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The vaccination for COVID-19 in children (aged 12-15) has already begun in countries like France and Germany. In India, vaccination for children aged 12-18 years is likely to begin in October after the approval of the final trial results.
Injection is the most common method of vaccine administration in all age groups, including children. It is also the common source of iatrogenic pain (pain caused by drugs or medical acts) during childhood, says a study. 
Pain caused due to injections can cause distress in children that if not addressed on time may lead to psychological problems like anxiety, fear of needles and avoidance of healthcare in the future.
The distress is also not limited to children but parents and the medical expert giving the injection too can feel distressed due to the process of vaccination in children.
The study adds that around 25 per cent of adults have fear of needles and this has been developed mainly during childhood. Also, around 10 per cent of the population usually avoids any needle procedures, including vaccination due to this fear.
In this article, we will discuss ways to manage vaccination-related pain in children and adolescents. Take a look.
Studies say that breast milk has analgesic effects, which is why experts often suggest mothers breastfeed the child during vaccination. Along with the breastmilk's analgesic effects, the whole process of breastfeeding is beneficial for the baby during vaccination. For example, skin-to-skin contact helps soothe the baby due to injection pain while the sweet taste of the milk and the act of sucking distracts the baby. 
2. Sugar water
Oral sweet-tasting solutions like sugar water can prove to be analgesic for newborns, infants and children too. A study has shown that doses of 0.24 g (2 ml of 12% sucrose solution) can help reduce the duration of crying and pain in newborns caused due to painful medical procedures.  This could be because of the analgesic effects of sugar solution along with the distraction strategy. Other methods like giving sweet chewing gums could be ineffective. The best way is to indulge your six months old (or younger) baby in breastfeeding while giving infants or children a sugar solution.
3. Position of a child during vaccination
The position of a child also influences the pain related to vaccination. A study has shown that lying supine (lying horizontally with the face and torso facing up) can cause more pain and distress in children compared to sitting upright or being held by one of the parents. The study adds that when the child is picked up immediately by the parents and held after vaccination, it automatically reduces the anxiety, which further leads to a reduction of perception of pain, no matter what the position is. 
4. Rapid injection technique
Intramuscular injection, when given with specific techniques, can help reduce the incidence of pain and the safety of vaccine administration in children. According to a study, rapid injection technique without aspiration can help reduce the intramuscular pain injection in babies between four to six months, compared to slow injection with inspiration. This could be because of the less contact time between the skin and the needle in rapid technique. 
5. Rubbing the skin
Some tactile stimulation like rubbing the skin near the site of injection before and during the administration of the vaccine can help reduce the sensation of pain and soothe the baby. Studies say that the warmth that the sensation of touch gives competes with the sensation of pain and thus, may help reduce it. 
Also, rubbing before the injection applies pressure to the skin area, which in turn, reduces pain during the time of injection.  Remember to rub with moderate intensity, as per the child's comfort levels and type of vaccination. For example, the COVID-19 vaccine may not need rubbing the site area and thus, should be avoided.
Things To Remember
- Multiple vaccines: When the child is receiving multiple vaccine injections, the medical expert should make sure that the painful dose should be given at the last.
- Training strategies: Parents should be given training on strategies related to distracting the child during the vaccine procedures. This includes training as per the child's age.
- Behavioural coaching: Coaching on parental behaviours is also important. For example, a parent should give suggestions to their child on how to cope or what are the advantages of vaccines, and not perform behaviours like apologising to the child.
- Topical creams: If the child is experiencing pain due to needle procedures, it is suggested to consult a medical expert soon for certain topical anaesthetics like placebo creams to effectively reduce the pain in the area. 
- Teaching the child breathing techniques: Experts say that when kids who are three years or older perform deep and slow breathing during vaccination, the pain could be reduced to the maximum. Breathing techniques by using toys like blowing bubbles can also serve as a way of distraction. 
Vaccination can be hard for both children and parents. Pain management is not the only effective way to deal with the situation, as preparing the child mentally for injection shots is also important. Therefore, it is good, to be honest with your child and explain the procedures of vaccination and its benefits. Never lie to them or behave aggressively if they cry. Consult a medical expert for better advice and ways to deal with childhood vaccination procedures.
Symptoms of vaccination pain in babies can last for a day or for around 3-4 days. Some babies may also do not feel the pain at all. Being a parent, if you notice that your child is crying or feeling uneasiness due to the pain or has got fever after vaccine administration, consult a medical expert for advice.
In babies below six months, the pain can be managed by indulging them in breastfeeding during the vaccination. For children, methods like giving them sugar water or distracting them with their favourite toys or songs can actually work. Whatever you do, make sure, to be honest with your child about the vaccination and avoid aggressive behaviours.
If there are multiple vaccines to be given to children, it is good to start with the less painful one and then proceed with painful ones at the last. According to a study published in the journal JAMA Network, when infants were given less painful vaccine DPTaP-HiB, followed by the painful PCV, they had experienced less pain compared to its reverse order.