By Katherine K. Dahlsgaard, Ph.D.
It's flu season, which means it’s flu shot season, which means it’s a good time for some parental tips to help your child calmly face those shots with confidence.
Yes, there is an inhaled flu mist vaccine available, but – as a psychologist who specializes in anxiety – I usually advise parents and children/teens with whom I work to choose the shot each time, ensuring that years don’t go by between confrontations with the dreaded needle. At least 30% of children report mild-moderate fears of receiving shots (as do about 20% of adults). It is estimated that 2-4% of children have injection phobias (i.e., extremely intense fears combined with high anticipatory anxiety that results in impairment in everyday living); among adults, injection phobia is estimated at 4% – 10%. The median age of onset is 5.5.
Children’s regular exposure to shots is part of a healthy life.  American children will receive around 20 shots for vaccinations during the course of their lives. Although the majority of these will be completed by age 6, several vaccinations occur during the tween and teen years, and young people frequently will require shots of Novocain at the dentist’s office or experience needle injections for blood draws. Without frequent, successful experience with shots, mild fears can lead to full blown phobias. Needle phobic children can grow to become needle phobic adults – and adults, unlike children, can and do refuse medical treatment because of their fears (by simply avoiding routine trips to the doctor’s/dentist’s office and even medically necessary interventions). This can result in decreased quality of life and significantly increased risk of mortality.
So if your child has even a mild fear of injections, it’s a very good idea to help him to learn and practice good, brave strategies so he can get through shots “like a Rock Star” or like the “Bravest Kid in the World” (let him or her take their pick). 
Here is what I recommend:
  1. Do not wait until the day of the doctor's appointment to surprise your child with the news that he'll be getting a shot. Many parents do this, reasoning that if they tell their child in advance, "he will worry about it all week." However, NOT telling your child in advance a) suggests that YOU think shots are so overwhelming and awful that he should, too, and b) denies your child a chance to develop and practice a good coping plan.
  2.  Tell him about the shot matter-of-factly, modeling calm behavior. If he expresses distress, you can empathize and reassure him that it's a normal reaction: "I understand that you're nervous – lots of people don't like shots."
  3.  Do not overly reassure your child ("It'll be okay! It'll be okay!") or tell him, "Don't worry – it won't hurt." First, shots do hurt, which he already knows. Second, the greater purpose here is to help him realize he can act bravely even when things are painful.
Tomorrow: Six ways to help your child be brave about shots -- including videos that take away the psychological “sting.”
Katherine K. Dahlsgaard, Ph.D., is lead psychologist at the Anxiety Behaviors Clinic in the Department of Child and Adolescent Psychiatry and Behavioral Sciences at the Children's Hospital of Philadelphia.