explorer lexprience les enfants vis -  - vis de la vaccination et leurs prfrences en matire danalgsie .
au total , 17 enfants ( de quatre  14 ans ) dune cole indpendante de toronto , en ontario , ont particip  trois entrevues au sein de groupes de discussion .
les rsultats ont t classs en trois grands thmes : lexprience de la vaccination , les rles et responsabilits relatives  la gestion de la douleur et les consquences de la gestion de la douleur .
les enfants se rappellent facilement les vaccins quils ont dj reus et parlent de la peur et de la dtresse queux ou dautres ont ressenties .
les enfants pensaient que les parents et les vaccinateurs devraient les prparer davance et recourir  des interventions pour grer et surveiller la douleur .
ils voulaient galement que des adultes les aident dans leurs efforts pour diriger la gestion de la douleur .
les enfants ont parl des avantages de grer la douleur , y compris la diminution de souffrances inutiles , une meilleure exprience de la vaccination , la diminution des risques de craindre les seringues et la diminution de la non - adhrence  la vaccination .
ils connaissaient les stratgies pour rduire la douleur , y compris la distraction , les anesthsiques topiques et les techniques dinjection .
ils ont compar la vaccination accompagne ou non dune gestion de la douleur et indiqu leur prfrence pour la gestion de la douleur .
les enfants ont soulign limportance de grer la douleur de la vaccination et dutiliser systmatiquement des interventions analgsiques . lintgration de la gestion de la douleur au processus de vaccination pourrait amliorer lexprience des enfants vis -  - vis de la vaccination et favoriser des attitudes et comportements plus positifs .
participants were selected using the qualitative sampling technique of maximum variation sampling ( 10 ) .
students ( n=47 ) from junior kindergarten to grade 8 attending an english , nondenominational , independent / private ( ie , requiring tuition payment ) school in toronto , ontario were eligible . parents received notification from the school principal that researchers were planning to interview children regarding their experiences with vaccination , and they signed a written consent form allowing the interviews to be videotaped .
ethics approval was obtained from the hospital for sick children s research ethics board ( toronto , ontario ) .
three separate focus group sessions , each lasting approximately 30 min , were held at the school on the study day ( june 4 , 2010 ) .
all sessions were moderated by the same interviewer using a semistructured interview guide ( table 1 ) .
the first focus group session was held outside in the school playground with six students from junior kindergarten to grade 5 .
the second session was held in a classroom with eight students from grades 6 to 8 .
the third was held in the principal s office with three students from grades 4 to 8 .
the vice principal , who facilitated the pilot testing in the previous year , provided feedback separately .
qualitative content analysis was used to generate codes inductively from the transcripts ( 10 ) .
line - by - line coding was performed independently by two researchers , and disagreements were discussed until consensus was reached .
the results were reviewed with students at the school ( ie , member checking ) and the vice principal .
participants were selected using the qualitative sampling technique of maximum variation sampling ( 10 ) .
students ( n=47 ) from junior kindergarten to grade 8 attending an english , nondenominational , independent / private ( ie , requiring tuition payment ) school in toronto , ontario were eligible . parents received notification from the school principal that researchers were planning to interview children regarding their experiences with vaccination , and they signed a written consent form allowing the interviews to be videotaped .
ethics approval was obtained from the hospital for sick children s research ethics board ( toronto , ontario ) .
three separate focus group sessions , each lasting approximately 30 min , were held at the school on the study day ( june 4 , 2010 ) .
all sessions were moderated by the same interviewer using a semistructured interview guide ( table 1 ) .
the first focus group session was held outside in the school playground with six students from junior kindergarten to grade 5 .
the second session was held in a classroom with eight students from grades 6 to 8 .
the third was held in the principal s office with three students from grades 4 to 8 .
the vice principal , who facilitated the pilot testing in the previous year , provided feedback separately .
qualitative content analysis was used to generate codes inductively from the transcripts ( 10 ) .
line - by - line coding was performed independently by two researchers , and disagreements were discussed until consensus was reached .
the results were reviewed with students at the school ( ie , member checking ) and the vice principal .
the children were four to 14 years of age and nine ( 53% ) were boys .
the grade 8 students had participated in the pilot test in the previous year , when they were in grade 7 .
the findings from all three focus group sessions were categorized into three main themes : experience of vaccination ; roles and responsibilities regarding pain management ; and impact of pain management ( figure 1 ) . all students recalled previous vaccinations and discussed fear and distress experienced by themselves and others , primarily siblings , during vaccination : 
 we would always be scared , like we would try to hide in our room or run away or something because we would nt want the sharp sensation in our arm.(p14)students reported that vaccinations were scary because they were painful : 
 it scares me because they hurt.(p7)some students reported disliking the needle : 
 it s just freaky to see something sharp or long get injected into you.(p9)pain was described as an individual experience : 
 well everyone has their own feelings , right ? and they feel the needle differently.(p14)perceptions of pain were reported to be influenced by age and previous experience . in some cases , fear worsened with increasing age and experience : 
 i feel a little bit more pain than before.(p16)in other cases , it diminished : 
 when i was little , i used to hate it , but now i m okay with it.(p9)several children discussed how their thoughts could modify their pain : 
 i was thinking in my mind what if the needle was too long and it went right through my arm ?
your imagination makes you go crazy!(p9)some students questioned whether health care providers cared about them because they did not address their pain : 
 i remember  they came in to give them a shot .
and what they would do is that they had a table and a couple of nurses sitting at the table .
and they would have the whole school line up and the nurse gave them their shot even if they were screaming .
some girls could nt even take it and the nurse would just give them the shot and tell them to go .
they just give the person the shot and get through it quickly.(p14)students that participated in the pilot also commented on the ability to provide feedback about their pain experience : 
 i like how we got to evaluate how it felt.its important to get peoples opinions on how the needle felt.(p14)none of these students reported ever being asked about their pain before .
we would always be scared , like we would try to hide in our room or run away or something because we would nt want the sharp sensation in our arm .
when i was little , i used to hate it , but now i m okay with it .
i was thinking in my mind what if the needle was too long and it went right through my arm ?
and what they would do is that they had a table and a couple of nurses sitting at the table .
and they would have the whole school line up and the nurse gave them their shot even if they were screaming
. some girls could nt even take it and the nurse would just give them the shot and tell them to go .
i like how we got to evaluate how it felt.its important to get peoples opinions on how the needle felt .
all students agreed that health care providers and parents are responsible for helping children feel less pain during vaccination and that interventions to mitigate pain should be routinely used .
students were aware of why they needed to be immunized : 
 to protect against diseases and viruses.(p12)however , they felt they should be better prepared for upcoming vaccinations .
this included knowing why vaccines need to be injected : 
  why ( it has ) to be poked in my arm , and i could nt take a tablet with a glass of water and have the same effect.(p12)and how the injection would feel : 
  if they know ( how they feel ) , they know it s nothing more horrible , so they do nt imagine something worse.(p12)they also wanted to be able to bring items to help them cope : 
 you have to know about it and prepare for it  like maybe you ll bring a toy or something like bubbles.(p3)students reported that neither parents nor doctors should lie to them about the pain : 
 it does nt help if they say you will feel no pain at all , it s just a big lie.(p16 ) 
 when they lie to you and then it does hurt , you re less likely to trust them later on.(p11)students reported that parents should be present to help them but that they should not act afraid themselves because they could transmit their feelings to children : 
 yeah , and if the parents are tense , the child will think , oh my parents are freaked , i guess this is really going to hurt.(p7)with respect to health care providers specifically , students reported they should be knowledgeable and use different pain - relieving methods : 
 what we re all trying to say is that doctors should know methods for us so that we would experience pain less.so going to the doctor should nt be such a painful thing to do.(p14)students reported that the school pilot and previous experiences with vaccination were their major sources of information about how to reduce pain .
students that were knowledgeable about pain management interventions talked about taking charge of their pain and leading their own pain management : 
 the most recent time i got vaccinated , i used the cream , used my laptop.(p12)one student described being frustrated by instances whereby her efforts to reduce pain were not supported by health care providers : 
 i would tell them that sometimes the only way for the pain to get out of me is to pinch myself , or pinch my knee .
the nurses or doctors always say to me to relax , and i ca nt do that .
i was pinching myself and they saw me tense , and they did nt know what i m doing and they tell me to relax so i ca nt do my thing.(p16)the same student recommended health care providers ask children about their preferences : 
 they should actually first ask the patient of what way they have to relieve the pain , so that they could tell them , for example , they like pinching or listening to music or something.(p16 ) to protect against diseases and viruses .  why ( it has ) to be poked in my arm , and i could nt take a tablet with a glass of water and have the same effect .
 if they know ( how they feel ) , they know it s nothing more horrible , so they do nt imagine something worse .
you have to know about it and prepare for it  like maybe you ll bring a toy or something like bubbles .
it does nt help if they say you will feel no pain at all , it s just a big lie .
when they lie to you and then it does hurt , you re less likely to trust them later on .
and if the parents are tense , the child will think , oh my parents are freaked , i guess this is really going to hurt .
what we re all trying to say is that doctors should know methods for us so that we would experience pain less.so going to the doctor should nt be such a painful thing to do . the most recent time
i would tell them that sometimes the only way for the pain to get out of me is to pinch myself , or pinch my knee .
the nurses or doctors always say to me to relax , and i ca nt do that .
i was pinching myself and they saw me tense , and they did nt know what i m doing and they tell me to relax so i ca nt do my thing .
they should actually first ask the patient of what way they have to relieve the pain , so that they could tell them , for example , they like pinching or listening to music or something .
the students offered many reasons for treating pain including : preferences for individuals not to have pain ; reducing unnecessary pain ; making the procedure easier by reducing  freaking out kids , or kids that were fighting or running away ; reducing needle phobia ; and reducing vaccine noncompliance by parents and children .
many students were knowledgeable of strategies for reducing pain including distraction , topical anesthetics and injection techniques .
( p4 ) , including talking , joking , counting , imagery , reading , and playing with toys , bubbles , windmills , dolls and electronic devices .
students also talked about blocking out environmental cues : 
 do nt ever look at the needle , it hurts more.(p15 ) 
 ... get my mind off the needle and other people chatting in the background.(p12)some students described how the injection technique could influence pain : 
 put it in and take it out as quickly as possible .
i had a nurse take the needle and wiggle it in my arm for a bit and then withdraw it really slowly and it hurts more.(p17).a few students described concurrent squeezing , pinching or rubbing the skin to provide a competing sensation to the needle : 
 what my dad does is he squeezes our hands.(p9)students also mentioned rewards : 
 getting a reward after is helpful.(p15 ) 
 they give you a lollipop after , and that would be the only reason that i go and get my shot.(p9)students contrasted vaccination with and without pain management and indicated a preference for pain management : 
 ... better if have something to take away the pain 
i did nt feel it.(p3).students who participated in the pilot reported having positive experiences and laughing about it later .
one student with a fear of needles indicated the fear diminished with adequate pain management : 
 i was given the numbing cream and some techniques for distraction and when i got the needle it did nt hurt as much .
i did nt really mind them so much anymore.(p12)the same student however reported that pain management was needed for successful vaccination : 
 i do nt think i can do it without the cream.(p12)one student who was previously unaware of available pain management interventions indicated she wanted topical anesthetics to be used the next time : 
 maybe if they put some numb cream or something so you could nt feel it , because when i got my needle i was so freaked out that i started crying a lot.(p4 ) do nt ever look at the needle , it hurts more . ...
i had a nurse take the needle and wiggle it in my arm for a bit and then withdraw it really slowly and it hurts more .
they give you a lollipop after , and that would be the only reason that i go and get my shot . ... better if have something to take away the pain
i was given the numbing cream and some techniques for distraction and when i got the needle it did nt hurt as much .
maybe if they put some numb cream or something so you could nt feel it , because when i got my needle i was so freaked out that i started crying a lot .
the children were four to 14 years of age and nine ( 53% ) were boys .
the grade 8 students had participated in the pilot test in the previous year , when they were in grade 7 .
the findings from all three focus group sessions were categorized into three main themes : experience of vaccination ; roles and responsibilities regarding pain management ; and impact of pain management ( figure 1 ) . all students recalled previous vaccinations and discussed fear and distress experienced by themselves and others , primarily siblings , during vaccination : 
 we would always be scared , like we would try to hide in our room or run away or something because we would nt want the sharp sensation in our arm.(p14)students reported that vaccinations were scary because they were painful : 
 it scares me because they hurt.(p7)some students reported disliking the needle : 
 it s just freaky to see something sharp or long get injected into you.(p9)pain was described as an individual experience : 
 well everyone has their own feelings , right ? and they feel the needle differently.(p14)perceptions of pain were reported to be influenced by age and previous experience . in some cases , fear worsened with increasing age and experience : 
 i feel a little bit more pain than before.(p16)in other cases , it diminished : 
 when i was little , i used to hate it , but now i m okay with it.(p9)several children discussed how their thoughts could modify their pain : 
 i was thinking in my mind what if the needle was too long and it went right through my arm ?
your imagination makes you go crazy!(p9)some students questioned whether health care providers cared about them because they did not address their pain : 
 i remember  they came in to give them a shot .
and what they would do is that they had a table and a couple of nurses sitting at the table .
and they would have the whole school line up and the nurse gave them their shot even if they were screaming .
some girls could nt even take it and the nurse would just give them the shot and tell them to go .
they just give the person the shot and get through it quickly.(p14)students that participated in the pilot also commented on the ability to provide feedback about their pain experience : 
 i like how we got to evaluate how it felt.its important to get peoples opinions on how the needle felt.(p14)none of these students reported ever being asked about their pain before .
we would always be scared , like we would try to hide in our room or run away or something because we would nt want the sharp sensation in our arm .
when i was little , i used to hate it , but now i m okay with it .
i was thinking in my mind what if the needle was too long and it went right through my arm ?
and what they would do is that they had a table and a couple of nurses sitting at the table .
and they would have the whole school line up and the nurse gave them their shot even if they were screaming
. some girls could nt even take it and the nurse would just give them the shot and tell them to go .
i like how we got to evaluate how it felt.its important to get peoples opinions on how the needle felt .
all students agreed that health care providers and parents are responsible for helping children feel less pain during vaccination and that interventions to mitigate pain should be routinely used .
students were aware of why they needed to be immunized : 
 to protect against diseases and viruses.(p12)however , they felt they should be better prepared for upcoming vaccinations .
this included knowing why vaccines need to be injected : 
  why ( it has ) to be poked in my arm , and i could nt take a tablet with a glass of water and have the same effect.(p12)and how the injection would feel : 
  if they know ( how they feel ) , they know it s nothing more horrible , so they do nt imagine something worse.(p12)they also wanted to be able to bring items to help them cope : 
 you have to know about it and prepare for it  like maybe you ll bring a toy or something like bubbles.(p3)students reported that neither parents nor doctors should lie to them about the pain : 
 it does nt help if they say you will feel no pain at all , it s just a big lie.(p16 ) 
 when they lie to you and then it does hurt , you re less likely to trust them later on.(p11)students reported that parents should be present to help them but that they should not act afraid themselves because they could transmit their feelings to children : 
 yeah , and if the parents are tense , the child will think , oh my parents are freaked , i guess this is really going to hurt.(p7)with respect to health care providers specifically , students reported they should be knowledgeable and use different pain - relieving methods : 
 what we re all trying to say is that doctors should know methods for us so that we would experience pain less.so going to the doctor should nt be such a painful thing to do.(p14)students reported that the school pilot and previous experiences with vaccination were their major sources of information about how to reduce pain .
students that were knowledgeable about pain management interventions talked about taking charge of their pain and leading their own pain management : 
 the most recent time i got vaccinated , i used the cream , used my laptop.(p12)one student described being frustrated by instances whereby her efforts to reduce pain were not supported by health care providers : 
 i would tell them that sometimes the only way for the pain to get out of me is to pinch myself , or pinch my knee .
the nurses or doctors always say to me to relax , and i ca nt do that .
i was pinching myself and they saw me tense , and they did nt know what i m doing and they tell me to relax so i ca nt do my thing.(p16)the same student recommended health care providers ask children about their preferences : 
 they should actually first ask the patient of what way they have to relieve the pain , so that they could tell them , for example , they like pinching or listening to music or something.(p16 ) to protect against diseases and viruses .  why ( it has ) to be poked in my arm , and i could nt take a tablet with a glass of water and have the same effect .
 if they know ( how they feel ) , they know it s nothing more horrible , so they do nt imagine something worse .
you have to know about it and prepare for it  like maybe you ll bring a toy or something like bubbles .
it does nt help if they say you will feel no pain at all , it s just a big lie .
when they lie to you and then it does hurt , you re less likely to trust them later on .
and if the parents are tense , the child will think , oh my parents are freaked , i guess this is really going to hurt .
what we re all trying to say is that doctors should know methods for us so that we would experience pain less.so going to the doctor should nt be such a painful thing to do . the most recent time
i would tell them that sometimes the only way for the pain to get out of me is to pinch myself , or pinch my knee .
the nurses or doctors always say to me to relax , and i ca nt do that .
i was pinching myself and they saw me tense , and they did nt know what i m doing and they tell me to relax so i ca nt do my thing .
they should actually first ask the patient of what way they have to relieve the pain , so that they could tell them , for example , they like pinching or listening to music or something .
the students offered many reasons for treating pain including : preferences for individuals not to have pain ; reducing unnecessary pain ; making the procedure easier by reducing  freaking out kids , or kids that were fighting or running away ; reducing needle phobia ; and reducing vaccine noncompliance by parents and children .
many students were knowledgeable of strategies for reducing pain including distraction , topical anesthetics and injection techniques .
( p4 ) , including talking , joking , counting , imagery , reading , and playing with toys , bubbles , windmills , dolls and electronic devices .
students also talked about blocking out environmental cues : 
 do nt ever look at the needle , it hurts more.(p15 ) 
 ... get my mind off the needle and other people chatting in the background.(p12)some students described how the injection technique could influence pain : 
 put it in and take it out as quickly as possible .
i had a nurse take the needle and wiggle it in my arm for a bit and then withdraw it really slowly and it hurts more.(p17).a few students described concurrent squeezing , pinching or rubbing the skin to provide a competing sensation to the needle : 
 what my dad does is he squeezes our hands.(p9)students also mentioned rewards : 
 getting a reward after is helpful.(p15 ) 
 they give you a lollipop after , and that would be the only reason that i go and get my shot.(p9)students contrasted vaccination with and without pain management and indicated a preference for pain management : 
 ... better if have something to take away the pain 
i did nt feel it.(p3).students who participated in the pilot reported having positive experiences and laughing about it later .
one student with a fear of needles indicated the fear diminished with adequate pain management : 
 i was given the numbing cream and some techniques for distraction and when i got the needle it did nt hurt as much .
i did nt really mind them so much anymore.(p12)the same student however reported that pain management was needed for successful vaccination : 
 i do nt think i can do it without the cream.(p12)one student who was previously unaware of available pain management interventions indicated she wanted topical anesthetics to be used the next time : 
 maybe if they put some numb cream or something so you could nt feel it , because when i got my needle i was so freaked out that i started crying a lot.(p4 ) do nt ever look at the needle , it hurts more . ...
i had a nurse take the needle and wiggle it in my arm for a bit and then withdraw it really slowly and it hurts more .
they give you a lollipop after , and that would be the only reason that i go and get my shot . ... better if have something to take away the pain
i was given the numbing cream and some techniques for distraction and when i got the needle it did nt hurt as much .
maybe if they put some numb cream or something so you could nt feel it , because when i got my needle i was so freaked out that i started crying a lot .
all students recalled previous vaccinations and discussed fear and distress experienced by themselves and others , primarily siblings , during vaccination : 
 we would always be scared , like we would try to hide in our room or run away or something because we would nt want the sharp sensation in our arm.(p14)students reported that vaccinations were scary because they were painful : 
 it scares me because they hurt.(p7)some students reported disliking the needle : 
 it s just freaky to see something sharp or long get injected into you.(p9)pain was described as an individual experience : 
 well everyone has their own feelings , right ? and they feel the needle differently.(p14)perceptions of pain were reported to be influenced by age and previous experience . in some cases ,
fear worsened with increasing age and experience : 
 i feel a little bit more pain than before.(p16)in other cases , it diminished : 
 when i was little , i used to hate it , but now i m okay with it.(p9)several children discussed how their thoughts could modify their pain : 
 i was thinking in my mind what if the needle was too long and it went right through my arm ?
your imagination makes you go crazy!(p9)some students questioned whether health care providers cared about them because they did not address their pain : 
 i remember  they came in to give them a shot .
and what they would do is that they had a table and a couple of nurses sitting at the table .
and they would have the whole school line up and the nurse gave them their shot even if they were screaming
. some girls could nt even take it and the nurse would just give them the shot and tell them to go .
they just give the person the shot and get through it quickly.(p14)students that participated in the pilot also commented on the ability to provide feedback about their pain experience : 
 i like how we got to evaluate how it felt.its important to get peoples opinions on how the needle felt.(p14)none of these students reported ever being asked about their pain before .
we would always be scared , like we would try to hide in our room or run away or something because we would nt want the sharp sensation in our arm .
well everyone has their own feelings , right ? and they feel the needle differently .
when i was little , i used to hate it , but now i m okay with it .
i was thinking in my mind what if the needle was too long and it went right through my arm ?
and what they would do is that they had a table and a couple of nurses sitting at the table .
and they would have the whole school line up and the nurse gave them their shot even if they were screaming .
some girls could nt even take it and the nurse would just give them the shot and tell them to go .
i like how we got to evaluate how it felt.its important to get peoples opinions on how the needle felt .
all students agreed that health care providers and parents are responsible for helping children feel less pain during vaccination and that interventions to mitigate pain should be routinely used .
students were aware of why they needed to be immunized : 
 to protect against diseases and viruses.(p12)however , they felt they should be better prepared for upcoming vaccinations .
this included knowing why vaccines need to be injected : 
  why ( it has ) to be poked in my arm , and i could nt take a tablet with a glass of water and have the same effect.(p12)and how the injection would feel : 
  if they know ( how they feel ) , they know it s nothing more horrible , so they do nt imagine something worse.(p12)they also wanted to be able to bring items to help them cope : 
 you have to know about it and prepare for it  like maybe you ll bring a toy or something like bubbles.(p3)students reported that neither parents nor doctors should lie to them about the pain : 
 it does nt help if they say you will feel no pain at all , it s just a big lie.(p16 ) 
 when they lie to you and then it does hurt , you re less likely to trust them later on.(p11)students reported that parents should be present to help them but that they should not act afraid themselves because they could transmit their feelings to children : 
 yeah , and if the parents are tense , the child will think , oh my parents are freaked , i guess this is really going to hurt.(p7)with respect to health care providers specifically , students reported they should be knowledgeable and use different pain - relieving methods : 
 what we re all trying to say is that doctors should know methods for us so that we would experience pain less.so going to the doctor should nt be such a painful thing to do.(p14)students reported that the school pilot and previous experiences with vaccination were their major sources of information about how to reduce pain .
students that were knowledgeable about pain management interventions talked about taking charge of their pain and leading their own pain management : 
 the most recent time i got vaccinated , i used the cream , used my laptop.(p12)one student described being frustrated by instances whereby her efforts to reduce pain were not supported by health care providers : 
 i would tell them that sometimes the only way for the pain to get out of me is to pinch myself , or pinch my knee .
the nurses or doctors always say to me to relax , and i ca nt do that .
i was pinching myself and they saw me tense , and they did nt know what i m doing and they tell me to relax so i ca nt do my thing.(p16)the same student recommended health care providers ask children about their preferences : 
 they should actually first ask the patient of what way they have to relieve the pain , so that they could tell them , for example , they like pinching or listening to music or something.(p16 ) to protect against diseases and viruses .  why ( it has ) to be poked in my arm , and i could nt take a tablet with a glass of water and have the same effect .
 if they know ( how they feel ) , they know it s nothing more horrible , so they do nt imagine something worse .
you have to know about it and prepare for it  like maybe you ll bring a toy or something like bubbles .
it does nt help if they say you will feel no pain at all , it s just a big lie .
when they lie to you and then it does hurt , you re less likely to trust them later on .
and if the parents are tense , the child will think , oh my parents are freaked , i guess this is really going to hurt .
what we re all trying to say is that doctors should know methods for us so that we would experience pain less.so going to the doctor should nt be such a painful thing to do . the most recent time
i would tell them that sometimes the only way for the pain to get out of me is to pinch myself , or pinch my knee .
the nurses or doctors always say to me to relax , and i ca nt do that .
i was pinching myself and they saw me tense , and they did nt know what i m doing and they tell me to relax so i ca nt do my thing .
they should actually first ask the patient of what way they have to relieve the pain , so that they could tell them , for example , they like pinching or listening to music or something .
the students offered many reasons for treating pain including : preferences for individuals not to have pain ; reducing unnecessary pain ; making the procedure easier by reducing 
freaking out kids , or kids that were fighting or running away ; reducing needle phobia ; and reducing vaccine noncompliance by parents and children .
many students were knowledgeable of strategies for reducing pain including distraction , topical anesthetics and injection techniques .
( p4 ) , including talking , joking , counting , imagery , reading , and playing with toys , bubbles , windmills , dolls and electronic devices .
students also talked about blocking out environmental cues : 
 do nt ever look at the needle , it hurts more.(p15 ) 
 ... get my mind off the needle and other people chatting in the background.(p12)some students described how the injection technique could influence pain : 
 put it in and take it out as quickly as possible .
i had a nurse take the needle and wiggle it in my arm for a bit and then withdraw it really slowly and it hurts more.(p17).a few students described concurrent squeezing , pinching or rubbing the skin to provide a competing sensation to the needle : 
 what my dad does is he squeezes our hands.(p9)students also mentioned rewards : 
 getting a reward after is helpful.(p15 ) 
 they give you a lollipop after , and that would be the only reason that i go and get my shot.(p9)students contrasted vaccination with and without pain management and indicated a preference for pain management : 
 ... better if have something to take away the pain 
i did nt feel it.(p3).students who participated in the pilot reported having positive experiences and laughing about it later .
one student with a fear of needles indicated the fear diminished with adequate pain management : 
 i was given the numbing cream and some techniques for distraction and when i got the needle it did nt hurt as much .
i did nt really mind them so much anymore.(p12)the same student however reported that pain management was needed for successful vaccination : 
 i do nt think i can do it without the cream.(p12)one student who was previously unaware of available pain management interventions indicated she wanted topical anesthetics to be used the next time : 
 maybe if they put some numb cream or something so you could nt feel it , because when i got my needle i was so freaked out that i started crying a lot.(p4 ) do nt ever look at the needle , it hurts more . ...
i had a nurse take the needle and wiggle it in my arm for a bit and then withdraw it really slowly and it hurts more .
they give you a lollipop after , and that would be the only reason that i go and get my shot . ... better if have something to take away the pain
i was given the numbing cream and some techniques for distraction and when i got the needle it did nt hurt as much .
maybe if they put some numb cream or something so you could nt feel it , because when i got my needle i was so freaked out that i started crying a lot .
children s pain during vaccination has been traditionally underestimated , underprioritized and undertreated , contributing to negative experiences for children and their families and future noncompliance with immunization ( 11 ) .
the present study sought to offer new information and a general view of the experiences of children undergoing vaccination .
we included children of different ages attending a school that participated in a pilot project involving implementation of pain management during school - based public health immunization clinics to capture a full range of attitudes and perspectives .
we found that children were concerned about pain during vaccination and wanted health care providers and parents to help reduce it .
children were cognizant of pain management interventions and the importance of treating pain , and indicated that pain management should be a routine part of vaccination .
the results confirm earlier reports that children regard needle procedures as frightening and painful , and are preoccupied with pain ( 9,1217 ) .
they also provide new information regarding children s experiences with implementation of the cpg in a school setting .
children remarked on the stark contrast in their experiences when their pain was managed versus when it was not managed .
this has implications for their reactions to and acceptance of future painful procedures ( 18 ) and suggests that addressing environmental and process factors in school and community clinics can significantly improve children s experiences . when pain was adequately managed and assessed , students believed that health care providers cared about them . students interpreted health care provider inattention to pain as an indication that they did not care about them .
they were also skeptical of individuals that told them that the injection would not hurt .
this is consistent with previous studies in children undergoing repeated needle procedures whereby increased levels of fearfulness and distrust of adults , particularly health care providers , was observed ( 17,19,20 ) .
in addition , a lower sense of control over health has been reported ( 19,20 ) .
considering the repeated nature of vaccination and the continual increase in the number of vaccine injections being administered to individual children over time , more attention should be devoted to the effects of pain on aspects of children s emotional health and wellbeing .
in addition , children reported on the individuality of the pain experience , and that they valued preparation and tailored approaches to pain management .
these factors should , therefore , be taken into consideration by parents and health care providers administering vaccinations to children .
children correctly identified evidence - based pain management interventions including topical anesthetics , distraction , injection techniques and tactile stimulation ( 8) .
they also correctly identified factors that increase pain perception , such as anxious parents ( 11 ) . based on these results ,
children appear interested and capable of learning about ways to control their pain during vaccination . at present
the present findings have important implications for stakeholders involved in immunization including children , health care providers , policy makers , parents and teachers . by simply providing children and parents with information about how to mitigate pain ahead of time , and making alterations to the physical environment and the process of vaccination ,
this has the potential to significantly improve children s vaccination experience , attitudes toward health care providers and vaccination , and future compliance with vaccination .
managing children s pain can also increase their feelings of security and self - efficacy .
this , in turn , will increase their confidence in their self - coping ability , and promote involvement and responsibility in other aspects of health .
first , only a single independent academic school in toronto was included and it is possible that not all children s perspectives were identified .
it is important to note , however , that children from across the greater toronto area attend the school , rather than only those from a specific neighbourhood .
in addition , the students come from a variety of ethnic backgrounds , reflective of the multicultural background of children in the greater toronto area .
second , the responses of children who participated in the pilot may have been influenced by a desirability to respond in a socially desirable way ( eg , make the issue of pain larger ) . however
, this is unlikely to have played a major role because the results are consistent with previous studies demonstrating the prominence of pain as the defining feature of the immunization experience for children .
in addition , the perspectives of children who did and did not have previous experience with pain management during immunization were specifically sought in the present study to capture many different perspectives .
third , the changes to the school - based clinic that occurred in the study school could be accommodated by school administrators and the regional public health unit ; however , they may be more difficult to implement in other schools and/or public health units , limiting the generalizability of the results . a collaborative relationship between school administrators and public health officials and a child - focused view
is required to realize changes to the process of school - based vaccinations that will improve the vaccination experience for children .
fourth , the analgesic supplies ( topical anesthetics and some distraction agents ) and food ( cookies , juice , pizza ) from the pilot were provided by investigators .
future pain management implementation projects should consider enlisting the help of parents with organization of clinic days , including acquisition of necessary supplies and execution of pain management interventions .
this will increase their engagement and participation and enable them to share in their children s positive vaccination experiences .
we have developed educational resources for parents , including an educational video and pamphlet ( available at www.immunize.ca/en/parents/pain.aspx ) to address gaps in their knowledge about evidence - based analgesic interventions ( 21 ) .
such resources could incorporate general information about vaccination , and be embedded within the school curriculum , allowing students and staff to benefit .
the credibility of the findings is improved by the focus group design , which allowed for a broad range of information to be identified .
the group environment allowed children to interact not only with the moderator , but with one another , allowing group norms and attitudes to arise .
participants are often more forthcoming in describing their attitudes and experiences in the presence of those who are their  peers and will often reflect and elaborate on their own views when they hear others put forth similar or divergent views .
the study included a broad representation of children with respect to age , sex and previous experience with and without pain management during vaccination , ensuring that a wide range of perspectives and experiences were described .
in addition , several other design features ensured that data collection and analysis were valid , including : use of a single trained interviewer and interview guide , transcribing videotaped interviews verbatim and double - checking all recordings , performing the analysis with two researchers , and verifying the results with students and the vice principal . a conventional approach to content analysis
rather , the knowledge generated from the analysis were based on participants unique perspectives and grounded in the actual data .
efforts to mitigate pain are recommended to improve the vaccination experience for children . to assist in the dissemination of these findings ,
video footage from the present study has been incorporated in videos about pain management intended for public use produced by the authors , in partnership with aboutkidshealth at the hospital for sick children , immunize canada and the canadian paediatric society , available at www.immunize.ca/en/parents/pain.aspx and www.sickkids.ca/learning/spotlightonlearning/profiles-in-learning/help-eliminate-pain-in-kids/index.html .
we recommend additional research aimed at scaling up implementation of the cpg about pain management across the various vaccination settings and evaluating the impact on children s pain experience and compliance with immunization .
 background : analgesic interventions are not commonly administered during childhood vaccination , despite the fact that two - thirds of children are afraid of needles and one - tenth are noncompliant with immunization.objective:to explore children s experiences of vaccination and preferences for analgesia.methods:a total of 17 children ( four to 14 years of age ) at an independent school in toronto ( ontario ) participated in three focus - group interviews . 
 the majority had previous experience with pain management interventions during vaccination . 
 thematic content analysis was used to analyze interview transcripts.results:the findings were categorized into three main themes : experience of vaccination ; roles and responsibilities regarding pain management ; and impact of pain management . 
 children easily recalled previous vaccinations and discussed fear and distress experienced by themselves and others . 
 children believed that parents and immunizers should prepare them ahead of time and use interventions to manage and monitor pain . 
 they also wanted adults to support their efforts to lead pain management . 
 children discussed benefits of managing pain , including reduced unnecessary suffering , improved vaccination experience , reduced risk of developing needle fears and reduced noncompliant behaviours . 
 they were knowledgeable about strategies for reducing pain including distraction , topical anesthetics and injection techniques . 
 they contrasted vaccination with and without pain management , and indicated a preference for pain management.conclusion:children reported that managing vaccination pain is important and that analgesic interventions should routinely be used . incorporating pain management in the process of vaccination 
 has the potential to improve children s experiences with vaccination and promote more positive attitudes and behaviours . 
HISTORIQUE :
OBJECTIF :
MTHODOLOGIE :
RSULTATS :
CONCLUSION :
METHODS
Participants and setting
RESULTS
Characteristics of participants
Experience of vaccination
Roles and responsibilities regarding pain management
Impact of pain management
DISCUSSION
CONCLUSION