Name two nonpharmacologic strategies to reduce a child's pain during injections.

• A. Distraction and parental presence
• B. Topical anesthetic such as lidocaine-prilocaine can be used
• C. Oral sugar solution during injection
• D. Fasting prior to injections

Answer: (A)

During injections, reducing pain starts with shaping the child’s experience and emotional state. Distraction helps by pulling the child’s attention away from the needle, which lowers perceived pain because attention and cognitive focus influence how intense the sensation feels. Simple, engaging activities—talking, storytelling, favorite toys, counting, or guided breathing and blowing bubbles—can make the moment feel shorter and less distressing.

Parental presence adds another layer of comfort. When a parent stays close, the child feels safer, anxiety decreases, and the caregiver’s calm behavior provides a model for coping. This sense of security can dampen the body's stress response and make the pain feel more manageable. Together, these nonpharmacologic strategies address both what the child is thinking and how they feel, which often leads to a noticeable reduction in pain and distress during injections.

Pharmacologic methods, like topical anesthetics, numb the skin and reduce pain at the source, but they aren’t nonpharmacologic. An oral sugar solution can help some infants by providing a soothing analgesic effect, but its evidence is strongest for newborn procedures and isn’t a universal strategy for injections in older children. Fasting has no role in pain reduction for injections.