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Vaccine Anxiety in Children

This video provides an overview of vaccine anxiety in children and tips for how to support them in a clinic setting. There is a special focus on children who have also experienced trauma and/or parental substance misuse. This information is presented by Melony Williams, LCMHC, from TLC Family Resource Center in Claremont, NH and Torie Miele, MS CCLS, Child Life Specialist at the Children's Hospital at Dartmouth Hitchcock in Lebanon, NH.

Learning Outcome

At the conclusion of this learning activity, participants, with knowledge of the effect that previous trauma (such as witnessing parental substance misuse) may impact a child’s presentation in a clinical setting, will be able to describe at least two strategies to reduce anxiety for children in preparation for receiving injections.

Activity Details
Start Date:  April 1, 2021
End Date:  April 1, 2024

You may claim CME credit for successful completion of this online course. In order to claim credit, you must follow these steps:

  1. Register for the learning activity by creating an account or logging in to your account.
  2. Click Continue to navigate to the Activity Material tab. Click View Presentation to view the recording. View the entire presentation.
  3. Return to this Activity page.
  4. Click Continue to navigate to the Evaluation tab; then click the Launch button to start the evaluation.
  5. Complete and Submit the evaluation and attestation form.

When the evaluation is submitted, you will be awarded credit. You may access your transcript for verification of participation at any time via Your Account. Need help? Visit the Support Page, send an Email, or call the Center for Learning and Professional Development at (603) 653-1234, Option 1.

  • Melony Williams, LCMHC and Torie Miele, MS CCLS

    About our presenters: 
    Melony Williams is the Clinical Supervisor for TLC Family Resource Center in Claremont, NH. She is an experienced Mental Health Counselor who specializes in working with young children and their families and families who have experienced trauma, loss or grief. She provides direct client care individually and in groups, supervises home visitors who work for the TLC Family Resource Center, and provides consultation to community providers. 
    Torie Miele is a Certified Child Life Specialist at the Children’s Hospital at Dartmouth Hitchcock. She works with children and families in the hospital to help them cope with medical and other difficult life experiences. She focuses on the mental, emotional, and social needs of each individual child and family and provides guidance through knowledge of child development, therapeutic play techniques, and family centered care.

Dartmouth-Hitchcock is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Dartmouth-Hitchcock designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Requirements for Successful Completion

In order to receive credit for this Continuing Medical Education (CME) activity, you must:

  • View the entire presentation
  • Complete the online Attestation of Attendance & Evaluation Form (you must register to access).

In accordance with the disclosure policy of Dartmouth-Hitchcock/Geisel School of Medicine at Dartmouth as well as standards set forth by the Accreditation Council on Continuing Medical Education and the Nursing Continuing Education Council standards set forth by the American Nurses Credentialing Center Commission on Accreditation, continuing medical education and nursing education activity director(s), planning committee member(s), speaker(s), author(s) or anyone in a position to control the content have been asked to disclose any financial relationship* they have to a commercial interest (any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on patients). Such disclosure is not intended to suggest or condone bias in any presentation, but is elicited to provide participants with information that might be of potential importance to their evaluation of a given activity.

The Activity Director(s), planning committee member(s), speaker(s), author(s) or anyone in a position to control the content have reported NO financial interest or relationship* with various companies. There were no individuals in a position to control the content that refused to disclose.
*A “financial interest or relationship" refers to an equity position, receipt of royalties, consultantship, funding by a research grant, receiving honoraria for educational services elsewhere, or to any other relationship to a company that provides sufficient reason for disclosure, in keeping with the spirit of the stated policy.

Bibliographic Material Resources For PARENTS: Medical Trauma Resources: Resources for Mental Health: Where to purchase items:
  • Buzzy
  • Shot Blockers
  • Stress balls and other fidgets
  • Comfort position posters - Rainbow Comfort Measures from Rainbow Babies and Children's Hospital
    Contact:  Lissy Zaremba MA, CCLS;  Clinical Educator, Family and Child Life Services
    Lissy.zaremba@uhhospitals.org  Phone: (216) 844-1353
Journal Articles:
  • McMurtry, C.M., Taddio, A., Noel, M., Antony, M.M., Chambers, C.T., Asmundson, G.J., Pillai Riddell, R., Shah, V., MacDonald, N.E., Rogers, J., Bucci, L.M., Mousmanis, P., Lang, E., Halperin, S., Bowles, S., Halpert, C., Ipp, M., Rieder, M.J., Robson, K., … Scott, J. (2016). Exposure-based interventions for management of individuals with high levels of needle fear across the lifespan: A clinical practice guideline and call for further research. Cognitive Behavioral Therapy, 45(3), 217-35. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4867871/
  • Ahmadpour, N., Weatherall, A. D., Menezes, M., Yoo, S., Hong, H., & Wong, G. (2020). Synthesizing multiple stakeholder perspectives on using virtual reality to improve the periprocedural experience in children and adolescents: Survey study. Journal of Medical Internet Research, 22(7), e19752. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7395245/
  • McMurtry C. M. (2020). Managing immunization stress-related response: A contributor to sustaining trust in vaccines. Canada communicable disease report, 46(6), 210–218. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7343055/
  • World Health Organization. (2019). Immunization stress-related response: A manual for program managers and health professionals to prevent, identify and respond to stress-related responses following immunization. Geneva (CH): World Health Organization. https://www.who.int/publications/i/item/978-92-4-151594-8
  • Sørensen, K., Skirbekk, H., Kvarstein, G., & Wøien, H. (2020). Children's fear of needle injections: a qualitative study of training sessions for children with rheumatic diseases before home administration. Pediatric Rheumatology Online Journal, 18(1), 13. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7007654/
  • Felitti, V.J., & Anda, R.F. (2014). The Lifelong Effects of Adverse Childhood Experiences. In Chadwick’s Child Maltreatment: Sexual Abuse and Psychological Maltreatment, (Vol. 2, pp. 203-216). St. Louis, MO: STM Learning, Inc.
  • Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., et al (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) study. American Journal of Preventive Medicine, 14, 245-258.
  • Merrick, M.T., Ford, D.C., Ports, K.A., & Guinn, A.S. (2018). Prevalence of adverse childhood experiences from the 2011-2014 Behavioral Risk Factor Surveillance System in 23 states. JAMA Pediatrics, 172, E1-E7. doi:10.1001/jamapediatrics.2018.2537
  • Substance Abuse and Mental Health Services Administration. (2014). SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach. HHS Publication No. (SMA) 14-4884. Rockville, MD: Substance Abuse and Mental Health Services Administration.
Provider Contact Information

Provider contact information for questions regarding accreditation of the activity:

Center for Learning and Professional Development
Dartmouth-Hitchcock Medical Center

Type:     Internet Activity (Enduring Material)
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