Four-year-old Lars Brotzman pretends to give his mother a shot after getting his own flu vaccine at a UW Health clinic on Madison's West Side.

Lars Brotzman, 4, was fussy before he even entered the doctor's office to get his swine flu vaccine at UW Health Clinic West. "I don't wanna get a shot," Lars said five times before placing his bum on the exam room bed.

The nurse, Trish Paris, tried several distractions to calm him down, handing Lars a puzzle page and encouraging his mother to sing a song. Paris even started up a brief intro to "Jingle Bells." As Lars pleaded to avoid the needle, he received the shot while barely even knowing it had happened.

The distractions are part of a new project started by Dr. Amy Plumb and Peggy Riley, a clinical nurse specialist at UW Health, to decrease children's potentially painful experiences with shots.

Their recent study of 800 UW Health patients between the ages of 4 and 17 found that using distractions while giving shots can decrease the pain from common childhood immunizations, such as the seasonal flu shot. Initial results from the four-month study found a 52 percent decrease in reported pain while using some form of distraction.

Riley and Plumb integrated distraction elements for younger patients in eight UW Health clinics, including reading a book, singing a song, applying ice, listening to an iPod or applying a topical ointment to the skin that numbs the area.

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"Some of this requires more silliness, and that's hard," Plumb said. "I think the kids have enjoyed it."

Increased communication with parents was a key part of Riley and Plumb's work.

The two tried to prep children and parents about the procedure in a mailer sent to parents explaining the benefits of talking with their child about getting shots before they show up at the doctor's office.

"The goal was to provide the communication between parents and caregivers to get them to both see a new role they play," Riley said.

After Lars received his H1N1 shot, Paris asked if it hurt. He looked confused for a minute, but then gently shook his head no. He dried his tears, embraced his new sticker as a reward and was given a toy syringe, a form of play therapy Paris has seen work with other children who are afraid of shots. Lars then gave pretend shots to Paris, his mother and even himself, all in preparation for his next doctor's visit.

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