Pain at the time of vaccine injection is a common concern amongst parents worldwide. However, many children and parents find immunisation visits are an easy and relatively pain-free experience. For some children and parents, needles can also be scary especially on the first visit. Children can easily tell when their parents are anxious and, as a parent, you need to be aware that your child will look to you for comfort and reassurance. You can download and print our information sheet Tips when immunising children that contains this information so you easily refer back to it later.
Before and during the immunisation
- Avoid using scary words about seeing the nurse or having injections and avoid reassurances that it won’t hurt at all.
- For children aged 4 years or older, tell them about the immunisation process in advance.
- Bring your child’s favourite stuffed toy, blanket, book, or game for them to hold during the immunisation or use to distract them.
- Hold your child during injection to help soothe them. Talk calmly. You can gently stroke their arm or back to reassure them.
- Mothers can breastfeed before immunisation and while the injections are being given if this is culturally acceptable.
- You can help older children by using distraction techniques such as talking, playing a favourite word game or playing an imagination game with them during the immunisation.
- For children aged 4 years or older, sit them upright and use a ‘comfort hold’ rather than restraining them.
- Try to remain calm and relaxed even if your child becomes upset.
- You can consider purchasing anaesthetic cream from the pharmacy if the cost is acceptable, the ‘over the counter’ pharmacy cost varies.
- If you choose to use an anaesthetic cream, apply it to the injection site and cover it with a dressing before you leave home for the immunisation visit.
After the immunisation
Your child may cry for a brief time after receiving their immunisations. This is normal and their way of coping.
- Comfort, hold and talk to your child supportively.
- Their favourite stuffed toy, blanket, book, or game may also help comfort or distract them.
- Feeding your baby straight after their immunisation will help them settle.
- You need to remain in the clinic for 20 minutes after the immunisation. Use this time to help your child settle, this can help make the next visit easier.
Vaccine responses such as mild to moderate fever, or redness, swelling, discomfort or pain at the injection site are normal and common responses to immunisation. They can occur as your child’s immune system learns to protect them from the diseases covered by the vaccines. But don’t worry if your child doesn’t have any visible immunisation responses, their immune system will still be learning what to do.
Immunisation responses can been seen as early as 4–6 hours after immunisation and usually start to settle down 24–48 hours after immunisation. There are some things you can do if the immunisation responses are making your child feel miserable or distressed.
Suggestions to help manage immunisation responses
If your child gets hot or has a fever
- Give lots of breastfeeds or fluids
- Undress them to a single layer, for example a singlet and pants
- Make sure the room is not too hot or too cold
- Give lots of cuddles
If your child has injection site discomfort or pain
- Do not rub the injection site
- Hold a cool damp cloth or an ice pack well wrapped in a dry cloth on the injection site
- Give lots of cuddles
Medication for temperature or pain
The use of paracetamol around the time of immunisation reduces the laboratory measured immune system response to immunisation, but there is no evidence that the reduced response leaves children with less protection from the diseases they were immunised against.
We do not recommend giving paracetamol before or after immunisation with most childhood vaccines just in case of fever or injection site discomfort. However, if your child has a fever or seems to have discomfort and they are miserable or distressed we do recommend the use of paracetamol. You must follow the dosage instructions on the bottle; it is dangerous to give more than the recommended dose.
The recommendation for Bexsero®, a purchased immunisation against meningococcal group B disease, when given to children aged under 2 years is different. This is because fever and injection site discomfort or pain are more likely to occur with Bexsero compared with other childhood vaccines. A fever over 38°C or 39°C is almost twice as likely as when Bexsero is administered at the same visit as other Immunisation Schedule than when the Immunisation Schedule vaccines are given alone. If you are purchasing Bexsero from your family doctor for your child when they are aged under 2 years, we recommend that you download and print our information sheet Paracetamol use with Bexsero in children aged under 2 years before you take them for their immunisation.
Ibuprofen is less effective than paracetamol in managing immunisation related fever or injection site discomfort or pain. Ibuprofen is not recommended to help manage the symptoms of an immunisation response.