The needle just might be the most dreaded symbol of health care. The reality is up to 90 per cent of young kids are scared of needles. But many parents don't realize that there are some simple ways to ease the anxiety and pain that needles bring.

Needles are never fun but are especially scary when you're under five years of age, as many kids getting the swine flu shot this week are.  As if the needle itself weren’t scary enough, then there the stress of waiting hours to get one amid crowds of strangers and howling children.

While parents we spoke to outside flu clinics said they planned to reward their inoculated children with a special dinner or special treat, there are some better, proven ways to reduce your child's pain by up to 50 per cent. These include:

Numbing creams and patches
Several products are available in Canada without a prescription, including EMLA (lidocaine-prilocaine) and Ametop (amethocaine). They cost only about $10, and are available without a prescription. These are applied 30 to 60 minutes before the shot and appear to cut down on pain more than the oral medications many parents currently use, such as Tylenol.

Before using these creams, make sure your child is not allergic to any of the ingredients. Follow the instructions carefully, being careful to apply them to the correct location and for the correct amount of time. Topical anaesthetics can cause temporary discoloration of the skin where they are applied. If you notice a rash, it could be a sign of an allergic reaction. Tell your health care professional.

Distraction
This has been shown to be very effective. Bring a shiny or noisy toy like a pinwheel or electronic toy, blow bubbles, squeeze a squeaky toy -- anything that will engage your child for a few seconds could make a big difference.

Breastfeeding and sugar
For younger toddlers, you can cut down on their pain by breastfeeding them as the shot is given, or put a little sugar water on their tongue, bottle or soother just before the shot.

"If parents could bring their kids to be vaccinated and have their kids be laughing and playing with bubbles, rather than screaming, it would completely change the climate of that situation,” says Dr. Anna Taddio, a scientist and clinical pharmacist at Sick Kids Hospital.

Not only will these steps help your child deal with the needle today, but it can help them in the future. It’s estimated that up to 10 per cent of adults have a significant needle phobia because of a traumatic experience they had in childhood.

“What we're learning is it's impacting us more than we thought and that it doesn't need to be there. So we can have it both ways. We don't have to sacrifice pain for good health. We can have good health and no pain too,” says Taddio.

Here are some more tips from the Hospital for Sick Kids:

Preparing your child
Talk to your child about the procedure using age-appropriate words. In general, tell young children under 4 years old immediately before the procedure. Tell older children at least 1 day before the procedure. Involve and listen to your child. Children often have helpful suggestions for how to manage their pain.

Before the procedure, tell your child:

• The reason for the procedure. For example, "to help you stay healthy."
• What will happen. For example, "You will get a medicine called a vaccine in the arm using a tube that looks like a straw called a syringe."
• How it will feel. For example, "You might feel a pinch and some pushing or pressure that will last a few seconds."
• What you are going to do about their possible discomfort. For example, "Some children think it is uncomfortable and some think it is okay. We don’t know how it will feel for you. We are going to do different things so that it does not feel as uncomfortable for you." Then tell your child what you will do.
• What they can do to help. For example: "You can help by holding still and breathing deeply with me."

Avoid words that focus attention on the procedure, such as "hurt," "pain," or "shot." Avoid reassuring words such as "It’ll be over soon" or "You’ll be okay." Avoid apologizing or empathizing, for example "I’m sorry you have to go through this" or "I know it hurts." Instead, talk about things that have nothing to do with the injection.

After the procedure, praise your child to reinforce their success in getting through the procedure.

Preparing your health care professional

• Let your doctor or nurse know what pain management strategies you are planning for your child’s vaccine injections and try to enlist their support. Show them this information sheet.
• Ask them to make vaccine injections less painful in the following ways:
• Give intramuscular vaccines quickly without aspiration. Aspiration is not a necessary step in vaccine injections.
• Give the most painful vaccine last when more than one vaccine is given in the same visit. There is no rationale for injecting the more painful vaccine first and it increases overall pain.