How can I help my seven-year-old son overcome his needle phobia?

By Patrick J. McGrath, OC, PhD, FRSC

Dr. Pat

Question:

My seven-year-old son requires blood work several times a year. Last time, his father, myself, two technicians, and a nurse had a horrible time to get him to allow the technician to get a sample of his blood. His screams could be heard all over the lab. He was totally out of control. I really do not think it hurts him physically, but I am beginning to believe he is afraid to bleed. He has been going for regular blood work for the past three years, and each time he goes, he is worse. He doesn't want to talk about this. Any help you can give would be appreciated!

Dr. Pat responds:

Your son has a severe needle phobia. Phobia just means an excessive fear of something.

You are right; the issue is only partly pain. He avoids needles at all costs and puts up a good fight. His fear has now spread so that he avoids talking about it.

Most children have some fear of needles because needles hurt. But your son's fear is interfering with his life and happiness. I am sure it is also difficult for the entire family.

Phobias can arise from a trauma. Perhaps his veins were difficult to access and it took several attempts. Perhaps your son had a technician who did not mesh with him at some time. Of course, every negative experience feeds his fear.

The key to overcoming all phobias is successful exposure to what is feared. The problem is getting to successful exposure.

Treatment usually involves using coping skills, distracting the child, teaching the parents what to do, and gradual exposure.

Your son may be taught coping skills to make it easier to face what he fears. For example, deep, slow breathing can help calm the body. Talking in a calming way to oneself can reduce mental anxiety.

You can learn to be calm and firm and how to use distraction effectively.

He would then be helped to gradually face his fear. First, he would use his imagination by:

• pretending to go to the hospital
• imagining going to the blood lab
• thinking about chatting with a technician
• pretending being prepared for a needle
• imagining having a needle

Then he might:

• play with a syringe (without the needle, of course) in the bath, to paint with, and so on
• role-play giving a needle to a teddy bear
• role-play giving dad a needle
• role-play being given a needle by mom

These steps might be repeated many times in different ways. He will gradually become more comfortable.

Visits might be arranged to the blood work lab to:

• see the lab
• see the chair
• see the equipment
• talk to the technician
• role-play sitting still
• role-play having the needle for blood work

Moving from one step to the next occurs when the child's anxiety is lessened.

Finally, a plan could be developed to ensure success of the next blood work by:

• using firm expectations
• using the best needle procedure
• using the right distraction
• having enough time

Your son can learn that since the blood work must be done, it will be easier, faster, and less painful if he is co-operative.

Throughout, a firm but loving approach is best. The child is required to participate in the process. Small rewards, such as a sticker chart, may be used to increase motivation at different steps.

Much of the treatment is done by the parent. The steps, and how fast progress is made, depend on the individual child.

Sometimes a cream that numbs the skin and reduces the pain will help as well. For example, EMLA® is available without a prescription. It is unlikely that EMLA® alone would work. In some children, it makes the veins a bit more difficult to find.

I would strongly recommend that you ask your doctor refer your son to a paediatric health psychologist who can devise an individual program.

Thanks to Elizabeth McLaughlin and Christine Sherren for advice on this answer.

Patrick J. McGrath OC, PhD, FRSC is a clinical psychologist and a researcher. He is Professor of Psychology, Pediatrics, and Psychiatry at Dalhousie University and Vice President - Research at IWK Health Centre in Halifax. Read more "Ask Dr. Pat" columns Ask Dr. Pat a question