who are freaking out and to sit in that room for a half hour or 20 minutes hoping so the data would tell us that we actually have reduced waiting times more business efficiency, increase provider satisfaction, increased parent satisfaction and increased patient satisfaction when we actually incorporate these into practice. So I can understand the hesitation, we hear it, we get it. And that's why we spend so much time figuring out how this would figure out into a workflow. How would this work? Because if it doesn't work for you as providers, then we're dead in the water anyway. This is such incredible information for me, I have to tell you, across the board, I'm so excited to implement a lot of what you've taught me. And I'm just thinking, how can we get your message out to more and more paediatricians and parents? Well, I'm pleased do I mean we we are all over the place. Honestly, at this point in time we're used in think we're at like 100 Something children's hospitals around the world. We have stuff in multiple languages. We just did a project with Budapest Children's Hospital, we're doing stuff in the Ukraine. We did our podcast for the American kid Academy of Paediatrics, which is very provider focused for any providers listening who want to listen, we have actually a bunch of articles on the healthy children.org website too, which is the American Academy of Paediatrics patient facing site. And then our website has everything. And just so we're clear, everyone is available to use any of our tools, download any of our resources link to any of our videos, we exist in order to be able to reduce barriers to good practice and care. And so all of our materials are available for use for free for anyone to use. So if there's ever any questions, you can always reach out to us. But please do so all of our stuff. And we have a great provider kit, which outlines how we can do that in provider practices. But yeah, we please, we can follow us on. We are on Twitter, Instagram, Facebook, which is just all tips and tricks that go out and encourage people to sign up for a newsletter. It's a great way to be reminded of all of our new stuff that's coming out because we also do stuff on other types of pain like post surgical pain. Hey, my kids having surgery. What do I do? How do we feel about opioids? How do I know about ibuprofen? And then chronic pain? Like my kids having a tonne of headaches or stomach aches? What do I do? How do I think about this? We don't want to over medicate, we want to figure out how we think about the role of psychology and pain. Because Newsflash, it always is a factor that's not crazy or weird. That's just how the human body is designed. And selfishly, as you so graciously pointed out earlier in the interview, I want people to come here to see us without being so scared. Yeah. And so if we can implement some of these practices and make the experience better for kids, they'll make such a difference. Is there anything else that we didn't talk about that you want to mention? Any closing remarks? You don't have to happen? I don't think so. I'm like, I don't know. I think we we covered a lot. I think I guess the thing I really want parents to know, one of the biggest barriers we know that we have is that people just see the Freecad round needles as a necessary, evil and unavoidable. And every bit of research, all of our experience would tell us that it's not that there are ways that we can be more powerful and in control, and manage this experience better for our patients, for our kids and for ourselves. And the other message that I think we want to give as we do know from our research as well is that parents are scared to use their voice when they come to see providers, they're usually unnecessarily freaked out that I can't see anything. And we really encourage this collaboration. You know, we say that paediatricians and providers are experts in medicine, but parents are experts in their kids. And this needs to take that collaboration. So when you know there are things that are going to bring your kid comfort, use your voice, knowing that everyone involved has the same goal, that they have a good positive experience and feel really great about coming back to the paediatrician to get their care. Ya know that if you show your kid some screen time, I will definitely not be reprimanding you or making you feel bad about it. Exactly like now is your moment. Yes. Yes, absolutely. No judgement on my end. Hopefully never. Exactly. But now is your moment screen away? Yes. Well, thank you. Yeah, screen away ice cream away, lollipop away whatever it takes to make it better. I'm on board. Absolutely. Yeah. Well, thank you so much for your time. I can't express enough how thankful I am for the work that you do. Thank you so much. Thank you for having me here and for helping us get the word out. Thank you for listening and I hope you enjoyed this week's episode of Ask Dr. Jessica. Also, if you could take a moment and leave a five star review wherever it is you listen to podcasts, I would greatly appreciate it. It really makes a difference to help this podcast grow. You can also follow me on Instagram at ask Dr. Jessica See you next