Many people do not like needles as part of medical procedures when they receive care. But for some, the fear of needles is so great that it might prevent them from getting life-saving medical care, like vaccinations. This fear often affects children but can affect adults, too. Fear of needles is also common in people with certain conditions that cause difficulties with managing strong sensations, such as in people with mental, emotional, or behavioral disorders. Fear of needles can also be common in people with disabilities that make it hard for them to understand the procedures and communicate their concerns. There are ways to manage this fear. Learn what you can do so fear does not get in the way of important medical care including vaccines.

Getting medications or vaccines through a needle – or having blood or other fluids taken by a needle – can be painful. Many people remember the discomfort and pain and worry about it occurring again when they return to get health procedures involving needles. This is typical. Younger children have fewer ways to handle their fears and need help and comfort from their parents or other caregivers. As children get older, many find ways to handle their fears on their own.

But for some, these fears are more severe, can persist into adolescence and adulthood, and are best described as phobias. Needle phobias can be learned from a past experience of pain, but there is also a biological component that makes some people react very strongly to the idea of procedures involving a needle.

These phobias can make procedures feel more painful, lead to severe panic, and in some cases to a physical response that causes fainting. This can make it extremely difficult to consider getting medical procedures involving needles. Estimates show that as many as 2 in 3 children and 1 in 4 adults have strong fears around needles.  As many as 1 in 10 people might delay the COVID-19 vaccine due to these fears. People who have mental, emotional, or behavioral disorders such as anxiety disorders, people with certain disabilities, and people with certain conditions that affect how they manage sensations like touch or movement, may have more difficulty managing such fears. People with disabilities may be less likely to get vaccinations even though they may be more at risk for certain illnesses, such as severe effects of COVID-19. Parents who have fears of needles themselves may hesitate to have their children vaccinated.

Showing fear is typical for younger children; but having extreme fear that lasts into adolescence and adulthood may lead to feelings of shame. People with phobias can include those who are highly tolerant of pain and risk, like those who play sports, manage injuries and illness without complaint, or even work in healthcare settings. The danger is imagined, but to the person, the fear or phobia is real and not a choice. It can feel like a part of the brain is playing tricks on the rest of the brain. Having a phobia does not mean using the fear to seek attention – people with a phobia might even hide the phobia and use other reasons to avoid getting the health care they need. Being around people who react negatively (by becoming angry or overly worried or fearful of the person’s fear) can make the fear worse. There are many positive ways parents, caregivers, and partners of people with a phobia can be supportive.

Fears and phobias can vary from mild to severe. For milder cases, preparation, support, and pain management can help.

• Information about the procedure: Understanding why the procedure involves needles and how it will protect the person can help.
• Understanding causes of fear:
  • Pictures: Seeing pictures of needles and watching news about vaccination can cause feelings of fear. It may be useful to avoid these images unless they are used by a trained mental health provider as part of therapy.
  • Words: For some people, substituting words like ‘shot’ with ‘poke’ might help limit the fear response.
  • Surroundings: For fearful people, it may be best to be in a private space rather than a large room with other people who are also getting the procedure. Drive-through vaccination can help some people by allowing them to be in the comfort of their own car. Special clinics for people with disabilities may offer calm and quiet spaces.
• Understanding the procedure: Knowing where the procedure will take place, who will be around, and what will happen before, during, and after can help reduce fears.
  • It is often best to be realistic – the provider or parent can explain that the vaccination might feel like a pinch or a poke, it may hurt, but usually just for a moment.
  • Planning and practicing what will happen, including role playing or using books and videos that show the steps, may help fearful people prepare.
• Managing pain: Even though the pain from the needle is usually not severe, the brain still focuses on it; managing the pain can reduce fear and panic.
  • Numbing creams and sprays: Healthcare providers can use medication that numbs the skin and prevents the person from feeling the procedure.
  • Vibration or cooling: Small devices that create a buzzing feeling or cool the skin can help the brain focus on that sensation and block out the pain from the procedure.
  • Distraction: Focusing on something else such as videos, toys, or even virtual reality devices can keep the person’s mind busy and away from the fear.
  • Relaxation, breath control, and hypnosis: Learning how to do relaxing breaths and using hypnosis or self-hypnosis to calm the mind can help.
• Tailoring the strategies: Each person is different, and what works depends on the individual. Combining different strategies may be helpful. Healthcare providers can help develop a plan that works best for each person.

For extreme fears, it is best to talk to a mental health provider to understand how severe the problem is and plan the best strategies to treat the phobia. Treatment for phobias can include counseling, exposure therapy where the person gradually faces their fears with the support of a mental health provider in carefully planned steps, and/or medication.

People with fears and phobias need support as they work to manage their feelings during procedures involving needles. Having a trusted person who understands the fear, remains calm, and provides comfort during the procedure can help the fearful person. It is also helpful to let the fearful person know there is no shame in having fears, even when the danger is not real. Fear is not a choice, and it is not necessary to make the fear go away; the goal is to manage fear enough to get the important potentially life-saving procedure. Family and friends can become part of the plan that works best for a person and help encourage and support the person’s choices to cope and manage their fears.

9 Things You Can Do for You and Your Baby

Learn about simple ways you can support your child before, during and after shots.

Take a moment to read about how you can prepare before your visit, and review any vaccine information provided by your child’s doctor. If you want to do additional research, use CDC’s vaccines for parents web site.

Tasting something sweet can help reduce your little one’s pain response. If your child is two years of age or younger, ask your child’s doctor to give your child a sweet solution of sucrose or glucose one to two minutes before the shot. Even a very small amount can help reduce pain during shots.

Breastfeeding can be a great way to calm and relax your baby, as it can help distract him or her and provide comforting close contact. Additionally, breastmilk has a slight sweetness, which can help reduce your child’s pain during shots.

Ask your child’s doctor for a pain-relieving ointment, which blocks pain signals from the skin. Because the ointment takes time to work, ask about it before your next well-child visit. Or, request a cooling spray (vapocoolant), which is applied on your child’s arm or leg right before the shot. Using an ointment or cooling spray may reduce your and your child’s stress during a well-check visit.

Kids are smart, so take time to explain in simple terms what to expect. Explain that your child may feel a little pinch and it will go away very fast. Use words like “pressure” or “poke” rather than “pain” or “shot.” Even if your baby can’t understand your words, your calm voice will be reassuring. Remain upbeat and relaxed before, during, and especially after shots.

Bring anything your child finds comforting, like a favorite toy, blanket, or book, to help them focus on something pleasant. Make sure to check with your doctor before bringing items into the room with you.

Right before the shot, call your child’s name, sing your child’s favorite song, tell a story, or just act plain silly to pull your child’s attention away from the shot giver. Keep the distraction going after the vaccine is given.

If your child is older, you can take deep breaths with them to help “blow out” the pain. Have them imagine the pain is leaving their mouth as they breathe out. Tell a story or point out interesting things in the room to help create distractions.

Calm young infants by swaddling them. Hugs, cuddles and soft whispers can help soothe older babies after a shot. Your child may have mild reactions, such as pain and swelling where the shot was given or a fever; these are common and will soon go away. Contact your child’s doctor if anything concerns you.

Healthcare providers can increase their own awareness of needle fears and phobias. Providers can let their patients and family members know they understand that extreme fears and phobias are a real concern. Healthcare providers can offer information and support to decrease feelings of shame and fear and assist people with developing a plan to manage their fears. Different strategies for pain management can be offered as a routine part of procedures involving needles.

People who have fears may not talk about them with their providers and may hesitate getting medical care that involves a possibility of needles. Telehealth may provide a way to talk with patients about their fears and develop trust as the first step to getting the care that is needed.

Healthcare providers can work with families and caregivers to find ways to make getting vaccinations easier. For people with severe fears, a referral to a mental health provider may be appropriate.

What is medical test anxiety?

Medical test anxiety is a fear of medical tests. Medical tests are procedures that are used to diagnose, screen for, or monitor various diseases and conditions. While many people sometimes feel nervous or uncomfortable about testing, it doesn't usually cause serious problems or symptoms.

Medical test anxiety can be serious. It can become a type of phobia. A phobia is an anxiety disorder that causes an intense, irrational fear of something that poses little or no actual danger. Phobias can also cause physical symptoms such as rapid heartbeat, shortness of breath, and trembling.

What are the different types of medical tests?

The most common types of medical tests are:

• Tests of body fluids. Your body fluids include blood, urine, sweat, and saliva. Testing involves getting a sample of the fluid.
• Imaging tests. These tests look at the inside of your body. Imaging tests include x-rays, ultrasound, and magnetic resonance imaging (MRI). Another type of imaging test is endoscopy. Endoscopy uses a thin, lighted tube with a camera that is inserted into the body. It provides images of internal organs and other systems.
• Biopsy. This is a test that takes a small sample of tissue for testing. It is used to check for cancer and certain other conditions.
• Measurement of body functions. These tests check the activity of different organs. Testing may include checking the electrical activity of the heart or brain or measuring the function of the lungs.
• Genetic testing. These tests check cells from the skin, bone marrow, or other areas. They are most often used to diagnose genetic diseases or find out if you are at risk for getting a genetic disorder.

These procedures can provide important information about your health. Most tests have little or no risk. But people with medical test anxiety may be so afraid of testing that they avoid them altogether. And this can actually put their health at risk.

What are the types of medical test anxiety?

The most common types of medical anxieties (phobias) are:

• Trypanophobia, the fear of needles. Many people have some fear of needles, but people with trypanophobia have an excessive fear of injections or needles. This fear may stop them from getting needed tests or treatment. It can be especially dangerous to people with chronic medical conditions that need frequent testing or treatment.
• Iatrophobia, the fear of doctors and medical tests. People with iatrophobia may avoid seeing health care providers for routine care or when they have symptoms of illness. But some minor illnesses can turn serious or even deadly if left untreated.
• Claustrophobia, the fear of enclosed spaces. Claustrophobia can affect people in many different ways. You may experience claustrophobia if you are getting an MRI. During an MRI, you are placed inside an enclosed, tube-shaped scanning machine. The space in the scanner is narrow and small.

How do I cope with medical test anxiety?

Fortunately, there are some relaxation techniques that may reduce your medical test anxiety, including:

• Deep breathing. Take three slow breaths. Count to three for each one, then repeat. Slow down if you start to feel lightheaded.
• Counting. Count to 10, slowly and silently.
• Imagery. Close your eyes and picture an image or a place that makes you feel happy.
• Muscle relaxation. Concentrate on making your muscles feel relaxed and loose.
• Talking. Chat with someone in the room. It may help distract you.

If you have trypanophobia, iatrophobia, or claustrophobia, the following tips may help reduce your specific type of anxiety.

For trypanophobia, fear of needles:

• If you don't have to limit or avoid fluids beforehand, drink lots of water the day before and morning of a blood test. This puts more fluid in your veins and may make it easier to draw blood.
• Ask your provider if you can get a topical anesthetic to numb the skin.
• If the sight of a needle bothers you, close your eyes or turn away during the test.
• If you have diabetes and need to get regular insulin injections, you might be able to use a needle-free alternative, such as a jet injector. A jet injector delivers insulin using a high-pressure jet of mist, instead of a needle.

For iatrophobia, the fear of doctors and medical tests:

• Bring a friend or family member to your appointment for support.
• Bring a book, magazine, or something else to distract you while you wait for your appointment.
• For moderate or severe iatrophobia, you may want to consider seeking help from a mental health professional.
• If you feel comfortable talking with your provider, ask about medicines that could help reduce your anxiety.

To avoid claustrophobia during an MRI:

• Ask your health care provider for a mild sedative prior to the exam.
• Ask your provider if you can get tested in an open MRI scanner instead of a traditional MRI. Open MRI scanners are larger and have an open side. It may make you feel less claustrophobic. The images produced may not be as good as those done in a traditional MRI, but it still may be helpful in making a diagnosis.

Avoiding medical tests can be harmful to your health. If you suffer from any type of medical anxiety, you should talk with your health care provider or a mental health professional.