Abstract
Background and Aim: Fear of needles in children is a well-recognised barrier to timely and complete immunisation, contributing to distressing vaccination encounters, delayed schedules, and missed vaccinations. While children’s experiences of needle fear have been explored in the literature, less is known about how healthcare providers manage these encounters in practice and the support available to them. The aim of this study was to explore i) healthcare workers’ experience of vaccinating children with a fear of needles; ii) current and potential strategies to support these children through the vaccination process; and iii) requirements for healthcare worker support.
Methods and Analysis: A qualitative study design was undertaken. Semi-structured interviews were conducted with 10 healthcare providers involved in childhood immunisation, including nurses and pharmacists working across primary care and community settings in Aotearoa New Zealand. Interviews explored providers’ experiences, perceived challenges, and strategies used when vaccinating needle-averse children. Data were analysed using a directed qualitative content analysis approach, enabling identification of both anticipated and emergent themes.
Outcomes: Three dominant themes were identified. First, providers described significant emotional and behavioural challenges, including managing high levels of child distress, resistance, and their own emotional burden. Second, providers employed a range of informal strategies to support children, such as distraction techniques, rapport-building, caregiver involvement, and sensory tools. Third, participants consistently highlighted gaps in training, resources, and system-level guidance, noting the absence of structured clinical pathways for managing needle aversion.
Conclusion and Future Actions: Healthcare providers frequently encounter needle-averse children but may be underprepared and under-resourced to manage these situations effectively. Future action should include the development of national guidance, targeted training, and practical resources to support providers and improve vaccination experiences. Addressing needle fear at a system level may enhance equity, access, and confidence in childhood immunisation services.