New Canadian guideline boosts efforts to ease vaccination pain with simple, evidence-based tricks

An updated clinical guideline in Canada highlights straightforward, low-cost techniques to reduce anxiety and pain during vaccinations, aiming to improve uptake and minimise distress among all age groups amid the busy autumn immunisation season.

A new clinical guideline says vaccination visits are still doing too little to prevent the pain and distress that often come with injections, even though many of the most effective remedies are simple and inexpensive. Published in the Canadian Medical Association Journal, the advice sets out 16 ways to make shots less upsetting for babies, children and adults, ranging from breastfeeding during an injection to using numbing creams and music. The timing is especially relevant for families now moving through the autumn vaccine season, when flu, COVID-19 and school catch-up jabs can mean repeated appointments and more opportunities for fear to build.

The guideline’s authors say the problem is widespread. Needle fear affects a large share of both children and adults, and pain or anxiety can be enough to put some people off vaccination altogether. That matters beyond a single tearful appointment, because distress can also bring on fainting, dizziness and the risk of injury if someone falls. The message from the panel is straightforward: much of this discomfort can be prevented if clinics use measures that are already available and supported by evidence.

To organise the recommendations, the authors grouped them into five areas covering the process of vaccination, the procedure itself, physical comfort, medicines and psychological support. For babies up to 12 months old, the strongest advice is to feed during the injection, whether by breastfeeding, bottle-feeding or giving a sweet-tasting liquid; a pacifier may also help. Singing and toys can distract infants, while topical anaesthetics, including numbing creams or patches, are recommended across age groups. The guideline also favours clinic techniques such as avoiding aspiration, which means not pulling back on the syringe before injecting, and giving the least painful vaccine first when several shots are due.

For older children and adults, distraction can make a real difference. The guideline gives music the strongest backing in this group, with games, videos and toys also listed as useful options in some settings. It also recommends preparing coping strategies in advance through the CARD approach, a framework that stands for Comfort, Ask, Relax and Distract. Lead author Anna Taddio of the University of Toronto and The Hospital for Sick Children said research shows effective ways to reduce distress, but these steps still are not routinely built into vaccination programmes.

The evidence behind the recommendations was reviewed using the GRADE method, which rates how certain researchers can be about the findings and how strong each recommendation should be. The panel drew on five systematic reviews of randomised and quasi-randomised trials published through 31 January 2025 and included vaccine recipients and support people in the process. Seven recommendations were strong, including education programmes that combine several approaches and feeding or pacifier use for infants. Nine were conditional, with some advising against approaches such as video or movie distraction for infants. The guideline does not alter which vaccines people should receive or when, and it was written for Canadian practice, though the practical steps are not country-specific.

There are limits to what the guidance covers. It does not address severe needle fear that leads people to avoid care entirely, which the authors say is better treated with exposure-based therapy delivered by a mental health professional. People with developmental or intellectual disabilities were also underrepresented in the studies behind the guideline. Even so, many families can act on the advice immediately: plan to feed an infant during the shot, bring music or a favourite toy for older children, and tell the vaccinator about any fear or past fainting. The CDC says breastfeeding is compatible with vaccination for most mothers, and its vaccine administration guidance also supports measures such as sweet liquids, topical anaesthetics and distraction to reduce discomfort.