Thanks so much for agreeing to kick off our advocacy week with the focus of pain management and how to advocate for our child. Please tell us about yourself and why pediatric pain management became your focus.

I am the Chief Executive Officer of MMJ Labs (named after my three children) and I invented Buzzy® after experiencing first-hand the indifference of the healthcare system to the pain and suffering of children. Buzzy grew from a desire to put inexpensive pain control in the hands of parents and patients.

After graduating from Yale University and Emory Medical School, I completed Pediatrics Residency and a Child Abuse Fellowship at Cincinnati Children’s Hospital, and Pediatric Emergency Medicine training at Children’s Hospital of The King’s Daughters in Virginia. I am the director of Emergency Research for Pediatric Emergency Medicine Associates at Children’s Healthcare of Atlanta, Scottish Rite, and a Clinical Associate Professor at Medical College of Georgia.

I always hated unnecessary pain or suffering during my training, and would get really irritated when residents or other doctors didn’t bother with pain medicine. I wanted to do research to show pain relief was important, but realized that decreasing pain wouldn’t change many people’s behaviors. If pain reduction helped the procedure or made them look better, doctors might care more, so I concentrated on research showing that pain relief improved the outcomes of procedures. Consequently, I studied anesthetics for spinal taps, and learned a lot about needle pain.

When my kids got old enough to remember I brought creams or distraction toys to lessen the impact of their shots. They were all really good shot takers until one nurse told my oldest out of nowhere, “You are going to sit still or this is really going to hurt and we will have to hold you down.” He did great for the shots but then threw up afterward and had been needle-phobic ever since. I was so mad at the system and myself for not being able to protect him that I wanted to come up with something that worked instantly that parents could bring and use even if the healthcare system wasn’t interested.

As a mom to 2 kids who’ve had hundreds of needle sticks, I’m fascinated by the product. Can you tell me a little bit about the development and technology and most importantly, why it works?

After my son had an adverse experience with immunizations when he was 4, I had intermittently tried to find a quick way to make it better. I was trying to reproduce the sensations that happen when you burn your hand and stick it under running water. The experiments included the whole family and got pretty messy! Believe it or not, the first effective prototype involved a vibrating personal massage motor and frozen peas. Science, innovation, and healthy vegetables against pain! After that we had help from a fantastic engineering undergraduate student who made my drawings three-dimensional, then the actual Buzzy was designed by Formation Design Group in Atlanta, Georgia.

Buzzy uses simple scientific principles to deliver natural pain relief. Buzzy’s combination of icy cold wings and a vibrating body confuses the body’s nerves to block sharp feelings, just like rubbing a bumped elbow helps stop the hurt, or cool running water soothes a burn.

Buzzy is a hand-held device, about the size of a computer mouse, which, through a combination of vibration and ice, minimizes pain from shots and other needle sticks like IV starts, blood draws and finger pricks. Buzzy uses the Gate of Pain Control (the vibration), coupled with the Descending Noxious Inhibitory Control (the ice), so the science is
pretty serious and very real, but the idea is really simple.

Buzzy works instantly, is reusable (eco-friendly, minimizes medical waste), FDA-compliant, and really affordable (available online at www.buzzy4shots.com for $34.95). Buzzy makes important and necessary medical visits and at-home regimens easier for the whole family.

We have presented data demonstrating that Buzzy decreases IV pain by half when used in older children (age 4+) for IV sticks. We know Buzzy is safe for infants, though we do not yet have the final data on how well it works. Babies still cry, even with numbing creams, so we are trying to see if the duration of crying is less. We have begun our research studies on shots for infants and children under age 4, so we should have some data soon. We know with certainty that children of any age can benefit from distraction during medical procedures, and our Bee-Stractors™ distraction cards are designed with age-specific questions to distract infants and children from the procedure.

Can you please provide some tips on how as parents/caregivers we can advocate for our kids in relation to their pain management?

In my research, I have found that needle pain has far-reaching adverse consequences for personal and public health. Although needle pain from a shot may not seem like a big deal, needle sticks are the most common and most feared cause of medical pain in the world. Though a shot may “only hurt for a second,” the impact for children can be a lifetime of needle phobia. As babies who are sensitized to needles grow up, they may avoid medical treatment, refuse to donate blood, or refuse flu shots due to fear of needle pain. When they have children, they may even be less likely to immunize their own children.

Children now get more than 20 needle sticks before they are two years old – and of course many more needle sticks are in store for children with special medical needs. Although the American Academy of Pediatrics recommends using pain control “whenever possible,” only 2.1 million of an estimated 18 million IV sticks each year are done with any sort of pain management. Only 6% of mothers report ever having even simple topical numbing creams used for their children’s shots. Buzzy puts a simple end to this inhumane incongruity between theory and practice.

Sadly, there are no global answers, but there are some general tricks of the trade you can try. Mind you, a bombastic “needle-wielding fiend” as my son says can undermine the best laid plains, but in general most pediatric practices will work with you.

For young children, pain is punishment and scary, so addressing fear is an important first step to making shots less of a big deal. Children are less fearful when they know what’s happening and feel in control. We see children crying and screaming as much from the cleaning swab as as from the poke that actually hurts. While the temperament of the child dictates just exactly how they will respond and the best way to prepare them, here are some general pointers:

• When asked “am I going to get a shot?” focus on the benefit. “Yes, they have medicine that keeps you healthy.”
• NEVER promise they won’t get a shot unless you intend to follow through and come back another time if they’re due for one.
• NEVER threaten with a shot if children don’t behave.

Establishing a needle as punishment or you as untrustworthy will guarantee a bad experience. If the child’s question is, “Is it going to hurt?”, avoid using the words pain or hurt. Instead, use the word “bother”, and answer this way: “Actually, a lot of kids aren’t that bothered by shots. Before you get them, I’ll show you how we will make getting them not a big deal.” If they’ve had a bad experience in the past, say “I found out about some new cool things we can do to make them much more comfortable.”

OK, you’ve modulated the anxiety in your child, now how do you deliver on your promise? Parental behaviors, positions of comfort, topical anesthetics, distraction, and using the body’s own nerves have all been proven to reduce distress for children getting shots.

First, relieving kids’ distress begins with you. Research shows that up to 50% of a child’s reaction to needles is predicted by how the parents behave and what words are used. The best combination is warm but firm. No apologizing, empathizing, or letting them “just go to the bathroom real quick.” Instead, use praise, “I know you can do this”, and direct them to pay attention to non-shot related things before they get anxious. More on that to come.

Second, the person giving the shots can help.

These are research-proven principles that make shots hurt less:

• Give the least painful shot first
• Give the shots sitting up in the arm after age 18 months
• Use a slower push
• Use a longer needle
• Use “position of comfort”: facing you on your lap, or with your arm around the child if they are older and receiving shots sitting up. Being held flat is the most vulnerable positing you can be in; much better if 4-6 year-olds can straddle your lap facing you and get shots while you hug them.

Third, to help overcome established needle-phobia, there are creams (over the counter LMX-4, Ferndale Labs) which can be applied 20 minutes in advance, or prescription EMLA (Astra-Zeneca) which needs at least an hour. Be sure they’re placed correctly, and know that they only numb the surface. Never promise complete pain relief, or a child may focus on the pain to try to prove you wrong. “I told you so” is an immensely satisfying accusation after being subjected to something unwanted in the first place. “These will help a LOT!” you say.

Studies show that appropriate distraction decreases distress. While the nurse is getting the injections, let a child choose from multiple visual games or tasks to focus elsewhere during the shot. “Do you want me to read to you, or give you things to find?” Where’s Waldo books, counting and popping bubbles, or blowing a pinwheel are all good choices. Finding and counting work even for adults. Be prepared to choose if they’re indecisive. “You know what I think would be good? Let’s do this . . . ” One option is to ask questions on the back of commercial Bee-Stractor distraction cards (buzzy4shots.com) while the child looks at the pictures on the front. “Which two monkeys look the same? Can you find all 6 apples?”

Tasks that include a sensation also help focus attention away from the poke: for example, tell your child to count zigzags as you scratch the edge of a fingernail on their arm. Tell the child to yell “now!” when a distraction card or fingernail gets to the elbow or wrist. For multiple shots or a seriously anxious child, bring an ice pack or vibrating toy to touch other body parts and have the child name the body part touched by ice. “Knee! Leg! Nose!” Even better, touch them with an ice pop and 5 right answers wins the pop!

Whatever happens, praise how your child did!

In closing, is there anything else you’d like to share with our readers?

As a needle pain researcher it is incredible to me that no one even talks about the issue of needle pain management in the treatment of chronic conditions, including diabetes and so many other frequent-stick illnesses. Here at Buzzy, we believe passionately that no one should be expected to simply tolerate needless needle pain. We have been so gratified by stories of kids who initially are addicted to their Buzzy but then reach place where they can handle the sticks, eventually using Buzzy only for pump changes and ultimately giving their Buzzy to someone else who was recently diagnosed.

We have recently received a grant from the National Institutes of Health, which funds our ongoing research of needle pain relief in children. We are constantly working to improve Buzzy and the world of pain management. We donate $1 from the sale of every Buzzy to the Child Life Council, which serves child life professionals as they empower children and families to master challenging life events. I encourage you to visit our interactive website, where you can leave a comment or send me a question at “Ask Dr. Amy.”