Giving shots to a 4 year old

[FredH]

My daughter was DX'd at age 3. We made the slow transition into the D'Life and after several months she was doing really well with the finger pokes and was mostly tollerating the shots. Fast forward 12 months to today and things have regressed greatly over the past several months. The finger pokes are great, they don't phase her at all, the shots are a whole other thing.

Currently she is on a MDI regiment and because of our schdule we are getting away with 2 shots a day (Humlin/Humalog).

I'm at a loss as what to do to help her with the shots. She gets so frantic when we start talking about them, that she works her self up into a full blown tizzy.

I've read many people talking on these forums about getting your child to submit to the shot, as opposed to forcing it, I guess that's all great in practice, I just can't seem to make it happen that way.

Last night for example I spent 45 mintues working with my daughter on taking her shot, eventually I had to hold her down and just give it. That certianly isn't the way I want to do it, I'm just at my wits end on how to deal with it.

Holding my daughter down while she is screaming bloody murder is taking it's toll on me as well, help.

How did you get your young child to adjust to the shots?

[Seans Mom]

My son was dxd last Aug. and turned 4 in Dec. He had his "off and on" resistance to shots. I never gave him the choice to get a shot or put it off trying to make him accept it better. I would give him a choice of where to inject IF he made up his mind quickly. He hated the thighs and refused the tummy. His arms were his preferred sites. In times when he wanted to resist I let him know that he needed his medication and that was how it was to be. It's not always easy but the sooner you get it out of the way the sooner everyone can go back to doing something else.

[Charmed7]

Some suggestions, though they all may not apply to you, so take what you can. :cwds:

-Be confident and firm. If you are weary, or frustrated, or feeling sad about giving the shot, then your daughter will pick up those feelings. They are very smart those 4 year olds. Look her in the eyes. Keep your back straight (I swear that works on my 2 year old on other things) and say calmly, "It is time for your shot." (Or your own wording) but don't make excuses, don't tell her your sorry etc.

-Make a ritual of the event. Write out a big poster board showing her the steps of the meal. ie: Step 1: Check sugar Step 2: Get shot Step 3: Eat Dinner. Make it nice looking, have her color in pictures. Then you can sort of lean on it, like saying "Well, lets see what the poster says. Oh, it says you have to get a shot." Also, have her take in three or four big breaths. Have another family member do the breaths with her. This increases the oxygen and the sting isn't supposed to be as bad. On her last exhale put the needle in.

-Numbing cream is an option. If you think it's because of pain, you can put that in the poster above. You can explain how the cream is going to help the shots.

-Offer "treats" for a successful event. It doesn't have to be a bribe per se. It's a reward system. For every time she does it without incident, she gets a ticket. At the end of the week she can trade the tickets in for something. If her attention span isn't long enough to wait a week, then at the end of the night. And the trade can be a family game, an extra book at bed time, a trip to the book store etc. And don't make a big deal about the "bad" experiences. Just calmly state, "That's too bad, you don't get a ticket this time. We'll try harder next time."

-Maybe offer her to choose the spot. It sort of makes her commit to the shot. "Do you want your arm or tummy?" That can back fire though, so be careful. You might have to say, "Well, if you won't choose, then I will." and that sort of takes the purpose away.

-When it's not time for a shot, let her talk to you. And don't talk back, just listen. Ask a few questions, let her sit on your lap and ask her about how shots make her feel. Let her tell you how she hates it. And every once in awhile just agree with her. Let her know you are on her side. Don't explain why she needs the shots (I'm sure she's heard it a million times, that's not the point.) The point is, shots suck. So just let her get that out in the open and tell her it's ok to feel that way.

Good luck, and if you need any more help, let me know.

Charmed

[Bsbllmom]

Some suggestions, though they all may not apply to you, so take what you can. :cwds:

-Be confident and firm. If you are weary, or frustrated, or feeling sad about giving the shot, then your daughter will pick up those feelings. They are very smart those 4 year olds. Look her in the eyes. Keep your back straight (I swear that works on my 2 year old on other things) and say calmly, "It is time for your shot." (Or your own wording) but don't make excuses, don't tell her your sorry etc.

-Make a ritual of the event. Write out a big poster board showing her the steps of the meal. ie: Step 1: Check sugar Step 2: Get shot Step 3: Eat Dinner. Make it nice looking, have her color in pictures. Then you can sort of lean on it, like saying "Well, lets see what the poster says. Oh, it says you have to get a shot." Also, have her take in three or four big breaths. Have another family member do the breaths with her. This increases the oxygen and the sting isn't supposed to be as bad. On her last exhale put the needle in.

-Numbing cream is an option. If you think it's because of pain, you can put that in the poster above. You can explain how the cream is going to help the shots.

-Offer "treats" for a successful event. It doesn't have to be a bribe per se. It's a reward system. For every time she does it without incident, she gets a ticket. At the end of the week she can trade the tickets in for something. If her attention span isn't long enough to wait a week, then at the end of the night. And the trade can be a family game, an extra book at bed time, a trip to the book store etc. And don't make a big deal about the "bad" experiences. Just calmly state, "That's too bad, you don't get a ticket this time. We'll try harder next time."

-Maybe offer her to choose the spot. It sort of makes her commit to the shot. "Do you want your arm or tummy?" That can back fire though, so be careful. You might have to say, "Well, if you won't choose, then I will." and that sort of takes the purpose away.

-When it's not time for a shot, let her talk to you. And don't talk back, just listen. Ask a few questions, let her sit on your lap and ask her about how shots make her feel. Let her tell you how she hates it. And every once in awhile just agree with her. Let her know you are on her side. Don't explain why she needs the shots (I'm sure she's heard it a million times, that's not the point.) The point is, shots suck. So just let her get that out in the open and tell her it's ok to feel that way.

Good luck, and if you need any more help, let me know.

Charmed
Those are really good suggestions:cwds: I'm sorry you are going through this. My son was 10 when diagnosed so I don't know how to help with a younger. I know right now it seems like it won't get easier but it will. Just hang in there. This is the right place to be and don't be afraid to ask ANY questions, you will get an answer.:cwds:

[Caydens_Mommy]

I wish that I could give you the magic answer to make it all better but I can't. My son was diagnosed in October at the age of 2. At first he was okay with everything everyone was really shocked, but here lately he has been fighting me as well. He takes at least 4 shots a day... Good luck, and i will keep you in my prayers.

[twodoor2]

My daughter was 4 when diagnosed, and would throw a bloody murder temper tantrum every time she got the shot. I guess I'm a mean mother, but I just ignored these tantrums, held her still with force, and did the shot. She would sock me afterwards, but I was really stern with her and told her that she had to have her shot, end of story, period. My husband thought I was awful, and tried coddling her. After a while, I just took over all shot giving because he was doing more harm than good.

Eventually, after ignoring her a while, she learned she couldn't get attention anymore for the temper tantrums, so she just submitted. After a while, she realized that the shots didn't hurt after all, and she finally admitted that to me as well. I just said, "of course they don't hurt." The insulin needle is so thin and fine, that it's really more psychological for kids, then painful. I had to take insulin doses when I went through fertility treatment, and they were very non-painful, so I based that on my experience. I also knew she was getting an even finer needle than I was. It helped a great deal for me to know that it wasn't very painful for her. But even if it was, I would still do it. I always told our endo that if I had to give her 100 shots a day to keep her healthy, I would do it.

I know we don't like to deal with our children having to suffer like this, and it tugs at our heartstrings, but I'm just of the belief that if she needs it for her health, then so be it. I think quite a bit about the old needles people had to use way back when in the early treatments of diabetes, and our kids have it much better now. I also think about how 95% of the rest of her day is wonderful, and how much love, care and fun she has. That helps me get through the agony of it all I guess.

Now she's amazingly good about everything, shots, finger pokes, site changes (I don't even use numbing cream). She's a really great kid.

[georgia]

First of all, I am so sorry that you are going through this. My daughter is now almost 5, but was diagnosed right after she turned 3. We battled shots for months, yes I held her down, bribed her etc. But they did get better.
I think Charmed had some great ideas. And I do think it important to let her know that it is okay to not like your shots, to not like having to do this everyday, but you've got to do. Currently our shots are going real easy, matter of fact. We give insulin (humalog) after meals, when she is done eating I wipe her arm with alcohol and then she goes off to play. Then I add up the carbs, measure the shot, and then go to her and it takes 5 seconds, she usually pauses her play for a second and then we are done. She doesn't like lantus, still hates it every am!
do make sure the alcohol that you wipe her arm or leg or whatever is dry. if it is still wet it will sting. Sometimes Amalia will say "not now", so I say " okay, 1 minute", and she usually comes to me with in that minute for her shot. I think having some control helps her deal.
Around Christmas we were having a terrible time with shots. She cried at everyone and said it hurt. We just pushed through, kept firm and told her we loved her. I think it was a phase and I know we will have more.
Have you asked your endo for tips? I know some people use an Iport (but I know nothing about this!)
Best of luck, again, I am so sorry you are going through this. It is so hard to see our children go through this everyday.

[hawkeyegirl]

My son was diagnosed in November at age 3. He hates the shots. What I do is to do it as quickly as I can. Time and time again, I notice that the build-up is the worst part for him. I get the shot ready, and then I go get him and put him on my lap. From that point on, my sole goal is to give him the shot as quickly as I can. He yells until I actually do it, and then he's fine. It's the anticipation he fears, not the shot itself. Sometimes he's kicking and screaming and yelling, and I just go ahead and do it anyway. I can't tolerate any stalling or negotiating techniques. It breaks my heart, but he will have to do this for the rest of his life, so the sooner he gets used to it the better. You're really not doing her any favors by letting it go on for 45 minutes. Not only is her sugar spiking during that time, but I swear it's more traumatic for you both than if you just hold her down and do it. No talking about it. Just 10 seconds, and it's over.

We are actually starting on the pump in April. Have you considered that option? I know he won't like site changes, but we can use numbing creme. And it will be one poke every two to three days, as opposed to the 4-5 a day we have now.

Good luck. I know exactly what you're going through.

Edited to add: We tried letting him pick where he wanted his shots at first, thinking that would help. The problem was, he'd pick the same spots every time. So now we have a rotation schedule. Morning is left thigh, Lunch is right arm on even days and left arm on odd days, supper is right thigh, bedtime is right butt on even days, left butt on odd days. He won't let us touch his tummy, so that's a battle I'm saving for later.

[Carrie]

I don't have any good answers, but I wanted to drop you a line and share in your pain and frustration.

This issue was probably the biggest reason I wanted to go with a pump. We were up to 4-6 shots a day, and every one of them seemed to be a struggle. She would have spurts where she would be a "big girl", but as soon as we hit a spot that would hurt, we regressed quickly. :( The pump hasn't taken away every struggle, but it has made it things a whole lot easier. She can tolerate site changes, as long as she doesn't see the needle. :rolleyes: Shots are still a huge struggle. She woke up high(er) this morning with some ketones. As soon as I announced that she needed a shot, the tears started, dropping to the floor, saying it's going to hurt, complaining that she can see the needle, etc. As a parent, it's hard to watch and it wears you out. Keep us posted.

[saxmaniac]

I agree with the others. We went through some brief fighting at first. First, it was never an option. There is never asking if he'd like to have a shot, or what time he'd like. You are getting it, the time is now. The options are where you'll get it. We always tried to remain relaxed, even give the appearance of being bored.

Comedy helps for Alex. He can't resist laughing at anything silly, so if I tell him, "OK, so you don't want it in your arm, I guess I'll have to give it in your nose" always breaks the ice.

When he really fought, there was a choice: OK, you're not picking a spot. You either do it the easy way, or have me hold you down and it's going to hurt more and take longer when you struggle. Either way you're getting it.

Any stalling would simply mean he gets it anyway. There is a time limit in choosing otherwise they'd stall forever. I got good at pinching and giving a quick shot before he could really react. Then he realizes that almost all the pain is in the anticipation.

Lots of love and kisses when it's over, regardless of what happened.

[thebestnest5]

Just adding a few more suggestions and things we did.

We always approached in a matter-of-fact manner.

We got sterile saline from the pharmacy and we let Livia (and the other kids) give DH and I shots. Our 4 year old gave DH and I shots in the tummy. We had family testing and played games like "guess the blood sugar". I let Livia test me anytime she wanted. We talked about how it really didn't hurt. To my surprise, our 9 year old DD volunteered to give herself a saline shot in the leg to help her sister know that it wasn't painful. I know you said that fingersticks are fine...just giving our experience and you can adapt it to fit your needs.

We went the CWD page that has lot of children's photos and mini-bios on it. We showed Livia that ALL of those kids were having shots and testing fingers. We told her that lots and lots of kids do this just like her. We even looked at a photo of a 6 week old baby with her insulin pump.

We had a basket of treasures for fingersticks and shots. Dollar store items wrapped in tissue work well. I would give something immediately after the shot/poke. IMO...the immediate gratification is much easier for a young child.


We also bought a cd-rom from dbaza that was fun to play for her and her brother and showed steps to testing and shots.

Give shots in the legs; they are usually much less painful and the child can sit while the shot is given. I can't tell you have many Type 1 people (now adults) told me to use the legs!

**Don't give an injection through wet alcohol. It stings if it's wet; let it dry.**

[FredH]

Thanks to all of you for your comments on this issue.

I totally agree with one of the posters earlier that it's not the pain of the shot that my daughter is resisting as much as the idea of getting one. It's good (well actually bad I guess) to hear that others are going through the same thing.

Yea, the 45 minute thing from last night was just an attempt by me to try something different. I've always been more on the side of let's do it as quickly as possible and get it over, although recently she hasn't even let me give her a shot (my wife has been doing them), so I wanted to try a softer approach, guess that didn't work.

[shekov]

Soft approach didn't work for me either. Totally not my style anyway:) I ask her where she wants it, give her a second to choose or I choose for her, then give the shot. We totally avoid tummy, she prefers legs to arms. We move up and down legs to vary sites. (By the way, MY first post on this site was begging for help with injections.)

[bgallini]

I wanted to try a softer approach, guess that didn't work.

No, with preschoolers and stuff they don't like, taking a softer approach rarely helps. Just be firm about the shots and other non-negotiatables (bedtime, putting coat on in freezing weather, etc) and then in other situations, give her more freedom and more choices.

[Emma'sDad]

Emma was 3.5 years old at Dx. Like you, at first, it was why are you doing this to me?? Ok, I'll let you do it. But I guess it's like the Chinese Water Torture, the first drop is like, yeah, whatever, after the 100th drop it's like, ok, it's getting annoying, and after the 200th drop you lose your mind and lose control until they take you off. (source from Mythbusters, statistical numbers are fictional).

Emma got to the point where we had to pin her on the bed and give it to her just to get it over with. Dragging it long just wasn't good for our sanity and hers. There were a few times she'd shake loose and the needle would drag from one end of her leg to the other leaving a bloody scratch. Got to feel badly about that.

Finally, (now) it feels like it happened overnight where she just let us do it and then she could go play. And even remind us after a meal that it's time to give the needle. At 5 years old, she started giving herself her own needles in her tummy in preparation for kindergarten. At first, we did the "Choose where you want" approach and the tummy and legs were absolutely off limits. If that makes you happy and lets us give you your needle, then we're more than happy to only do the arm and rump. Lately, she's given us permission to do her legs for her Levemir at night as long as she has something she can count. Again, whatever makes you happy as long as we get to give you the needle.

[kiwikid]

We used the Injectease for about 2 years before pumping. It was a lifesaver for us. It injects quickly and always to the same depth. You still have to fill the syringe, load it into the InjectEase, then press both the release button and the plunger on the syringe, but it hides the needle and makes it quick and easy. You twist the Inject Ease to make the area less sensitive before releasing the syringe.
For a young child fighting injections I recommend it. They can help by pressing the release button.
www.palcolabs.com/section_products/injectease.html
www.childrenwithdiabetes.com/d_06_310.htm

[FredH]

I actually own an inject ease but have never used it. My daughter took one look at in and threw a bigger fit then normal so I figured why bother. One of the reasons we havn't looked at the pump yet is we know it's a change in routine and my daughter seems to be very resistant to change. (we will get there someday)


As for being firm, it seems to be really easy to be firm on normal day stuff, bedtime, clean your room, etc.., it's just when it comes to D that I have second thoughts about the firm approach. I guess I feel like my normal kid parenting skills are pretty ok, it's just the D parenting skills I'm still working on...

[lynn]

I actually own an inject ease but have never used it. My daughter took one look at in and threw a bigger fit then normal so I figured why bother. One of the reasons we havn't looked at the pump yet is we know it's a change in routine and my daughter seems to be very resistant to change. (we will get there someday)


As for being firm, it seems to be really easy to be firm on normal day stuff, bedtime, clean your room, etc.., it's just when it comes to D that I have second thoughts about the firm approach. I guess I feel like my normal kid parenting skills are pretty ok, it's just the D parenting skills I'm still working on...


I think that it is easy to feel like D stuff has a catergory all its own. Like we should stay firm on the teeth brushing and eating their veggies because every kid has to do that. It's all normal and part of being healthy. The thing is that diabetes and all that comes with it is "normal" for all of our kids. They don't differentiate. Somehow we have to get our mindset lined up like theirs.

I realize that is easier said then done. I have had my share of difficulty. He too started out fine. It was after a year or so that he was tired of it. One day when we were at my mom's house Nathan was having a fit about his shot---crying, stalling, trying to negotiate. I'm sure you know the routing... I was having such a hard time. It is painful to have to be firm when it comes to inflicting pain. I tried to talk him into it all the time. That day my mom (who, ironically, can't watch the needle pierce the skin) said that he was doing it to me. She said she could see him working me.

After I got over being mad at her for saying that I started noticing that she was right! Dang! I quit trying to talk him into it after that. I still repeat for the millionth time that "We have to give you insulin to keep you healthy. I love you too much to let you go without insulin. Etc, etc." It really didn't take long for him to stop the nonsense after I realized that I wasn't being as business-like as I imagined.

I think four year olds just like to push things too. Some days it feels like all I do is try to keep my territory with my four year old.

I hope you are able to find some peace.
Lynn

[hawkeyegirl]

One of the reasons we havn't looked at the pump yet is we know it's a change in routine and my daughter seems to be very resistant to change. (we will get there someday)

Your daughter sounds a lot like my son! :) He is VERY resistant to change. We just got him potty trained on his 4th birthday. (I think he figured that since he's always gone in his pants and it was working well for him, he saw no reason to do anything different! :rolleyes:) We're starting the pump now, because I fear that it will only get worse as he gets older. Right now, we'll just tell him it's the way it has to be, and he'll have to get used to it.

I'm not trying to push you towards a pump. Just giving you some thoughts from one parent to another who also has a stubborn little one!

[Jodi's dad]

My son was dxd last Aug. and turned 4 in Dec. He had his "off and on" resistance to shots. I never gave him the choice to get a shot or put it off trying to make him accept it better. I would give him a choice of where to inject IF he made up his mind quickly. He hated the thighs and refused the tummy. His arms were his preferred sites. In times when he wanted to resist I let him know that he needed his medication and that was how it was to be. It's not always easy but the sooner you get it out of the way the sooner everyone can go back to doing something else.


My daughter was dxd last month just before her second birthday and her preferred spot is the arms also. But she has slipped back a bit elswhere, she was almost pottytrained when this happened and she was talking alot too. But now she is back to diapers and when she wants something she just points and whines. Hopefully this will end soon

[Judy&Alli]

I haven't had issues with shots since her first few at diagnosis. What they did at the hospital for her was have her blow bubbles while she was getting the injection. This had something to do with the breathing out and also worked as a distraction. It worked for her maybe it is worth a try. Good luck!
Judy:)

[czardoust]

poor baby. :( My daughter was 3 when she was first dx. She gave herself her first shot when she was about your daughters age and what prompted me to do this was seeing her so upset when it came time to get a shot (she is also MDI on Lantus/Novolog). I let her hold the Novolog Junior Pen, we talked about how without the shots she was very sick and she is healthy now, and then I dialed it up and showed her where to stick it in, how to count to 10 when you push your thumb down, and she did it. And the feeling of being somewhat in control of her own body helped her cope with having to take the shots. You might try this. Warning though (funny side note but meant as serious): Afer she learned how to dial up the pen when she was 4, she dialed it to 35 and shot a nice stream of insulin across the inside of the minivan when I was driving on the interstate, and some got into my sons eye (vitrous fluid sucks it right up), we ended up taking him to the ER just in case! But he was fine because since he is not D, his body adjusted everything as soon as it happened. :rolleyes:

[bgallini]

My daughter was dxd last month just before her second birthday and her preferred spot is the arms also. But she has slipped back a bit elswhere, she was almost pottytrained when this happened and she was talking alot too. But now she is back to diapers and when she wants something she just points and whines. Hopefully this will end soon

I think at 2 years old, it is perfectly normal for her to regress some after dx. I also see that you have a 4 mo old baby at home too. That in an of itself can lead to regression with potty training and talking. I would just ignore the potty training for a bit and then at some point in a few months (or even when she is close to 3 yo), tell her that she is getting too old for diapers and the store won't sell them anymore and she has to wear underpants (not pullups) when the diapers run out. She'll believe it and will take over and start using the toilet w/ no problem (I swear this works). As for talking, if she points and whines (assuming she was able to say 'I want that' before), tell her 'I don't understand the whining' and ignore her until she uses a word. When she does use a word, respond pleasantly and quickly. (You can still say, 'sorry you can't have that.' if it's something she can't have.)

Barbie

[Anja821]

Evan ws 2 1/2 when diagnosed and I remember when he resisted the shots. Our nurse suggested getting the gadget that holds the needle and keeps the depth consistent. This way we didn't have one shot hurt more than the other. I wish I could remember what it was called! It only worked with the BD needles, though, so we had to get prescriptions that were brand-specific.

Plus, the gadget didn't look as threatening because the needle was hidden. Using the end of it, rub where the needle will go in to overstimulate the site and make the injection hurt less.

If I remember the name of this thing, I'll edit my posting.