The Comfort Promise at UCSF Benioff Children's Hospitals
Ouchless Jab Challenge
Dr. Stefan Friedrichsdorf, pediatric pain specialist and medical director of UCSF’s Stad Center, has issued a challenge to clinicians worldwide: Ease the pain of needle procedures for all pediatric patients, using simple soothing and distraction tools.
| Please note: The Comfort Promise program is not yet available everywhere at UCSF. We're rolling it out over time and hope to have it in place in all our pediatric hospitals and clinics by the end of 2024. To find out whether it's in effect in your child's unit, clinic or lab, check with the medical team there. |
Kids don't like needles, and no one wants to see their child in pain. That's why we promise to do everything possible to minimize the pain of needle procedures for children of every age, from babies to teens.
Whether your child needs a vaccine, a blood draw or an IV catheter placement, our experienced and compassionate providers partner with you to use simple pain-reduction tools and techniques that work for your family.
Our Comfort Tool Kit
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Numbing cream
Makes needle procedures less painful
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Comfort positions
Helps children feel calm and secure
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Distractions
Puts the focus on an entertaining activity
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Choices
Provides the patient with some sense of control
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Breastfeeding or sugar water
Soothes and reduces babies' pain
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Memory-shaping
Frames the experience in a positive way
Comfort tools, by developmental age
Kids mature at their own pace and have different needs, so the suggested age groups below are flexible. We partner with you to identify the pain-prevention tools and strategies that work best for your child.Birth to 12 months
- Numbing cream: applied at least 30 minutes before the needle procedure (not used for hospitalized premature babies or full-term infants under 28 days old)
- Comfort position: skin-to-skin with you, swaddled, chest-to-chest or sitting in your lap (at least 6 months old or able to sit up on their own)
- Breastfeeding or drop of sugar water: starting two minutes before the procedure
- Distractions: singing, talking, rattle, light-up toy, patting, playing peekaboo, comfort item, books
- Caregiver's choices: options, such as pausing the procedure if the baby seems stressed
13 months to 5 years
- Numbing cream: applied at least 30 minutes before the needle procedure
- Comfort position: upright on your lap, held chest-to-chest, back-to-chest or at your side
- Distractions: light-up toy, pop-up picture book, storytelling, bubbles, singing, drawing or coloring, stuffed animal, favorite item from home, breathing exercises, electronic app
- Child/caregiver's choices: option to watch, use "start/pause" or another communication sign, pick left or right arm (if applicable)
- Memory-shaping: Ask child (if verbal) about the experience and present it in a positive way by praising accomplishments – for example, sitting still or being brave.
6 to 12 years
- Numbing cream: applied at least 30 minutes before the needle procedure
- Comfort position: Upright, held by or close to you
- Distractions: music, books, storytelling, handheld toy, tablet, drawing or coloring, singing, stuffed animal, favorite object from home, guided imagery, stress ball, breathing exercises, distraction app, virtual reality headset
- Child's choices: option to watch, use "start/pause" or another communication sign, pick left or right arm (if applicable)
- Memory-shaping: Ask child about the experience and present it in a positive way by praising accomplishments – for example, sitting still, breathing deeply or being brave.
13 to 17 years
- Numbing cream: applied at least 30 minutes before the needle procedure
- Position: upright or in a position of their choice
- Distractions: music, books, handheld game, tablet, phone, storytelling, telling jokes, relaxation app or video, stress ball, breathing exercises, virtual reality headset
- Child's choices: option to watch, use "start/pause" or another communication sign, pick left or right arm (if applicable)
- Memory-shaping: Ask child about the experience and present it in a positive way by praising accomplishments – for example, breathing deeply or being brave.
When your child needs extra support
If the comfort tools and techniques we offer don't make needles manageable for your child, talk with us about other options to explore what might work. Some of these include:
UCSF child life specialists
These health care professionals are trained to help kids feel ready for whatever their medical care entails, including IV catheter placements and other needle procedures. They use age-based teaching tools, such as dolls, pictures and medical equipment; techniques to reduce anxiety and promote relaxation, such as imagery and distraction; and therapeutic play before, during or after a procedure. Learn more about Child Life Services at UCSF.
Behavioral health treatments
For kids who are especially fearful of needles (including young children) and require ongoing needle procedures, consulting with a psychologist or a therapist can be helpful. There are effective techniques that can build kids' confidence about coping with needles.
Mild sedation with nitrous gas
Small doses of nitrous oxide (sometimes called "laughing gas") can calm children who are afraid of needles and reduce their pain. It doesn't affect their breathing, and they can respond to verbal commands. Nitrous oxide isn't yet available everywhere at UCSF, but we're working on providing it for kids throughout our system.
Moderate-deep sedation
Our team may recommend this kind of sedation for some kids, especially those who are hospitalized or in the emergency room.
Additional tips
If you're looking for even more ways to help your child cope with the pain and anxiety of a needle procedure, consider these supportive practices:
- Help your child understand what to expect. Explain that the procedure is needed to help their body be healthy. Don't claim that it won't hurt. Instead, try saying, "You may feel a pinch or pressure, and you can use [child's preferred distraction] to make it easier."
- Fill out a coping card. Have your child indicate how they'd like things to go during their needle procedure.
- Give your child a job to do. For example, let them know that their job is to keep their arm still or to squeeze your hand.
- Have them try deep breathing. Encourage your child to take calming breaths before the procedure, and use big exhales to "blow away the pain" while it's happening.
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