tag:theconversation.com,2011:/us/topics/injections-30726/articlesInjections – The Conversation2022-03-29T12:35:49Ztag:theconversation.com,2011:article/1770252022-03-29T12:35:49Z2022-03-29T12:35:49ZKids afraid of getting shots? Here are 3 easy ways for parents to help them<figure><img src="https://images.theconversation.com/files/451390/original/file-20220310-27-z9ze7b.jpg?ixlib=rb-1.1.0&rect=17%2C0%2C5734%2C3794&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Children are not little adults – they need time to process what is going to happen.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/close-up-of-a-young-african-american-little-girl-royalty-free-image/1300111984">Ivan Pantic/E+ via Getty Images</a></span></figcaption></figure><p>Few things are more challenging than trying to vaccinate a terrified and uncooperative child. I have seen children wedge themselves into a corner and refuse to budge. I have seen them thrash and yell. And I have seen them sit perfectly still, but cry the entire time. </p>
<p>I’m an <a href="https://msm.edu/about_us/FacultyDirectory/Pediatrics/LynnGardner/index.php">associate professor of pediatrics</a> and have been a primary care pediatrician for more than 25 years. I’ve encountered these situations thousands of times in my career.</p>
<p>While getting shots provokes anxiety in most children, the degree of anxiety can be lessened. As a parent, there are three things you can do to improve the vaccine experience for your child. I refer to them as “The Three P’s.” </p>
<h2>Preparation</h2>
<p>It’s important to let your child know they will be receiving vaccines, unless you know your child will have a severe anxious response. You may think it’s best to keep upcoming shots hidden until your child gets to the doctor’s office, but this approach can make them more anxious and less able to cope. Children need some time to process what is going to happen. Let them know on the day of the visit, but with enough time to discuss it with them beforehand.</p>
<p>It is essential that you ask your child how they are feeling about receiving a shot. Giving them the <a href="https://www.healthychildren.org/English/safety-prevention/immunizations/Pages/Managing-Your-Childs-Pain-While-Getting-a-Shot.aspx">opportunity to express their feelings can decrease the amount of stress and anxiety </a> they feel about it. Validate their feelings by telling them you know needles can be a bit scary, but then reassure them that they can handle it. Explain why they’re receiving vaccines and emphasize it is for their overall good.</p>
<p>You should also describe specifically what will happen. For example, tell your child the nurse will clean their arm with an alcohol pad, count to three and then give the injection. It often helps if you have a plan for after the vaccines as well. For example, let your child know they will get to visit a grandparent or go to the park. Try not to reward them with food, as this can <a href="https://www.sciencedaily.com/releases/2016/04/160412090707.htm">inadvertently teach them to emotionally eat</a>. </p>
<p>Giving your child basic information along with the opportunity to express their feelings will save them from having to process what’s happening all at once. This often <a href="http://csefel.vanderbilt.edu/documents/teaching_emotions.pdf">helps children better cope</a> with the process. </p>
<h2>Proximity</h2>
<p>When your child is preparing for the vaccine to be administered, stay physically close to them. Speak to your child in a calm voice and remind them of the things you discussed at home. Let your child hug you with the opposite arm while getting their shot. This is often all it takes to get them through it. </p>
<p>Such support teaches children you will be there for them when they need you, which <a href="https://www.healthychildren.org/English/health-issues/conditions/emotional-problems/Pages/Understanding-Childhood-Fears-and-Anxieties.aspx">builds security</a>. This security, in turn, gives them confidence to try things they may otherwise avoid. </p>
<h2>Praise</h2>
<p>After your child receives their injection, give them a moment to gather themselves – 30 seconds or so. Then tell them how well they did and that you’re proud of them. Point out that they did something they either didn’t want to do or didn’t think they could do. </p>
<p>This teaches children they can do things even when they are afraid or anxious. You can remind children of this experience when they need to get shots again – or if they are afraid or worried about something else, like public speaking or a school project. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/451426/original/file-20220310-23-1rdmhf3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A girl with bandaid on her bicep at the doctor's office. A smiley face is drawn on the bandaid." src="https://images.theconversation.com/files/451426/original/file-20220310-23-1rdmhf3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/451426/original/file-20220310-23-1rdmhf3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/451426/original/file-20220310-23-1rdmhf3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/451426/original/file-20220310-23-1rdmhf3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/451426/original/file-20220310-23-1rdmhf3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/451426/original/file-20220310-23-1rdmhf3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/451426/original/file-20220310-23-1rdmhf3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Building confidence by doing hard things.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/portrait-of-smiling-little-child-with-adhesive-royalty-free-image/1316865387">portishead1/E+ via Getty Images</a></span>
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<p>Children are not little adults. They don’t always have the capacity to know what they are feeling or to express themselves when needed. It’s up to you to give them the opportunity and space to identify their feelings – and then help validate those feelings. </p>
<p>Preparing your child for vaccines, staying in close proximity to them during the process and praising them for a job well done will help them navigate this often challenging process with more confidence, courage and assurance.</p>
<p>[<em>Get the best of The Conversation, every weekend.</em> <a href="https://memberservices.theconversation.com/newsletters/?nl=weekly&source=inline-weeklybest">Sign up for our weekly newsletter</a>.]</p><img src="https://counter.theconversation.com/content/177025/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lynn Gardner does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A pediatrician recommends helping your child cope with getting vaccines by employing “The Three P’s” – Preparation, Proximity and Praise.Lynn Gardner, Associate Professor of Pediatrics and Director of Pediatric Residency Program, Morehouse School of MedicineLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1616362021-06-11T12:41:33Z2021-06-11T12:41:33ZOver half of adults unvaccinated for COVID-19 fear needles – here’s what’s proven to help<figure><img src="https://images.theconversation.com/files/402979/original/file-20210526-17-1f6ei8o.jpeg?ixlib=rb-1.1.0&rect=0%2C0%2C7951%2C5304&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Though many adults report a fear of needles, most research on needle fear has focused on children.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/portrait-of-a-happy-woman-in-a-car-with-a-get-royalty-free-image/1303039108?adppopup=true">FG Trade/E+ via Getty Images</a></span></figcaption></figure><p>If you’re among the 25% of Americans averse to needles, you’re probably not surprised by the COVID-19 immunization stall. Even for those who want immunity, bribes with beer or lottery tickets may not be enough to override anxiety made worse by <a href="https://doi.org/10.1016/j.vaccine.2015.08.064">pervasive images of needles in the media</a>. </p>
<p>As a <a href="https://www.practicalpainmanagement.com/author/29618/baxter">physician specializing in pain management</a>, I study the impact of pain on vaccination. Research-proven adult interventions for pain, fainting, panic and fear can make vaccination more tolerable. At a minimum, understanding the reasons needle fear has become common might make the embarrassment easier to bear.</p>
<h2>Why needle anxiety has increased</h2>
<p>Needle fear has increased dramatically since a landmark 1995 study by J.G. Hamilton reported that <a href="https://pubmed.ncbi.nlm.nih.gov/7636457/">10% of adults and 25% of children</a> feared needles. In that paper, adult patients who remembered when their fear began described a stressful needle experience around age 5. </p>
<p>The childhood experiences of the patients usually related to an unexpected illness; at the time the Hamilton participants were in preschool, vaccines were scheduled only until age 2. For most people born after 1980, however, <a href="https://www.immunize.org/timeline/">booster injections</a> given between ages 4 to 6 years became a routine part of the vaccine experience. The timing of boosters maximizes and prolongs immunity, but unfortunately falls <a href="http://ppl.childpain.org/issues/v10n2_2008/v10n2_yap.pdf">within the age window</a> when phobias form. A 2012 Canadian study of 1,024 children found that <a href="https://doi.org/10.1016/j.vaccine.2012.05.011">63% of those born in 2000 or later</a> now fear needles. In a 2017 study, my colleagues and I confirmed this increase in prevalence: <a href="https://doi.org/10.1016/j.vaccine.2017.06.029">Half of preschoolers</a> who got all their boosters on one day – often four or five injections at once – were still severely afraid of needles as preteens. </p>
<p>[<em>The Conversation’s science, health and technology editors pick their favorite stories.</em> <a href="https://theconversation.com/us/newsletters/science-editors-picks-71/?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=science-favorite">Weekly on Wednesdays</a>.]</p>
<p>Unsurprisingly, needle fear affects how willing teens and adults are to get vaccinated. A 2016 study found needle fear to be the most common reason teens didn’t get a <a href="https://doi.org/10.1177/003335491613100304">second HPV vaccine</a>. Health care workers are no exception: A 2018 study found that <a href="https://doi.org/10.1111/jan.13818">27% of hospital employees</a> dodged flu vaccines due to needle fear. And most recently, an April 2021 national survey of 600 not-yet-COVID-19-vaccinated U.S. adults found that <a href="https://www.pollfish.com/dashboard/results/256471406/1978802675">52% reported moderate to severe needle fear</a>. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/402986/original/file-20210526-15-a2mqex.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Nurse applying band-aid to a person's arm." src="https://images.theconversation.com/files/402986/original/file-20210526-15-a2mqex.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/402986/original/file-20210526-15-a2mqex.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/402986/original/file-20210526-15-a2mqex.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/402986/original/file-20210526-15-a2mqex.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/402986/original/file-20210526-15-a2mqex.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/402986/original/file-20210526-15-a2mqex.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/402986/original/file-20210526-15-a2mqex.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">The shame accompanying needle fear can make it difficult to research among adults.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/90ejoVTj2-M">CDC/Unsplash</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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<h2>Potential solutions for adults</h2>
<p>For children, evidence shows that addressing their <a href="https://doi.org/10.1016/j.pcl.2013.06.012">fear and pain while distracting them</a> from the procedure is most effective in reducing distress.</p>
<p>While adults are not just big children, combining these concepts with findings from available adult injection studies suggest a few potential interventions. For the many who want a vaccine but need some support, here’s what we know: </p>
<h2>1. Pain reduction</h2>
<p>Relieving injection pain may reduce needle fear by giving patients a feeling of control. For example, a group of patients in New Zealand were repeatedly missing their monthly antibiotic injections for rheumatic heart disease. Their doctors created a special clinic, offering either anesthetics, a vibrating cold device or both during the shot. The interventions in 107 adults <a href="https://doi.org/10.1111/jpc.12400">reduced pain and fear by 50%</a> after three months. Six months later, half the patients still used the interventions, and the special “missed dose” clinic was no longer needed.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/404587/original/file-20210604-10042-18lge05.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Venn diagram showing the intersection of pain, fear, and focus is distress" src="https://images.theconversation.com/files/404587/original/file-20210604-10042-18lge05.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/404587/original/file-20210604-10042-18lge05.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=549&fit=crop&dpr=1 600w, https://images.theconversation.com/files/404587/original/file-20210604-10042-18lge05.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=549&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/404587/original/file-20210604-10042-18lge05.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=549&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/404587/original/file-20210604-10042-18lge05.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=690&fit=crop&dpr=1 754w, https://images.theconversation.com/files/404587/original/file-20210604-10042-18lge05.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=690&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/404587/original/file-20210604-10042-18lge05.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=690&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Interventions targeting the pain, fear and focus components of distress can help reduce needle fear.</span>
<span class="attribution"><a class="source" href="https://doi.org/10.1016/j.pcl.2013.06.012">Amy Baxter</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-nd/4.0/">CC BY-NC-ND</a></span>
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<p>Specifically for vaccination, <a href="https://doi.org/10.1016/j.pmn.2018.07.001">applying a vibrating cold device</a> to the injection site a minute prior to injection, then pressing just above the site during injection, relieved pain and improved satisfaction for adults, and was <a href="https://doi.org/10.1097/PEC.0b013e318237ace4">most effective for those with needle fear</a>. A <a href="https://doi.org/10.1097/hnp.0000000000000105">horseshoe-shaped plastic device</a> using sharp prongs to confuse the nerves also reduced injection pain but increased anxiety, possibly due to discomfort from the prongs themselves.</p>
<p>Cold spray doesn’t help reduce <a href="https://doi.org/10.1097/ajp.0b013e3181a00414">vaccination pain for children</a>, but has been shown to be more effective than topical anesthetics for <a href="https://doi.org/10.2310/7060.2004.19101">adult injections</a>.</p>
<h2>2. Psychological therapy</h2>
<p><a href="https://www.apa.org/ptsd-guideline/patients-and-families/exposure-therapy">Exposure-based therapy</a> involves asking a patient to rank anxiety caused by parts of a procedure, like seeing a picture of a tourniquet or thinking about sharp things, and gradually exposing them to these parts in a controlled environment. Free <a href="https://martinantony.com/wp-content/uploads/Overcoming-Medical-Phobias1.pdf">self-guided resources</a> are available for fears ranging from flying to spiders. However, <a href="https://doi.org/10.1097/AJP.0000000000000273">none of the three studies</a> testing this approach on adult needle fear showed long-term fear reduction. </p>
<p>One of the studies that taught techniques to reduce fainting, however, was considered a success. Fainting, or <a href="https://www.ncbi.nlm.nih.gov/books/NBK470277/">vasovagal syncope</a>, and needle fear are often conflated. While passing out due to injections is more common with anxiety, it is often <a href="https://doi.org/10.3389/fcvm.2019.00175">a genetic response</a>. Tensing the <a href="https://doi.org/10.1002/da.22616">stomach muscles</a> increases the volume of blood the heart can pump, keeping blood in the brain to prevent lightheadedness during needle procedures.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/405725/original/file-20210610-25-1dwi9ad.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Health care worker pointing at arm after getting vaccinated." src="https://images.theconversation.com/files/405725/original/file-20210610-25-1dwi9ad.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/405725/original/file-20210610-25-1dwi9ad.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/405725/original/file-20210610-25-1dwi9ad.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/405725/original/file-20210610-25-1dwi9ad.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/405725/original/file-20210610-25-1dwi9ad.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/405725/original/file-20210610-25-1dwi9ad.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/405725/original/file-20210610-25-1dwi9ad.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Planning ahead can help make vaccine day more approachable.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/portrait-of-happy-frontline-helathcare-worker-royalty-free-image/1304460904?adppopup=true">recep-bg/E+ via Getty Images</a></span>
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<h2>3. Distraction</h2>
<p>Surprisingly, there are <a href="https://doi.org/10.1097/AJP.0000000000000270">no studies on adults</a> using distraction for injections. Two studies, however, have found that <a href="https://doi.org/10.1155/2019/9459103">pretending to cough</a> reduces pain from blood draws. </p>
<p>Dropping F-bombs could also help: A recent study found that <a href="https://doi.org/10.3389/fpsyg.2020.00723">swearing reduced pain by one-third</a> compared to saying nonsense words. Distraction with virtual reality games or videos has been shown to be more effective in children, although there have been <a href="https://doi.org/10.2196/17980">mixed results in adults</a>.</p>
<p>Mentally engaging tasks may also help. <a href="https://doi.org/10.1111/wvn.12359">A visual finding task</a> given to children during intramuscular shots has been shown to reduce pain and fear, with 97% rating the experience more pleasant than previous blood draws. Adults may need a more complicated task, but a similar intervention could work for them as well.</p>
<h2>Use multiple interventions and go in with a plan</h2>
<p>To reduce needle fear, research suggests the more interventions, the better. A 2018 study summarizing research on vaccine pain concluded that patient-operated <a href="https://doi.org/10.1080/21645515.2018.1480238">cold and vibration devices combined with distraction techniques</a> were most effective. Canada has implemented a practical <a href="https://immunize.ca/sites/default/files/Resource%20and%20Product%20Uploads%20(PDFs)/COVID-19/preparing-for-your-covid-19-vaccine-a-guide-for-adults_web_e.pdf">national needle fear intervention</a> for their vaccine rollout, emphasizing preparing ahead to help make vaccine day more comfortable. </p>
<p>Adults who don’t like needles are in the majority. Taking control of your vaccination experience may be the best way to combat needle anxiety.</p>
<p><em>Editor’s note: Portions of this article originally appeared in a previous <a href="https://theconversation.com/fear-of-needles-could-be-a-hurdle-to-covid-19-vaccination-but-here-are-ways-to-overcome-it-139029">article published</a> on June 8, 2020.</em></p><img src="https://counter.theconversation.com/content/161636/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Amy Baxter founded and owns Pain Care Labs, makers of Buzzy. She previously received funding from the NICHD for vaccine pain research, and is currently funded by NIDA for work with mechanical stimulation for low back pain as part of the HEAL initiative to end opioid addiction long-term. </span></em></p>Free doughnuts and lotteries may drive some people to get their COVID-19 vaccine. But for those who are afraid of needles, other interventions may be necessary.Amy Baxter, Clinical Associate Professor of Emergency Medicine, Augusta UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1612592021-05-21T12:26:11Z2021-05-21T12:26:11ZWhy do we get shots in the arm? It’s all about the muscle<figure><img src="https://images.theconversation.com/files/401985/original/file-20210520-15-1sxwoph.jpg?ixlib=rb-1.1.0&rect=503%2C0%2C3704%2C2552&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A man receives the COVID-19 vaccine in Lima, Peru.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/elderly-man-being-inoculated-with-the-covid-19-vaccine-in-a-news-photo/1232367320?adppopup=true">Carlos Garcia Granthon/Fotoholica Press/LightRocket via Getty Images</a></span></figcaption></figure><p>Millions have rolled up their sleeves for the COVID-19 vaccine, but why haven’t they rolled up their pants legs instead? Why do we get most shots in our arms? </p>
<p>As an <a href="https://www.purdue.edu/hhs/nur/directory/faculty/richards_libby.html">associate professor of nursing</a> with a background in public health, and as a mother of two curious kids, I field this question fairly often. So here’s the science behind why we get most vaccines in our arm. </p>
<p>It’s worth noting that <a href="https://www.cdc.gov/vaccines/hcp/admin/administer-vaccines.html">most, but not all, vaccines</a> are given in the muscle – this is known as an <a href="https://www.healthline.com/health/intramuscular-injection#purpose">intramuscular injection</a>. Some vaccines, like the rotavirus vaccine, are given orally. Others are given just beneath the skin, or subcutaneously – think of the <a href="https://www.cdc.gov/vaccines/vpd/mmr/public/index.html">measles, mumps and rubella vaccine</a>. However, many others are given in the muscle. </p>
<p>But why is the muscle so important, and does location matter? And why the arm muscle – called the <a href="https://www.physio-pedia.com/Deltoid">deltoid </a>– in the top of the shoulder?</p>
<h2>Muscles have immune cells</h2>
<p>Muscles make an excellent vaccine administration site because muscle tissue contains important immune cells. These immune cells recognize the <a href="https://www.news-medical.net/life-sciences/What-is-an-Antigen.aspx">antigen</a>, a tiny piece of a virus or bacteria introduced by the vaccine that stimulates an immune response. In the case of the <a href="https://www.cdc.gov/coronavirus/2019-ncov/vaccines/different-vaccines/mrna.html">COVID-19 vaccine,</a> it is not introducing an antigen but rather administering the blueprint for producing antigens. The immune cells in the muscle tissue pick up these antigens and present them to the <a href="https://www.verywellhealth.com/understanding-the-purpose-of-lymph-nodes-2249122">lymph nodes</a>. Injecting the vaccine into muscle tissue keeps the vaccine localized, allowing immune cells to sound the alarm to other immune cells and get to work.</p>
<p>Once a vaccine is recognized by the immune cells in the muscle, these cells carry the antigen to lymph vessels, which transport the antigen-carrying immune cells into the lymph nodes. Lymph nodes, key components of our immune system, contain more immune cells that recognize the antigens in vaccines and start the <a href="https://www.technologynetworks.com/immunology/articles/antigen-vs-antibody-what-are-the-differences-293550">immune process of creating antibodies</a>. </p>
<p>Clusters of lymph nodes are located in areas close to vaccine administration sites. For instance, many vaccines are injected in the deltoid because it is close to lymph nodes located just under the armpit. When vaccines are given in the thigh, the lymph vessels don’t have far to travel to reach the cluster of lymph nodes in the groin. </p>
<figure class="align-center ">
<img alt="A man gives a shot to another man at a vaccination center." src="https://images.theconversation.com/files/401986/original/file-20210520-15-8bwrro.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/401986/original/file-20210520-15-8bwrro.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/401986/original/file-20210520-15-8bwrro.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/401986/original/file-20210520-15-8bwrro.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/401986/original/file-20210520-15-8bwrro.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/401986/original/file-20210520-15-8bwrro.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/401986/original/file-20210520-15-8bwrro.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">It’s much easier to roll up one’s shirt sleeve than to drop one’s drawers – and it is faster, too.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/people-receive-a-covid-19-vaccination-shot-at-the-broadway-news-photo/1317682308?adppopup=true">Spencer Platt/Getty Images</a></span>
</figcaption>
</figure>
<h2>Muscles keep the action localized</h2>
<p>Muscle tissue also tends to keep vaccine reactions localized. Injecting a vaccine into the deltoid muscle may result in <a href="https://doi.org/10.1136/bmj.321.7271.1237">local inflammation</a> or soreness at the injection site. If certain vaccines are injected into fat tissue, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1118997/">the chance of irritation and inflammation reaction increases</a> because fat tissue has poor blood supply, leading to poor absorption of some vaccine components. </p>
<p>Vaccines that include the use of <a href="https://www.cdc.gov/vaccinesafety/concerns/adjuvants.html">adjuvants</a> – or components that enhance the immune response to the antigen – must be given in a muscle to avoid widespread irritation and inflammation. <a href="https://www.chop.edu/centers-programs/vaccine-education-center/vaccine-ingredients/aluminum">Adjuvants </a> act in a variety of ways to stimulate a stronger immune response. </p>
<p>Yet another deciding factor in <a href="https://www.healthline.com/health/intramuscular-injection#injection-sites">vaccine administration location</a> is the size of the muscle. Adults and children ages three and older tend to receive vaccines in their upper arm in the deltoid. Younger children receive their vaccines mid-thigh because their arm muscles are smaller and less developed. </p>
<p></p>
<p>Another consideration during vaccine administration is convenience and patient acceptability. Can you imagine taking down your pants at a mass vaccination clinic? Rolling up your sleeve is way easier and more preferred. Infectious disease outbreaks, as in flu season or amid epidemics like COVID-19, require our public health system to vaccinate as many people as possible in a short time. For these reasons, a shot in the arm is preferred simply because the upper arm is easily accessible. </p>
<p>All things considered, when it comes to the flu shot and the COVID-19 vaccine, for most adults and kids, the arm is the preferred vaccination route. </p>
<p>[<em>Understand new developments in science, health and technology, each week.</em> <a href="https://theconversation.com/us/newsletters/science-editors-picks-71/?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=science-understand">Subscribe to The Conversation’s science newsletter</a>.]</p><img src="https://counter.theconversation.com/content/161259/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Libby Richards receives funding from the National Institutes of Health and the American Nurses Foundation. </span></em></p>Most shots work best when inserted into muscle. The shoulder muscle known as the deltoid works best.Libby Richards, Associate Professor of Nursing, Purdue UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1579632021-04-08T20:11:26Z2021-04-08T20:11:26ZPictures of COVID injections can scare the pants off people with needle phobias. Use these instead<figure><img src="https://images.theconversation.com/files/393709/original/file-20210407-17-1exa6m6.jpg?ixlib=rb-1.1.0&rect=2%2C2%2C995%2C558&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">See, no crying or big needles, just a person of colour showing off his plaster. This image does the job without scaring people and demonstrates diversity.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/vaccinated-african-guy-showing-arm-after-1941784336">from www.shutterstock.com</a></span></figcaption></figure><p>This year is shaping up as the year of the COVID-19 vaccination photo, with the pandemic providing seemingly endless photo opportunities. We’ve seen stock photos of people getting vaccinated in news reports, images of the <a href="https://www.abc.net.au/news/2021-02-21/australia-covid-vaccinations-begin-first-shots-administered/13176288">prime minister receiving his shot</a> and health workers posting #vaxxies on social media.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1355800552282615808"}"></div></p>
<p>But evidence shows the wrong images can make <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0199870">some people</a> reluctant to get vaccinated. So our well-meaning efforts to use images to help demystify the vaccination process or share our pride in getting a COVID-19 vaccine can backfire.</p>
<p>Here’s what we can all do to choose and share vaccination images responsibly.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/posting-covid-19-vaccine-selfies-on-social-media-can-cause-anger-frustration-153504">Posting COVID-19 vaccine selfies on social media can cause anger, frustration</a>
</strong>
</em>
</p>
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<h2>Images are powerful</h2>
<p>Communicating public health strategies like vaccination can be challenging. There can be complex and unfamiliar technical terms and health concepts, and not everyone can understand them. So pictures play an essential role. </p>
<p><a href="https://www.sciencedirect.com/science/article/abs/pii/S0738399105001461">Pictures can</a> draw attention to the message, help people relate to and remember what is being said, and may nudge people to act on a health recommendation. People also rate brochures with pictures <a href="https://pubmed.ncbi.nlm.nih.gov/1419592/">more positively</a> than ones with just text. </p>
<p>Pictures not only provide meaning, they have an emotional impact. Images we see on social media can also shape our perception of social norms (what we believe others are thinking or doing) and <a href="https://www.nature.com/articles/s41562-020-0884-z">our behaviour</a>. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/friday-essay-covid-in-ten-photos-145318">Friday essay: COVID in ten photos</a>
</strong>
</em>
</p>
<hr>
<p>But what happens when the picture is a <a href="https://www.shutterstock.com/image-illustration/doctor-fighting-coronavirus-using-vaccine-injection-1790691281">giant needle</a>, or a needle poked into <a href="https://www.shutterstock.com/image-photo/male-doctor-holding-syringe-making-covid-1859217856">someone’s arm</a>? We have all seen these images to illustrate media articles about COVID-19 vaccination.</p>
<p>In addition to being a bit gruesome, stock photos commonly used in stories about vaccination are <a href="https://www.self.com/story/vaccine-stock-photos">often inaccurate</a>. The needle might be in the wrong position, the health worker may be <a href="https://www.shutterstock.com/image-photo/doctor-nurse-scientist-researcher-hand-blue-1506051596">wearing gloves</a> when they are not needed or the liquid inside the needle <a href="https://www.shutterstock.com/image-photo/close-woman-doctor-holding-syringe-vaccine-1928393204">seems coloured</a> rather then clear.</p>
<h2>Do vaccination images really matter?</h2>
<p>Yes, vaccination images matter. A study looking at vaccine-related news coverage found nearly <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0199870">one in eight</a> images contained something negative, such as the classic “<a href="https://www.alamy.com/stock-photo-syringe-and-crying-baby-injection-in-arm-137810405.html">crying baby</a>”.</p>
<p>This may lead new parents, who have yet to really experience the vaccination process, to become anxious. And this negative photo may override any positive vaccination messages accompanying it. </p>
<p>This issue is especially important because when a photo <a href="https://journals.sagepub.com/doi/10.1177/0392192107087919">is of someone’s face</a>, it can trigger an emotional response, making it easier for someone to have a strong reaction to that communication.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/393708/original/file-20210407-23-1c9o9lu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Baby crying with vaccine needle" src="https://images.theconversation.com/files/393708/original/file-20210407-23-1c9o9lu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/393708/original/file-20210407-23-1c9o9lu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=398&fit=crop&dpr=1 600w, https://images.theconversation.com/files/393708/original/file-20210407-23-1c9o9lu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=398&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/393708/original/file-20210407-23-1c9o9lu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=398&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/393708/original/file-20210407-23-1c9o9lu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/393708/original/file-20210407-23-1c9o9lu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/393708/original/file-20210407-23-1c9o9lu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">We can still illustrate vaccination without using scary images like this of a crying baby and an oversized needle.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/vaccination-concept-syringe-crying-baby-350223140">from www.shutterstock.com</a></span>
</figcaption>
</figure>
<p>We know images can help people <a href="https://www.sciencedirect.com/science/article/abs/pii/S0738399105001461">remember</a> health messages. But if we use an inappropriate photo, such as the wrong needle size or someone looking anxious, this is the image that can stick with us, not the <a href="https://www.sciencedirect.com/science/article/pii/S0738399105001461">public health messages or statistics</a> we intended to convey.</p>
<p>For some people, photos of needles are so scary this might put them off vaccination. While we don’t know precisely which types of needle imagery could stimulate such a response, we know needle phobia is a real issue. In fact, one survey found <a href="https://corporate.target.com/press/releases/2012/08/target-survey-shows-adult-americans-237507">23% of adults</a> have avoided influenza vaccines due to fear of needles. And we don’t want to risk this happening with COVID-19 vaccines. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/fear-of-needles-could-be-a-hurdle-to-covid-19-vaccination-but-here-are-ways-to-overcome-it-139029">Fear of needles could be a hurdle to COVID-19 vaccination, but here are ways to overcome it</a>
</strong>
</em>
</p>
<hr>
<h2>What can we do about it?</h2>
<p>Whether we are choosing images for news articles or for our personal social media, it is important we consider the potential impact of the photos we use. Here are some tips for choosing the right image: </p>
<ul>
<li><p><strong>focus on positive outcomes.</strong> Consider showing a <a href="https://www.shutterstock.com/image-photo/woman-looking-happy-after-getting-vaccine-1929048425">smiling person</a> with a <a href="https://www.shutterstock.com/image-photo/vaccination-little-girl-doctors-office-funny-1821728597">plaster on their arm</a> or someone holding a vaccination card or sticker. Flickr provides <a href="https://www.flickr.com/photos/selfmagazine/albums/72157710332198661">free photos</a> that reflect the reality of immunisation and are medically accurate</p></li>
<li><p><strong>humanise the process.</strong> People develop, deliver and receive vaccines. Show these people where possible, instead of disembodied needles </p></li>
<li><p><strong>depict diversity.</strong> Ensure images of vaccination <a href="https://www.shutterstock.com/image-photo/vaccinated-african-guy-showing-arm-after-1941784336">show diversity</a> of ethnicity, gender, age and disability</p></li>
<li><p><strong>imply rather than illustrate vaccination.</strong> Why do we need the needle in the photo? We <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0199870">do not illustrate</a> articles about urinary tract infections in children with photos of urine samples or invasive medical treatments. An image of a health worker speaking to someone with their sleeve rolled up is enough to evoke a mental image of the vaccination process, particularly when it accompanies a story about vaccines</p></li>
<li><p><strong>highlight the vial not the needle.</strong> For stories about vaccine production or rollout with no personal or emotive element, showing the vaccine vial is a neutral option </p></li>
<li><p><strong>avoid inaccurate images.</strong> The emoji of a <a href="https://emojipedia.org/syringe/">needle full of blood</a>? Not a great choice to tell your friends and family you have been vaccinated. The <a href="https://emojipedia.org/adhesive-bandage/">plaster emoji</a> is a good alternative. Publications should check any vaccine images with medical professionals for accuracy. </p></li>
</ul>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/5-ways-we-can-prepare-the-public-to-accept-a-covid-19-vaccine-saying-it-will-be-mandatory-isnt-one-144730">5 ways we can prepare the public to accept a COVID-19 vaccine (saying it will be 'mandatory' isn't one)</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/157963/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Holly Seale is an investigator on a study funded by NHMRC and has previously received funding for investigator driven research from NSW Ministry of Health, as well as from Sanofi Pasteur and Seqirus. She is the Deputy Chair of the Collaboration on Social Science and Immunisation.</span></em></p><p class="fine-print"><em><span>Jessica Kaufman receives funding from the National Health and Medical Research Foundation (Vaccine Barriers Assessment Tool, GNT1164200). She is a member of the Collaboration on Social Science and Immunisation (COSSI) network.</span></em></p>Our well-meaning efforts to use images to help demystify the vaccination process or share our pride in getting a COVID vaccine can backfire.Holly Seale, Associate professor, UNSW SydneyJessica Kaufman, Research Fellow, Vaccine Uptake Group, Murdoch Children's Research InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1343282020-04-29T19:05:06Z2020-04-29T19:05:06ZFear of needles: 5 simple ways to ease vaccination pain for your child (and yourself)<figure><img src="https://images.theconversation.com/files/331539/original/file-20200429-51474-1xkc00c.jpg?ixlib=rb-1.1.0&rect=39%2C3%2C2005%2C1358&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Strategies to ease pain and fear during injections are recommended by health organizations such as the Canadian Paediatric Society.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/selfmagazine/48545962716/in/album-72157710332198661/">(Heather Hazzan, SELF Magazine/flickr)</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>Vaccinations are one of the most common reasons for injections in children. But for people who fear needle pain, the mere mention of a vaccination evokes immense dread and bad childhood memories of painful injections at the doctor’s office or at school. </p>
<p>Indeed, <a href="https://doi.org/10.1111/jan.13818Ci">20-50 per cent of kids and 20-30 per cent of adults report significant needle fears</a>. People who are afraid of needles <a href="https://doi.org/10.1111/jan.13818Ci">are less likely to get the flu shot</a> or <a href="http://dx.doi.org/10.1016/j.vaccine.2012.05.011">to have their children vaccinated</a>. They are also more likely to avoid medical care. This means that, unless we develop a needle-free vaccine, managing pain and fear from needles is critical to the success of vaccines — including an eventual coronavirus vaccine. </p>
<p>But don’t fear. As a psychologist with expertise in pain management, I know there is a wealth of research clearly showing how to prevent pain and soothe your needle fears. These five strategies are simple, easy to implement and helpful for all ages — including babies, children and adults. These <a href="https://doi.org/10.1503/cmaj.150391">science-backed strategies</a> are recommended by the <a href="https://www.cps.ca/en/documents/position/managing-pain-and-distress">Canadian Paediatric Society</a> and the <a href="https://www.who.int/immunization/policy/position_papers/reducing_pain_vaccination/en/">World Health Organization</a>, among others. </p>
<h2>1. Plan ahead and be honest</h2>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/330930/original/file-20200428-76586-a3v9p2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/330930/original/file-20200428-76586-a3v9p2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=397&fit=crop&dpr=1 600w, https://images.theconversation.com/files/330930/original/file-20200428-76586-a3v9p2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=397&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/330930/original/file-20200428-76586-a3v9p2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=397&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/330930/original/file-20200428-76586-a3v9p2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=499&fit=crop&dpr=1 754w, https://images.theconversation.com/files/330930/original/file-20200428-76586-a3v9p2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=499&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/330930/original/file-20200428-76586-a3v9p2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=499&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Let kids know about the vaccination a few days ahead of time, and create a comfort care plan.</span>
<span class="attribution"><span class="source">(James Gathany/Centers for Disease Control and Prevention)</span></span>
</figcaption>
</figure>
<p>Think ahead about what strategies you plan to use to manage fear or pain during the vaccination. Parents often avoid telling kids they are going for a needle until the very last minute to avoid making them anxious. This often has the opposite effect and causes anxiety to skyrocket, along with distrust.</p>
<p>It’s usually best to tell kids a few days ahead and use that time to create a <a href="http://www.calgarylabservices.com/files/CLSForms/PX-SC290_Attach3.pdf">comfort care plan</a> together with strategies they can use to manage worry and pain. <a href="https://immunize.ca/sites/default/files/resources/parentscanada-ad-feature-needles-dont-have-to-hurt.pdf">Handouts</a> summarize effective pain management strategies in one place to make vaccinations easy peasy when the time comes. </p>
<p>For parents, assessing and managing their own anxiety will enable them to best support their child. Plan to be with your child during the vaccination unless they are older and request to be on their own. </p>
<h2>2. Use numbing cream</h2>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/331538/original/file-20200429-51470-2qtx9r.jpg?ixlib=rb-1.1.0&rect=386%2C15%2C1569%2C1091&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/331538/original/file-20200429-51470-2qtx9r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=325&fit=crop&dpr=1 600w, https://images.theconversation.com/files/331538/original/file-20200429-51470-2qtx9r.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=325&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/331538/original/file-20200429-51470-2qtx9r.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=325&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/331538/original/file-20200429-51470-2qtx9r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=408&fit=crop&dpr=1 754w, https://images.theconversation.com/files/331538/original/file-20200429-51470-2qtx9r.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=408&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/331538/original/file-20200429-51470-2qtx9r.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=408&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Topical anesthetics can be applied in advance to numb the injection area.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/selfmagazine/48545839516/in/album-72157710332198661/">(Heather Hazzan, SELF Magazine/flickr)</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Also called <a href="https://www.aboutkidshealth.ca/Article?contentid=3627&language=English">topical anesthetics</a>, these creams help to numb the skin where the needle will be injected. Topical anesthetics (Emla, Ametop and Maxilene) can be purchased over the counter from any pharmacy and come as a patch or in a tube. </p>
<p>They typically need to be applied to the skin 30 to 60 minutes before the needle, so applying the numbing cream is often something that can be done at home, and later removed at the clinic. Insider tip: Some kids don’t like having the patch removed because it’s like taking off a bandage. Instead, you can apply the numbing cream and wrap the area with cling wrap. </p>
<p>To be sure the numbing cream is applied in the right place on the body, check ahead with a pharmacist or health-care provider to find out where the shot will be injected. </p>
<h2>3. Sit upright</h2>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/331275/original/file-20200429-51489-jw409e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/331275/original/file-20200429-51489-jw409e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=559&fit=crop&dpr=1 600w, https://images.theconversation.com/files/331275/original/file-20200429-51489-jw409e.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=559&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/331275/original/file-20200429-51489-jw409e.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=559&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/331275/original/file-20200429-51489-jw409e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=702&fit=crop&dpr=1 754w, https://images.theconversation.com/files/331275/original/file-20200429-51489-jw409e.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=702&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/331275/original/file-20200429-51489-jw409e.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=702&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Hold children in a supported sitting position during the injection.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/selfmagazine/48545984852/in/album-72157710332198661/">(Heather Hazzan, SELF Magazine/flickr)</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>It’s best to sit up in a comfortable, relaxed and supported position during the vaccination. Kids can sit on a parent’s lap and be held in a hug either facing the parent or to the side, often called <a href="https://www.youtube.com/embed/YPi3xT6UCOs?rel=0">comfort positions</a>. Lying down or being held down can increase fear and pain, and create a sense of loss of control. </p>
<p>Infants can be <a href="https://youtu.be/3nqN9c3FWn8">cuddled skin-to-skin</a>, clothed only in a diaper, held facing inward against a parent’s bare chest. For kids two years and younger, <a href="https://youtu.be/7NDJ463j2iI">breastfeeding or use of a sweet-tasting solution</a>, such as a small amount of sugar water, is also recommended. </p>
<p>Kids and adults who typically feel faint when getting needles can use a technique called <a href="https://www.uoguelph.ca/pphc/sites/default/files/Muscle-Tension-Resource.pdf">muscle tension</a> to help raise their blood pressure to feel better. To use this technique, sit or lie down and tighten your arm, leg and stomach muscles for about 15 seconds until your cheeks feel flush. Then release tension for 20 to 30 seconds (without fully relaxing) before tensing again and repeating until the needle is over or you stop feeling faint. </p>
<h2>4. Use distraction</h2>
<p>Draw attention away from the pain before and during the injection by <a href="https://doi.org/10.1002/14651858.CD005179.pub4">focusing on something fun, engaging and interactive</a>. Playing games or listening to music on a smartphone is an easy, effective tool for managing pain and distress, and most people have it right in their pocket! </p>
<p>Although high-tech things like virtual reality help, low-tech distractions like talking to someone or imagining something fun work too. Taking a few deep breaths can also help maintain calm and minimize pain. To make it easier for kids, have them blow a pinwheel or bubbles. </p>
<p>For parents, <a href="https://youtu.be/KgBwVSYqfps">try to avoid reassuring your child</a>. Although it’s instinct, saying things like, “I’m sorry” or “It will be over soon” can actually increase pain and distress by inadvertently signalling to the child that there’s something to worry about it. </p>
<h2>5. Talk about what went well</h2>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/331063/original/file-20200428-110734-15e14wl.jpg?ixlib=rb-1.1.0&rect=900%2C0%2C4602%2C4016&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/331063/original/file-20200428-110734-15e14wl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/331063/original/file-20200428-110734-15e14wl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/331063/original/file-20200428-110734-15e14wl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/331063/original/file-20200428-110734-15e14wl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/331063/original/file-20200428-110734-15e14wl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/331063/original/file-20200428-110734-15e14wl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Talking about the experience can help make the next vaccination easier.</span>
<span class="attribution"><span class="source">(Scott Housley/Centers for Disease Control and Prevention)</span></span>
</figcaption>
</figure>
<p>There’s more you can do even when the vaccination is over. <a href="https://doi.org/10.1111/papr.12572">Remembering and talking about what went well after the fact</a> — even if it wasn’t perfect — helps make it less stressful and less painful next time. Plan something fun to celebrate and remember a job well done!</p>
<p>If you or your child are so afraid of needles that you try to avoid them at all costs, you may benefit from additional help. In this case, <a href="http://dx.doi.org/10.1080/16506073.2016.1157204">exposure-based therapy</a> delivered by a trained mental health professional is recommended ahead of time in order to benefit most from the five simple strategies discussed above. </p>
<p>Even though these strategies are easy, science-based and widely recommended, they are unfortunately not always used. Our team at <a href="https://twitter.com/KidsInPain/">Solutions for Kids in Pain (SKIP)</a> is working hard to improve children’s pain management by partnering with researchers, parents and caregivers, health-care providers, children’s health-care institutions and more than 100 other organizations. Our goal is to ensure that information about children’s pain gets into the hands of those who need it faster. </p>
<p>During <a href="https://www.who.int/news-room/events/detail/2020/04/24/default-calendar/world-immunization-week-2020">World Immunization Week</a>, let’s remember that #VaccinesWork and #ItDoesntHaveToHurt. </p>
<p><em>This story is part of a series produced by <a href="https://www.kidsinpain.ca">SKIP (Solutions for Kids in Pain)</a>, a national knowledge mobilization network whose mission is to improve children’s pain management by mobilizing evidence-based solutions through co-ordination and collaboration.</em></p><img src="https://counter.theconversation.com/content/134328/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kathryn Birnie is Assistant Scientific Director of Solutions for Kids in Pain (SKIP). </span></em></p>These strategies for easing needle pain and fear make vaccinations and other injections easier for parents and children. They are simple and helpful for all ages, from infants to adults.Kathryn Birnie, Assistant Professor and Psychologist in Pediatric Pain, University of CalgaryLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1168232019-07-08T06:10:06Z2019-07-08T06:10:06ZDo vitamin drips really work? The evidence says ‘no’, so save your money and eat real food<figure><img src="https://images.theconversation.com/files/282803/original/file-20190705-51297-5glhpi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Are the celebrities onto something with their IV vitamin cocktails? Let's look at the evidence before rushing to the therapy lounge.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/1336177190?src=XI05qOuZSPhGMPfXX9BKrA-1-8&studio=1&size=huge_jpg">from www.shutterstock.com</a></span></figcaption></figure><p>Want to boost your immune system, reduce your physical signs of ageing, or cleanse your blood to get rid of toxins? Intravenous (IV) vitamin therapy, or vitamin drips, promise to help. Some claim they can even benefit serious conditions like cancer, Parkinson’s disease, the eye condition macular degeneration, the pain of fibromyalgia and depression.</p>
<p><a href="https://www.refinery29.com/en-us/2018/03/192731/vitamin-iv-drip-side-effects-kendall-jenner-hospitalized">Celebrities</a> have promoted them on social media. The demand has led to <a href="https://www.theguardian.com/lifeandstyle/2019/mar/03/intravenous-vitamin-injection-goes-mainstream">alternative therapy lounges</a> popping up around the world, including in Australia. Patients can kick back in comfy leather chairs while they’re hooked up to IVs in the infusion lounge, watch Netflix and have some tea.</p>
<p><div data-react-class="InstagramEmbed" data-react-props="{"url":"https://www.instagram.com/p/zVhJhNJjc_/?utm","accessToken":"127105130696839|b4b75090c9688d81dfd245afe6052f20"}"></div></p>
<p>But do they work? Or are you just paying for really expensive urine? Let’s look at what the science says.</p>
<h2>What is IV vitamin therapy?</h2>
<p>IV vitamin therapy administers vitamins and minerals directly into the bloodstream via a needle that goes directly into your vein. Fans of the therapy believe this enables you to obtain more nutrients as you avoid the digestion process.</p>
<p>Providers of these injections say they customise the formula of vitamins and minerals depending on the perceived needs of the patient. </p>
<p>Right now for example, many Australian lounges are offering drip “cocktails” containing immune boosting vitamins like vitamin C and zinc to help <a href="https://www.irefresh.com.au">protect against the flu</a>. Other popular therapy sessions come under names like <a href="https://infusion.clinic/treatments">“Energy Cocktail”</a> and <a href="https://www.dripiv.com.au/services">“Glow”</a>. One vitamin IV therapy session can take 30-90 minutes and will cost between A$80 to $1,000.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-eat-your-vitamins-when-you-can-now-shoot-them-up-16298">Why eat your vitamins when you can now shoot them up?</a>
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<h2>Does IV vitamin therapy work?</h2>
<p>IV therapy itself is not new and has been used in the medical profession for decades. In hospitals, it is commonly used to <a href="https://www.nice.org.uk/guidance/cg174">hydrate patients</a> and administer <a href="https://nutritionj.biomedcentral.com/articles/10.1186/1475-2891-2-18">essential nutrients</a> if there is an issue with gut absorption, or long-term difficulty eating or drinking due to surgery. Single nutrient deficiencies like vitamin B12 or iron are also often treated in hospital with infusions under medical supervision.</p>
<p>But the “cocktails” IV vitamin therapy clinics create and administer are not supported by scientific evidence. There have been no clinical studies to show vitamin injections of this type offer any health benefit or are necessary for good health. In fact, there are very few studies that have looked at their effectiveness at all.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-are-some-people-more-gullible-than-others-72412">Why are some people more gullible than others?</a>
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</em>
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<p>There is <a href="http://www.altmedrev.com/archive/publications/7/5/389.pdf">one review</a> on the use of the “Myers’ cocktail” (a solution of magnesium, calcium, vitamin C and a number of B vitamins). But it just contains a collection of anecdotal evidence from singular case studies. </p>
<p>Another <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2894814/">trial</a> looked into the effectiveness of IV vitamin therapy in reducing symptoms of 34 people with the the chronic pain condition fibromyalgia. It found no significant differences between those who received the “Myers’ cocktail” once a week for eight weeks and those who did not. In fact, the authors noted a strong placebo effect. In other words, many people said their symptoms improved when they were only injected with a “dummy” cocktail.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/explainer-what-is-fibromyalgia-the-condition-lady-gaga-lives-with-116729">Explainer: what is fibromyalgia, the condition Lady Gaga lives with?</a>
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</em>
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<hr>
<p><a href="https://www.ncbi.nlm.nih.gov/pubmed/17515022">Another study</a> that examined IV vitamin use in fibromyalgia patients was missing a placebo group, involved just seven patients and showed only short-term improvement in symptoms. The only other published <a href="https://nutritionj.biomedcentral.com/articles/10.1186/1475-2891-3-6">study</a> examined IV vitamin therapy use for asthma. But that study was of even poorer quality.</p>
<h2>What are the risks of IV vitamin therapy?</h2>
<p>Even when it comes to vitamins and minerals, you can have too much of a good thing. For example, if you take in more of the fat soluble <a href="https://onlinelibrary-wiley-com.libraryproxy.griffith.edu.au/doi/abs/10.1002/lt.21007">vitamin A</a> than you need, your body stores it, risking <a href="https://www.ncbi.nlm.nih.gov/books/NBK234920/">damage</a> to major organs, like the liver.</p>
<p>IV vitamin therapy “cocktails” also often contain significant levels of the water soluble vitamins C and B. These are processed by the kidneys and excreted into urine when the body cannot store any more. This makes for some very expensive urine.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/new-vitamin-supplement-study-finds-they-may-do-more-harm-than-good-97246">New vitamin supplement study finds they may do more harm than good</a>
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</em>
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<hr>
<p>There is also the risk of infection with IV vitamin therapy. Any time you have an IV line inserted, it creates a direct path into your bloodstream and bypasses your skin’s defence mechanism against bacteria.</p>
<p>People with certain conditions like <a href="https://www.tandfonline.com/doi/full/10.3109/0886022X.2014.882714">kidney disease or renal failure</a> shouldn’t have IV vitamin therapy because they cannot quickly remove certain minerals from the body. For these people, adding too much <a href="https://onlinelibrary.wiley.com/doi/abs/10.1046/j.1525-139X.2001.00087.x?casa_token=Q5YupqqGg5gAAAAA:raHNHEk0AHDe45EvVsC3MnNjfxlFqoCoJL8QijrwJLQW5MLCERDly2g_krTTYjMNvreuQuzya211">potassium</a> could lead to a heart attack. </p>
<p>People with heart, kidney or blood pressure conditions should also avoid IV vitamin therapy as there is risk of <a href="https://www.ahajournals.org/doi/10.1161/CIRCHEARTFAILURE.115.002922">fluid overload</a> without consistent monitoring. The <a href="https://bmcnephrol.biomedcentral.com/articles/10.1186/s12882-016-0323-6">consequences</a> of fluid overload in these patients can include heart failure, delayed wound healing, and impaired bowel function.</p>
<h2>What’s the bottom line?</h2>
<p>For most of us, the quantities of vitamins and minerals needed for good health can be obtained by eating a healthy diet with a wide range of foods and food groups. Obtaining vitamins and minerals from your diet is much easier, cheaper, and safer. </p>
<p>Unless you have a medically diagnosed reason for getting a vitamin infusion and it was prescribed by your doctor, you are always better off obtaining vitamins and minerals through food.</p><img src="https://counter.theconversation.com/content/116823/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Emily Burch does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>If their social media accounts were anything to go by, celebrities can’t get enough of vitamin and mineral infusions, or vitamin drips. Now therapy lounges are popping up for everyone else to try.Emily Burch, Accredited Dietitian/Nutritionist & PhD Candidate, Griffith UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/653092016-12-16T03:19:38Z2016-12-16T03:19:38ZWhy are young women without wrinkles using Botox?<figure><img src="https://images.theconversation.com/files/150378/original/image-20161215-26032-g20ysg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Once you start, you can't stop.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/376962886?src=njSSB5BDXp_224Cp4_l4fQ-1-4&id=376962886&size=huge_jpg">'Injection' via www.shutterstock.com</a></span></figcaption></figure><p>The battle against wrinkles has lasted for centuries. Long before surgical facelifts, people ingested powders and potions, stretched their faces using thread and tape, and rubbed their skin with Crisco, acid and animal blood to fight the signs of aging. </p>
<p>But when the FDA approved Botox for cosmetic use in 2002, it forever changed the anti-aging market. Since then, <a href="http://www.amaskincare.com/services/botox/">11 million Americans</a> have been forking over hundreds of dollars per session to have a licensed provider inject the drug into their facial muscles, a process that temporarily paralyzes their facial movement and erases existing wrinkles. </p>
<p>Capitalizing on cultural pressure for women’s bodies and faces to stay forever young, Botox manufacturer Allergan started marketing the product to the typical middle-aged everywoman. It paid off: <a href="https://d2wirczt3b6wjm.cloudfront.net/News/Statistics/2015/plastic-surgery-statistics-full-report-2015.pdf">Over 90 percent of users</a> are women. <a href="https://d2wirczt3b6wjm.cloudfront.net/News/Statistics/2015/plastic-surgery-statistics-full-report-2015.pdf">Almost 60 percent</a> are between the ages of 45 and 54. </p>
<p>However, a small – but growing – number of younger women have started turning to this anti-aging “wonder drug.” Today, <a href="https://d2wirczt3b6wjm.cloudfront.net/News/Statistics/2015/plastic-surgery-statistics-full-report-2015.pdf">almost 20 percent</a> of Botox users are in the 30-39 age demographic. Responding to the advice of many dermatologists who preach prevention, these young women are using Botox as a deterrent, hoping that it will halt the development of facial creases and wrinkles down the road. </p>
<p>In my forthcoming book “<a href="http://nyupress.org/books/9781479825264/">Botox Nation</a>,” I show how Botox is now aggressively marketed to young women as a drug with curative and preventive powers that can permanently prolong the appearance of youth. </p>
<h2>A lifetime of maintenance</h2>
<p>The belief that Botox is preventive has been circulating for almost as long as the drug itself. The idea is that long-term paralysis of facial movement will mean no facial wrinkles. It’s a theory promoted in magazine articles by beauty and medical “experts” who tell young women that the best time to start using Botox is when their wrinkles are minimally visible. </p>
<p>However, the theory of preventative Botox use is flawed. Botox’s ability to freeze the youthful face is fleeting: The effect only lasts four to six months. So because Botox’s effects are temporary, they only really prevent wrinkles if you get injections two to three times a year. Botox may conceal wrinkles, but as soon as an individual stops using Botox, those wrinkles reappear. To start young, then, means to enlist in a lifetime of treatment. </p>
<p>Nonetheless, media messages about Botox regularly advocate these proactive efforts, oftentimes glossing over the fact that repeat injections are required.</p>
<p>In my research I found that news coverage of Botox was peppered with preventative claims, such as “You want to clean up your room before it gets too dirty” or “I do tons of Botox because I believe in holding yourself in place to prevent aging.” </p>
<p>Likewise, when I interviewed young Botox users, they told me things like “I use Botox because it’s a preemptive strike” and “If you start using Botox early, it totally prevents your lines from getting deeper.” There was the general feeling among users that you should begin a lifelong regimen of preventative aesthetics early in life – before reaching thirty – in order to gradually “freeze” your youthful look in place. To them this was preferable to starting treatment at a later age – after wrinkles had emerged – which would drastically alter the face’s appearance, making it obvious that it had been treated. </p>
<p>The fact that young, wrinkle-free women are freezing their faces in time speaks volumes about <a href="https://books.google.com/books/about/The_Beauty_Myth.html?id=XgfokiNQl0sC">the demands American culture places on women to stay young and beautiful</a>. </p>
<h2>Treatments become ‘crack like’</h2>
<p>Regular visits to the Botox doctor come at a financial – and, in some cases, physical – cost. </p>
<p>The expense of a single Botox treatment is between US$300 and $400, which initially seems much more affordable than a face-lift (a procedure that can cost upwards of $6,000). However a woman who starts using Botox in her 20s or 30s will end up spending much, much more if she undergoes regular treatments to prevent the effects from wearing off.</p>
<p>It should also be noted that Botox is derived from botulism, <a href="https://en.wikipedia.org/wiki/Botulinum_toxin">the deadliest toxin on the planet</a>. Even though the drug is, for the most part, safe, there have been reports of <a href="http://www.rxlist.com/botox-side-effects-drug-center.htm">adverse effects</a> , including blurred vision, ptosis (drooping eyelids), slurred speech and progressive muscle weakness. Among the Botox users I interviewed, a handful reported suffering from debilitating headaches for days after the injection. One woman suffered from ptosis. </p>
<p>Botox’s temporary results can also lead to compulsive, repetitive behaviors. In my interviews, many women said they weren’t able to stop the treatments. They spoke of Botox as if it were a drug, one that left them dependent on its short-lived effects. As one woman told me, she was “crack-like” about her Botox injections, rushing to her dermatologists’ office the moment she noticed faint brow wrinkles. Not only did women report feeling addicted to Botox, it also seemed serve as a gateway to other cosmetic procedures, such as dermal fillers.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/150380/original/image-20161215-26027-2o3dwb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/150380/original/image-20161215-26027-2o3dwb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=371&fit=crop&dpr=1 600w, https://images.theconversation.com/files/150380/original/image-20161215-26027-2o3dwb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=371&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/150380/original/image-20161215-26027-2o3dwb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=371&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/150380/original/image-20161215-26027-2o3dwb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=466&fit=crop&dpr=1 754w, https://images.theconversation.com/files/150380/original/image-20161215-26027-2o3dwb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=466&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/150380/original/image-20161215-26027-2o3dwb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=466&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Many who start with Botox will graduate to other cosmetic procedures, like dermal fillers.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/pic-117191437/stock-photo-doctor-woman-giving-botox-injections-isolated.html?src=whfm4H6oZ0Oh_3enhW5WRA-1-69">'Dermal filler' via www.shutterstock.com</a></span>
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<p>The multi-billion-dollar beauty and anti-aging industry <a href="http://search.proquest.com/openview/6c2d3c38b3becd3ae3e1407bbb9fa552/1?pq-origsite=gscholar">cultivates feelings of personal inadequacy</a> to convince people to buy their products. </p>
<p>For example, one advertisement for Botox asserted: “It is really up to you. You can choose to live with wrinkles. Or you can choose to live without them.” This projects the message that control over our aging faces is putatively in our grasp. If we “choose to live” with our wrinkles, we are complicit in our own aging and, therefore, have consciously decided to not live up to society’s standards of beauty.</p>
<p>As long as women are held to these unattainable standards, the urge to freeze the face in place will persist.</p><img src="https://counter.theconversation.com/content/65309/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dana Berkowitz receives funding from Louisiana State University and the Louisiana State Board of Regents. </span></em></p>By getting young women hooked before they’ve even formed wrinkles, Botox peddlers have realized they can enlist them in a lifetime of treatment.Dana Berkowitz, Associate Professor of Sociology, Louisiana State University Licensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/642502016-08-29T14:36:22Z2016-08-29T14:36:22ZPoor prescription practices across Africa are putting patients at risk<figure><img src="https://images.theconversation.com/files/135784/original/image-20160829-17876-13bfk35.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>When sick people visit a doctor, nurse or pharmacist they expect to be prescribed with medication that will restore them to health. </p>
<p>The expectation is that the health care provider has applied their knowledge of therapeutics to select an appropriate treatment regimen: the correct drugs, the right dosage and the ideal treatment duration. </p>
<p>But this is not always the case.</p>
<p>Irrational prescriptions are a major global health problem. The World Health Organisation estimates that more than half of all medicines are <a href="http://www.who.int/medicines/areas/rational_use/en/index.html">inappropriately prescribed</a>, dispensed or sold. In addition, half of all patients fail to take them correctly.</p>
<p>In Africa, where most countries have weak health systems and underdeveloped mechanisms for routine monitoring of medicines, this problem is common.</p>
<p><a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-016-3428-8">Our study</a> found sub-optimal measures of prescribing at primary health care centres across Africa. Too many medicines are being prescribed to patients in general and too many antibiotics and injections are being administered. </p>
<p>The implications of these findings are far reaching and may include antibiotic resistance as well as exposing patients to undue risk and creating shortages for those who do critically need the medication. </p>
<h2>Africa’s health system challenges</h2>
<p>In the early nineties, the World Health Organisation set <a href="http://apps.who.int/medicinedocs/en/d/Js2289e/3.1.html">indicators</a> to assess trends in prescribing within primary health care settings. </p>
<p>These indicators guide the average number of medicines prescribed per patient, what percentage should have a generic name; how often antibiotics or injections should be prescribed as well as the percentage of medicines that should come from an essential medicines list.</p>
<p>We reviewed studies from 11 countries: Ghana, Nigeria, Burkina Faso, Ethiopia, South Africa, Tanzania, Kenya, Zambia, Zimbabwe, Botswana and Gambia. These studies collected data from more than 141,000 patient visits at 572 primary care centres. Of these, 359 were public and 213 private.</p>
<p>We <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-016-3428-8">found</a> that prescription patterns at primary health care centres in Africa had not improved much over two decades.</p>
<p>Primary health care is usually the first point of contact with the health system. This could mean an outpatient department of a hospital run by doctors, or a community health centre staffed by nurses and dispensers. </p>
<p>On average, just over three medicines were prescribed per patient. This was higher than the recommended value of less than two medicines. Nearly half of the patients who were served received antibiotics and a quarter were given injections. This exceeds the recommendations in primary care settings that health care practitioners may only prescribe antibiotics to one in every three patients they consult with each day. Similarly, they may only prescribe an injection for one in every five patients they consult every day.</p>
<p>This means that ideally if 10 people visit a health care centre, up to three may receive an antibiotic and no more than two an injection. </p>
<p>The World Health Organisation recommends that generic medicines are prescribed and that medicines on the approved essential medicines list are used. But in many countries, adherence to these recommendations require major improvements. </p>
<h2>Implications</h2>
<p>The results highlight the weaknesses in health systems. These include:</p>
<ul>
<li><p>a lack of adequate diagnostic tools that often facilitate more presumptive treatment, </p></li>
<li><p>the limited availability of in-service-training to teach health personnel,</p></li>
<li><p>poor community understanding around medicines that are prescribed and </p></li>
<li><p>industry influence.</p></li>
</ul>
<p>The implications of poor medicine use in these countries can be enormous. Irrational antibiotic use can increase health care costs. In one study, <a href="http://www.ncbi.nlm.nih.gov/pubmed/11391845">antibiotics made up 40%</a> of the patient’s costs.</p>
<p>Prescribing antibiotics inappropriately also contributes to antibiotic resistance, which may result in more expensive and unavailable antibiotics being needed.</p>
<p>The use of injections also increases the workload: health care personnel must administer these doses. It also heightens the risks of spreading blood-borne infections including hepatitis and HIV. </p>
<p>Therapies that are outside the established local essential medicines lists may be risky. Such therapies have not been thoroughly assessed in terms of safety, efficacy and cost-effectiveness within the settings in which they are being used. </p>
<p>Prescribing outside approved essential medicines lists could therefore mean high cost for patients – especially in Africa where <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2649544/">out-of-pocket</a> payments remain prevalent. This could drive many families below the poverty line.</p>
<p>A patient who receives an inappropriate drug could be exposed to undue risk. And another patient who may genuinely need such a therapy could be denied. </p>
<h2>Promoting rational medicines use</h2>
<p>A significant proportion of health care spending in the countries we studied goes to pharmaceuticals. Much of this comes straight out of patients’ pockets. Improvements in medicine use could lead to major savings and release funds for other health areas. </p>
<p>Improving on medicines use requires effective monitoring so that prevailing practices and challenges can be understood.</p>
<p>Irrational use of medicines leads to health care wastage. It can harm both individuals and whole communities. Prescribing needs to be justifiable, evidence-based and must demonstrate sound clinical practice.</p>
<p>African governments, health professionals and non state actors must put in more effort to urgently implement measures to tackle the continent’s poor prescribing practices. </p>
<p>These must include adoption of broad approaches that seek to strengthen health systems, and rational prescribing.</p><img src="https://counter.theconversation.com/content/64250/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Irrational prescriptions are a major global health problem. The World Health Organisation estimates that more than half of all medicines are inappropriately prescribed, dispensed or sold.Richard Ofori-Asenso, PhD student in the Department of Epidemiology and Preventive Medicine, Monash UniversityAllyson M Pollock, Professor of Public Health Research and Policy, Queen Mary University of LondonPetra Brhlikova, Faculty member at the Centre for Primary Health and Public Health, Queen Mary University of LondonLicensed as Creative Commons – attribution, no derivatives.