"Fear and pain — together referred to as distress — are among the most common negative effects of vaccine injections," says Dr. Anna Taddio, Leslie Dan Faculty of Pharmacy, University of Toronto and The Hospital for Sick Children (SickKids), Toronto, Ontario, with coauthors. "Research shows there are effective ways to reduce distress, but these strategies are still not routinely built into vaccination programs or practices, even though clinical guidelines recommend them."
This guideline is an update to the 2015 Help Eliminate Pain in Kids & Adults (HELPinKids&Adults) Collaborative recommendations. The authors hope this guideline, aimed at clinicians who administer vaccines, organizations that offer vaccination services, as well as people who receive vaccines and their support persons, will provide updated evidence-based guidance to help ease distress that may come with vaccination.
The authors suggest evidence-based interventions across the 5P framework: process, procedural, physical, pharmacologic, and psychological, emphasizing that people who are being vaccinated and their caregivers should choose the option that works best for them.
Key recommendations:
- Process: Education of all groups from administrators to vaccine recipients about distress-reducing interventions, and use of these
- Procedural: Adoption of methods, such as rapid injections, that minimize distress and promote more positive vaccination experiences
- Physical: For infants 12 months and younger, oral solutions such as breastfeeding, bottle-feeding, sweet-tasting liquids, or pacifiers
- Pharmacological: Topical anesthetics at injection sites for all ages
- Psychological: Distraction techniques, such as toys and singing for infants, and music and digital distractions or toys and games for older children and adults
"Building on earlier work, the guideline provides new research-based tools and practical strategies to help health system leaders, health care providers, people receiving vaccines, and those supporting them improve the vaccination experience. The goal is to make vaccination a more positive experience, reduce fear, and help people feel more comfortable getting vaccines in the future," says Dr. Taddio.
To help reduce vaccination distress, the guideline recommends choosing coping strategies before and/or during vaccination, framed around the CARD system (Comfort–Ask–Relax–Distract), an evidence-based tool developed by several of the authors.
With this updated guidance, the authors hope to lessen the stigma around needles and encourage vaccination.
"Since the COVID-19 pandemic, confidence in vaccines has declined, and vaccination rates have been low among both adults and children," Dr. Taddio says. "This makes the updated guidance especially timely for vaccine providers and organizations looking to follow best practices to make vaccination a more positive experience for everyone."
"Reducing distress during vaccine injections: 2026 clinical practice guideline update" is published September 21, 2026.
