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As announced by the government, Malaysia has kickstarted the Covd-19 vaccination for children aged 5 to under 12 years old in February 2022. To register your child for the vaccine, parents can refer to the steps outlined below. 
For many children, getting an injection may be traumatic, and this could be more stressful for children with autism. In addition to the anticipated pain from the needles, children with autism will need to tolerate going to an unfamiliar place, possibly sensory overload issues, and having strangers (doctors and/or nurses) holding their arm while administering the injection. Hence, in order to make this experience smoother for your child with autism, here are some tips and strategies that could help prepare your child with autism for the vaccination shot. We have also made a short video on this previously for Autism at Home and check it out below: Before Going for the Vaccine
1. Predictability
Predictability is always key to prevent stress and behaviours in children with autism arising from the lack of expectations. You can inform your child about the vaccination via a social story and/or visual schedule on what is going to happen on that day, and show your child videos of a child getting an injection, or even a video of the place they are getting the vaccination from, in order to familiarise them with the place. For a printed copy of social stories and visuals, you can get it from our Autism At Home platform. You can also find more resources here to incorporate into your own version of social story!
For older children, or children with more awareness and advanced skills, explaining what vaccines do can encourage them to take the vaccine. Social stories and pretend plays can also be used to inform them on the purpose and effects of the vaccination, other than providing predictability on the events happening on that day. Other than that, you can also play educational videos and songs that help explain the mechanisms of vaccines. Some examples of videos and songs are as below:
Informational videos:
A kid’s guide to Covid-19: How vaccines work
How vaccines work against COVID-19: Science, Simplified
Songs:
👩🏽⚕️ Everybody Needs Shots! | Vaccines Kids Song | Mooseclumps | #VaccinesWork,
The Soldiers in the Vaccine | Vaccine Song | Healthy Habits | Super JoJo Nursery Rhymes & Kids Songs,
Time for a Shot | The Vaccine Song | Baby Joy Joy
2. Practice prerequisite skills
It is also wise to identify and practice the prerequisite skills required for the vaccination process and practice with your child at home. Some examples of prerequisite skills required are cooperation, the ability to follow First-Then instructions, attention, imitation, as well as some tolerance to waiting, sitting still and having the injection syringe touching their arm for a while. You can also roleplay the visit, and go through the flow of the event with your child. Practising increases familiarity, in addition to acquiring the skills mentioned. For more information on how to practice these skills systematically with your child, do check out Autism At Home!
Things to Bring/Prepare
1. Behaviour Prevention Tools and Preparation
Another incredibly helpful strategy would be identifying your child’s possible triggers, and putting effort in prevention. For example, numbing cream could be used, if pain is a sensation your child struggles with. If your child has the tendency to be triggered by crowds and noises, bringing a pair of earmuffs would be helpful. Parents can also check out the vaccination centres beforehand on the accommodations and facilities available (special express lanes, calming rooms), and the eligibility for your child to enjoy the services.
2. Occupying your child
To speed up the whole vaccination process, it would be helpful to print and fill up the consent forms beforehand. As there will be a considerable amount of waiting times throughout the vaccination process, parents can pack a “busy-bag” of items that can keep your child occupied during the waiting times. Last but not least, remember to bring the promised reward for your child! The reward should be of the highest motivational level, and could be awarded to your child immediately after they are done with the vaccination.
On The Day
1. Before going
Bring all the items mentioned above (social story, visual schedule, busy bag, reward etc.), and make sure your child has enough rest and their meal before their vaccination appointment. Remember to communicate to your child again on what will happen before heading to the vaccination centre, not leaving out what they are getting as reward once they are done with their vaccination. Start your journey earlier to ensure that you will be arriving on time, or have ample time for your child to familiarise with the place if needed!
2. Arrival
Inform the staff upon arrival, if special/express lane service is available and if your child is eligible for it. While registering your child and going through each station, keep in mind to always use the visuals and social stories to communicate in advance to your child on what is happening next, as well as the duration they need to wait (e.g. 5 more minutes of (play activity), then injection). A timer will be great to inform and help your child to track the time.
3. During the shot
Do a little exercise (e.g. shake their arms/stretch) to help them relax their muscles- tensed muscles will intensify the pain! Hold your child while they are seated and make sure you can prevent them from moving their limb while the injection is being administered. Right before the injection, apply numbing cream (if applicable) on their arm, and hold them in place (click here for examples on how to hold your child during vaccination). Distracting your child (by counting/singing a song etc.) and removing their attention from the shot could help ease the process too. Make sure you have their reward in sight, to be given to your child once they are done with the injection. One important reminder for caregivers is to stay calm through this process!
For older children, it may be hard or impossible to carry them-do hold their hands as support, and practice relaxation techniques (taking deep breaths, counting, squeezing hands etc.) together with them. Distracting them during the injection may help too! Remember to praise and reinforce them after the shot! Support, comfort and praise are important for big children as well.
After the Shot
1. Occupying your child
As it is mandatory to wait on site for a few moments after the shot, your child can enjoy their reward and be occupied with the “busy-bag” activities prepared. Provide predictability by informing them on the duration of waiting (using a timer), letting them know from time to time how much time is left.
2. Side effects
As of date of writing, there have been no reports of adverse side effects from vaccination among kids so far. However, it would be good to be prepared for a couple of down days after your child’s vaccination appointment. It will be good to also inform your child on what is happening, as well as what they can do to feel better (e.g. rest, drink water, take medicine). This can be done in the form of social stories as well. If symptoms of side effects persist, or are unusual, do visit the doctor immediately.
References
- Infographic 1: https://covid-19.moh.gov.my/user/pages/04.vaksin-covid-19/04.pickids/20220126-pickids-info-en.jpg
- Infographic 2: https://covid-19.moh.gov.my/user/pages/04.vaksin-covid-19/04.pickids/01.semasa/2022/02/langkah-langkah-mendapatkan-janji-temu-vaksinasi-pickids-melalui-mysejahtera/reg-pickids-en1.jpg
- Video of children getting vaccination: https://www.youtube.com/watch?v=TtwBplsGeAQ
- Autism At Home lesson on Preparing For Swab Tests and Vaccinations: https://www.autismmalaysia.com/autismathome/lessons/preparing-for-swab-tests-vaccinations/
- Guide and Visual Schedule for Covid-19 Vaccination: https://www.vaksincovid.gov.my/upload/media/PICK-Guide-ASD-ENG.pdf
- Informational videos on vaccines: https://www.youtube.com/watch?v=5SproXmRUkI, https://www.youtube.com/watch?v=p7fDNWwWyBE, https://www.youtube.com/watch?v=uWGTciX795o
- Songs about vaccines:https://www.youtube.com/watch?v=QVDfBCLHLTE, https://www.youtube.com/watch?v=G6NNvurBU08, https://www.youtube.com/watch?v=Lu5Sm819zBA
- Vaccination consent forms: https://drive.google.com/file/d/1GQxx2EdnqPJyF9aQ6vah7GYWtRKqXW6s/view
- How to hold your child during vaccination: https://www.cdc.gov/vaccines/parents/visit/holds-factsheet.html
- No adverse side effects from vaccination among kids so far: https://www.thestar.com.my/news/nation/2022/02/07/covid-19-no-adverse-side-effects-from-vaccination-among-kids-so-far-says-khairy
- Infographic 3: https://covid-19.moh.gov.my/user/pages/04.vaksin-covid-19/04.pickids/20220202-pemantauan-anak-en.jpg
