Distraction Techniques
Positive techniques to distract from pain should be considered when immunizing children with special needs in primary care. Providing a trustworthy and honest relationship is more likely to minimize anxiety in children with special needs.21,27 Distraction techniques used in practice when immunizing children include streaming movies on hand-held devices, blowing bubbles or pinwheels, deep breathing, or music therapy.28 Squeezing a squishy object, such as a small soft ball, reduces pain in children during painful procedures.28 Because topical anesthetic creams need to be applied 1 hour prior to immunization, other pain-relieving strategies are preferred in the literature.
Implementing new, innovative technologies into immunization practices may also reduce distress in children with special needs. Rossi et al found social assistive robots (SAR) used during vaccination procedures reduced pain and distress. The robot captures the child’s attention and redirects attention towards interesting objects.29
Thermomechanical stimulation devices, which use cold therapy and vibration, help reduce vaccination pain but have not been found to decrease children’s anxiety about the procedure.30
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Children with special needs benefit from being held in their parent’s lap as this position offers comfort and secureness for the child while reducing anxiety, either facing or looking away from the procedure site.19 The goal of comforting restraints is to offer the least amount of force possible while keeping the child with special needs safe during immunizations. Restraining with use of excessive force may cause high levels of distress in children with special needs.31 Children with special needs feel an increased loss of control with prolonged restraint time. Comforting restraining time should be minimal.32
Neurodiversity Movement
The neurodiversity movement is a relatively new concept for health care providers to understand when meeting holistic needs, including immunization for children with special needs. Advocates view autism as a combination of an individual’s natural variation and disability.33 Common neurodiverse diagnoses include autism, attention-deficit/hyperactivity disorder (ADHD), and dyslexia.34 The main goals of the neurodiversity movement are achieving equal rights and respect for the individual, providing resources for support and educational opportunities, accommodating autistic differences, and providing a more decisive role for autistic voices in policy development.35,36 Central to the neurodiversity movement is the idea of using identity-first (eg, autistic person or autistic) vs person-first (person with autism) language.35,36 Pediatric providers must continue to follow the neurodiversity movement to provide the highest quality of care, including immunization administration, to children with special needs.34
Conclusion
Caring for children with special needs is a rewarding but challenging part of pediatric practices. A priority for any provider is to meet the holistic health care needs of children, including providing routine immunizations. Children with physical disabilities, neurologic and neurodevelopmental disorders, and autism are at higher risk for vaccine-preventable illnesses and face significant health disparities. Physical and psychosocial barriers exist when immunizing children with special needs and are vital considerations in practice. Health care providers should provide the most current, evidence-based immunization recommendations to children with special needs to promote optimal health outcomes. Offering an honest and trusting relationship with children with special needs is rewarding for patients and their families as well as clinicians.
Alison W. Bray, MSN, APRN, CPNP-PC, is a pediatric nurse practitioner in Rockwall, Texas, and a Doctor in Nursing Practice candidate at Baylor University Louise Herrington School of Nursing in Dallas, Texas. Jessica L. Peck, DNP, APRN, CPNP-PC, CNE, CNL, is a clinical professor at the Baylor University Louise Herrington School of Nursing, and immediate past president of the National Association of Pediatric Nurse Practitioners (NAPNAP).
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