Use these simple steps to help minimize the fear and challenging behavior that often accompanies getting shots with your young child.
My daughter just had her 18 month set of immunizations. In the past, she has not reacted well to getting shots (i.e. screaming, crying, struggles to calm down). So this time around I decided to try a few behavior strategies to prepare her in hopes of a more positive experience.
This visit was also going to be a little different. Due to COVID-19, the immunizations were being provided as a drive-through service. I wasn't sure how she would do with having a stranger open her door to the car, wearing a mask, and giving her a shot while she is strapped in and I am not in view. Needless to say, the strategies appeared to be successful. Long story short, no tears!
Here are a few behavior strategies that I used that may be worth trying with your little one:
Social Skills Training (practice before the shots)
Priming (reviewing the routine)
Redirection (playing her favorite song)
Positive Reinforcement (I used mini chocolate chips; one of her favorites!)
Strategy #1: Social Skills Training
Explain what we are practicing and why
Some of you may be asking, what is social skills training (SST)? Essentially it is providing opportunities for your child to practice the appropriate behavior. It is an effective strategy used to teach social skills, replacement behaviors, and expected behaviors in specific situations. SST is useful because it walks the child through what they can expect to happen and teaches them how they are expected to behave.
The first thing I did was practice the doctor's visit at home.
Explain what and why: I had her sit in her comfy chair and we pretended to be in the car. I said, "We are going to go to the doctor. When we get there they are going to give you a shot in your leg to help keep you healthy."
Model: I showed her what was going to happen on my leg first. I took the "shot toy" from our doctor kit and pretended to give myself a shot in my leg, rubbed it and placed a pretend band-aid on it.
Practice: Then we practiced on her, which she appeared to really enjoy! I gave her a "shot" in her leg, we rubbed it, put on a pretend band-aid, and then gave her a little chocolate chip.
Reinforcement: My little girl has a major sweet tooth! I gave her a few options for what she wanted after the "shot", but of course, it was the mini chocolate chips. After practicing she got a little chocolate chip. I'll talk about positive reinforcement more down below.
Strategy #2: Priming
What is priming?
Priming is a behavior strategy used to prevent inappropriate behavior from occurring. With priming it is common to explain (verbally or with visuals) what will happen in the future. Many young children and children with a disability struggle with change and may display challenging behavior when something is out of the ordinary. By letting the child know what to expect in an upcoming situation it often helps decrease anxiety and challenging behavior.
How to use it in this situation:
On our drive to the hospital, I used priming. Simply by talking to her about what we were going to do. This reminded her of what was going to happen and the expectations.
Example: While in the car driving, "When we get to the doctor, someone is going to open your door, give you a shot in your leg, and then you get a piece of chocolate! We are also going to listen to Ferdinand."
Strategy #3: Redirection
What is redirection?
Redirection, put simply, is distracting the child from the situation in which challenging behavior is likely to occur. You probably use redirection all the time with your little one without even knowing it.
How to use redirection in this situation:
When it was time for her shots I turned on her favorite song in the car. This distracted her at first from the shots and I think provided her some comfort. You can use anything that is of interest to your child.
Strategy #4: Positive Reinforcement
What is positive reinforcement?
Okay, I am going to geek out a little bit, so bear with me. Positive reinforcement when talking about it through the lens of the science of applied behavior analysis describes a relationship between the behavior and the reinforcer. The principle of reinforcement is used when we want a behavior to increase. That means that if a behavior that we want to increase is followed by a reinforcer, then over time, the behavior will increase. Whatever follows the behavior is only considered a reinforcer if the behavior increases overtime. You want to make sure the reinforcer provided after the behavior is something the child has chosen prior to the situation. This helps increase motivation for the child, because it's something they really want. Whew, that was very technical. So let's look at an example below.
How I use positive reinforcement in this situation:
In this case I wanted the behavior of sitting and getting a shot without crying to increase. If I give my daughter something she likes after the expected behavior (sitting and watching without crying) and that expected behavior increases over time (meaning she does the expected behavior the next time) then whatever I gave her (mini chocolate chips) served as a positive reinforcer. I want the behavior of her sitting and getting a shot without crying to continue. She has not done this before when she has gotten a shot.
Reinforcement was delivered while practicing (immediately after she got a pretend shot I gave her something that she likes that she chose, in this case a mini chocolate chip). We practiced this a few times and then when it was time for the real thing, immediately after she got her shot I gave her 2 mini chocolate chips before she had an opportunity to cry. Since she demonstrated the appropriate behavior I would label the mini chocolate chip as a positive reinforcer.
Side note: I'm sure the nurse was wondering what I was doing, standing behind her with chocolate chips...lol. I think me getting out of the car probably defeated the purpose of a drive-through immunization experience, but it was worth it.
Did I need to use all of these strategies?
Although I used multiple strategies for this situation just 1, 2, or 3 of them may have been just as effective as using all 4. I wouldn't know unless I eliminated one strategy at a time. Try using one or a few of these strategies next time your child has shots or for other challenging situations and see if it makes a difference.
Until next time!