Needle pokes: Reducing pain with numbing cream

​To help reduce needle poke pain, your child may benefit from numbing cream. You can buy numbing cream over-the-counter at your local pharmacy without any prescription.

How do numbing creams work?

Numbing creams (also called topical anaesthetics) contain lidocaine. When placed on your child’s skin they numb the area, so helping to reduce the pain of a needle poke.

How do I prepare my child?

Explain to your child that the cream will be put on their skin and covered up while it works. Just before the needle poke, the health-care provider will remove the covering. You can tell your child that this might sometimes feel like having a bandage removed. Also tell your child that the cream keeps working for up to an hour after it is wiped off, so they might still feel a slight pressure on their skin after it is removed.

When to apply numbing cream

For best results, put the cream onto the skin at least 30 minutes before the needle poke. It can be left on your child’s skin for up to two hours.

Where to apply numbing cream

The area where you apply the cream is called a site.

For needle pokes and IV starts

Common sites include the inside forearm or the top of the hand.

For vaccines

The site will depend on your child’s age, the size of the needle and the type of vaccine. The most common sites include the deltoid (upper arm) or the front outer side of the thigh.

Sometimes your child will have a needle poke in more than one site on the same day. Before you apply the cream, make sure you confirm the correct site(s) with your child's health-care provider.

How to apply numbing cream

1. Wash and dry the site where your child will receive the needle poke. Never put the cream on an open wound such as a cut or scratch.
2. If opening a new tube of cream, use the point on the top of the cap to break the seal over the tube.
3. Put the correct amount of cream on the site:
   • a dime-sized spot if child weighs less than 22 pounds (10 kg)
   • a quarter-sized spot if child weighs 22 pounds (10 kg) or more.
4. Cover each site with plastic wrap or a clear bandage (such as Tegaderm®) to keep cream in place and prevent your child from touching it and getting it in their mouth or eyes.
• If using a clear bandage, remove the center cut-out piece and leave on the paper frame.
• Peel the paper liner off.
• Holding the paper frame, cover the cream, but do not press down on the centre. The cream works better in a thick layer.
• Smooth down the edges of the clear bandage.
• Remove the paper frame.
5. Once the cream is covered, it works best if it is not touched. Do not let your child chew, suck or prod it.
6. If cream oozes out from under the covering, wipe it away with a cloth. Avoid contact with the mouth, eyes or nose. Rinse your hands with water after applying the cream.

Does numbing cream have any side effects?

When used as directed, numbing cream has few side effects.

• Your child’s skin may be whiter for a short time. This is normal.
• Your child may develop itching, redness or a rash. If this happens, remove the cream and contact your child's health-care provider for further instructions.

Do I need to take any safety precautions with numbing cream?

Expiry dates

To make sure the cream is still safe to use, check the expiry date on the tube before you apply it.

Disposing of numbing cream

Ask your pharmacist what to do with expired or unused cream. If the pharmacy does not have a "take back" program, empty the tube of cream into the trash.

Storing numbing cream

Store numbing cream in its original container out of children’s reach and away from direct sunlight, heat and humid places such as the bathroom. Make sure any caps are closed tightly and, if possible, lock the cream away with other medicines.

When should I call the health-care team?

Call the health-care team if:

• you have questions about where to place the cream or about the health of a site, for instance if there’s a small scrape or cut where the cream should be applied
• your child shows signs of a skin reaction, such as redness, itching or a rash
• your child gets the cream in their mouth or eyes. In this case, call the health-care provider only after rinsing the area with plain water.

Call 911 immediately if your child shows signs of an allergic reaction to the cream. These include:

• fever or chills
• hives
• swelling
  
• wheezing or shortness of breath.

At SickKids

If your child needs support during the procedure, please call the Child Life department or tell your health-care team.

Further information

​For more information about the Comfort Promise bundle of options to reduce the pain of needle pokes, please see the following pages:

Needle pokes: Reducing pain in infants aged up to 18 months

Needle pokes: Reducing pain in children aged 18 months or over

Pain relief: Comfort kit

Needle pokes: Reducing pain with sucrose or breastfeeding

Needle pokes: Reducing pain with comfort positions and distraction