What is Needle Phobia?

Imagine you are a 6 year old, and you’re going to the doctor for an annual check up. You sit down on the crinkly paper of the exam table, and all of a sudden, a nurse walks in with a vaccine tray. Immediately, you notice your palms start to sweat; you feel dizzy and nauseated, and your heart is beating faster and faster. You look to your parent, and they say, “It’s okay.” The nurse tells you, “It won’t hurt that bad, just hold still.” You feel as if you have lost all control in this moment…

This is what many children and teens experience if they have needle phobia, also known as trypanophobia. Needle phobia is considered to be a specific phobia, in which a child has an extreme, uncontrollable fear of something that is typically not dangerous. Needle phobia falls under the “blood-injection-injury type” of specific phobias, a category characterized by intense fear and sometimes fainting in response to medical procedures involving needles or blood.

In order for your child to be diagnosed with a needle phobia, their anxiety and avoidance around needles must cause problems in their daily life, and it must happen nearly every time your child encounters needles. 

Common Signs

When we are afraid of something, we tend to avoid it. This is the first common symptom those with needle phobia may exhibit: avoidance of getting shots. Additional signs that a child may have needle phobia include: extreme fear of needles, having panic-like symptoms or panic attacks when they see or think about needles, crying or throwing tantrums, trembling, sweating, heart palpitations, dizziness, nausea, fear of fainting, and/or difficulty sleeping before an appointment. 

Treatment

With specific phobias, the best treatment is cognitive behavioral therapy (CBT) with exposure and response prevention (ERP). CBT helps children understand how their thoughts, feelings, and behaviors are connected. ERP involves gradually facing fears (exposure) without relying on avoidance, safety behaviors, or compulsions to feel better (response prevention). Now you may be asking yourself “How does someone do exposure work with needles? Is my child just going to start poking themselves?” The answer is absolutely not! 

At InStride, we collaborate with you and your child to find an agreed upon starting point, creating a hierarchy of different scenarios (we call this a Fear and Avoidance Hierarchy or FAH). Your child will rate each scenario on a scale from 0-10 based on how distressing that scenario is. Throughout treatment, your child will face the various situations on the FAH during sessions and will practice exposures between sessions too. Needle exposures may look like: watching a tour of a doctor’s office, looking at pictures of needles/shots, watching videos of someone getting a vaccine, looking at or touching a needle, and eventually meeting with a doctor to go through the procedure at the doctor’s office. 

For children who faint or come close to fainting during needle procedures (a common reaction in blood-injection-injury phobia), a key skill called applied tension can prevent the blood-pressure drop that leads to fainting. Applied tension involves tensing major muscle groups, including arms, legs, core, for 10-15 seconds, then briefly relaxing, and repeating this cycle throughout the procedure. A trained therapist can teach your child how to use this technique safely and effectively so they remain alert and upright during exposures and real-life medical visits.

Psychoeducation is also helpful, as it teaches children that their physical symptoms (like a racing heart) are a “false alarm” from their body and not a sign of danger. Additionally, as part of care, children learn to notice and name the specific worry thoughts that fuel their fear, understand how those thoughts influence their feelings and actions, and practice responding in flexible ways (such as cognitive defusion where they learn to notice their scary needle-related thoughts without getting pulled into them, so the fear doesn’t take over their behavior). This cognitive work increases self-awareness and builds flexible thinking skills.

Caregiver Support

Now you may be asking yourself, how do I help my child who has a fear of needles with their vaccines or medical experiences? Here are some ways to support them through the process:

• Validate Their Feelings. The first place to start is validating their feelings with empathetic and supportive statements. Rather than saying, “It’s okay, just hold still, it won’t hurt,” you could say, “I hear that this seems really scary to you right now, and we can work together on helping you be brave.” 
• Prepare Them for What to Expect. Next, you would want to provide preparation and an explanation for the procedure to them in ways they can understand. Being honest and positive with your child is so important to maintain trust. For younger children, it can even be beneficial to use a stuffed animal to demonstrate your child’s “job” during the procedure as a means of preparation. 
• Offer Choices. During the poke, give your child appropriate choices. Giving them a sense of control can significantly reduce their anxiety. Some choices include which leg/arm to use, looking at the needle or looking away, and/or finding a comfortable position to sit. Feel empowered to advocate for your child and ask which pain management techniques are available. Some options could include numbing cream or combined vibration/cold packs.
• Create a Coping Plan. Having a coping plan for the procedure will allow it to go much more smoothly. This creates a shared agreement between you and your child ahead of time on what will happen and how they want to be supported. For example, this could include deciding where in the office to sit, which arm to use, who will hold their hand, and which fun reward they will get afterward. Once the plan is created, be sure to share it with the provider giving the shot. Connecting with the provider ahead of time allows you to give them a heads-up about your child’s fears and ensures everyone is aligned on the plan before the appointment begins. A great resource for creating a coping plan is the Meg Foundation for Pain Poke Plan. 
• Reinforce Their Efforts. The last step of providing support to your child during this process is to reinforce their efforts. Rather than focusing on the outcome of the procedure, focus on the effort your child put forth while facing their fears. Some example statements include, “I am really proud of you for telling us what you needed during the poke” or “Great job taking slow breaths.” By reinforcing their effort, you are validating their feelings, and your child will be more likely to continue choosing brave behaviors. 
• Never Worry Alone. If your child’s fear of needles is preventing them from getting necessary medical care or causing significant distress despite your best efforts, consider reaching out to a trusted provider for support. If you need specialized care, InStride Health is here to help. Our care team can work with your family to build skills, boost confidence, and make future visits manageable.

Now, imagine you are that 6 year old, sitting down on the crinkly paper of the exam room. You noticed the nurse walking into the room with a vaccine tray. You notice your palms start to sweat, and your heart is beating faster and faster. You look over to your parent and they say,  “I know this is tough. I’m right here, and we’ll get through it together.” In that moment, you do not feel as if you have to worry alone, and you can do hard things.