As a family medicine doctor, Dr. John Bissett of Novant Health New Hanover Primary Care - Autumn Hall treats infants through seniors.

One thing he sees, no matter the age? At least one-third of his patients express concern about needles.

And that’s just the fraction that says something: “There are also people that feel it and don’t express it,” Bissett said. “They may be embarrassed about it, so they don’t say anything — they just don’t get their labs done.”

Why do needles make some people feel woozy or anxious? And if you’re “some people,” how can you get through vaccines and blood draws? Keep reading.

How do people commonly react to needles?

I hear, “I’m scared of needles,” “I don’t do well with needles,” or “I pass out around needles.” Kids may cry or try to leave the office when they know a shot is coming.

What do you do to help people who are uncomfortable with needle procedures like shots and blood draws?

First of all, I normalize it: “Hey, this is very common, and isn’t anything to be embarrassed about. It happens very frequently.”

Then I say, “I understand that this is invasive. I promise that I wouldn't order this if I didn't think it was very important for your health.”

I explain why it’s important: “Labs are some of the most powerful tools that we have to keep you healthy, and blood draws help us proactively monitor your health and get ahead of things.” If they need an injectable medication, we’ll talk about how it could help their condition.

With kids, I try to put it in terms they'd understand: “This is how we make sure your body is healthy and make sure there's no bad germs in there.” I don’t want to mislead them and say it won’t hurt at all, but I try to put them at ease — I say, “You might feel a little pinch, but Mom or Dad will be right there with you, and it’s gonna be over really fast.”

Is anxiety the main reason people have issues with needles, or is there more to the story?

Some people feel anxious. Other people don’t feel nervous, but have an involuntary reaction called “vasovagal syncope” in response to a needle. “Vaso” refers to blood vessels, “vagal” refers to the vagus nerve, which helps control your heart rate and blood pressure, and “syncope” is the medical word for fainting.

When needles make you pass out

Why do needles make some people pass out?

When some people see needles or blood or experience pain, their body overreacts: Their heart slows down and their blood vessels widen, so their brain doesn't get enough blood for a few seconds and they faint.

The body’s smart — it knows that passing out will bring you to the ground, and gravity will bring the blood back where it needs to go. The blood supply returns, and you usually “come to” within a few seconds.

Sometimes people have a clue before it happens — they’ll break out in a sweat, feel clammy or lightheaded, get blurry or tunnel vision and they’ll say, “I need to lie down.” Other times, they’ll pass out without warning.

What happens if someone faints in a doctor’s office?

We help them stay safe for that few seconds until they wake up. Then we’ll encourage them to sit there for a few minutes and not to get up too fast, to avoid fainting again. Often, we’ll give them some cold water or juice to help them feel better.

We’ll also make sure they didn’t hurt themselves during the fall. Most labs will have a doctor take a look and grab a quick set of vitals (blood pressure, pulse, respiratory rate and temperature).

The typical vasovagal response is a very brief fainting and very fast recovery. If it’s anything outside of that, we call someone to evaluate because it could be another medical issue.

Are there ways to prevent fainting from a needle?

The morning of your shot or blood draw, eat a good breakfast and drink a full glass of water since dehydration can trigger vasovagal syncope. (If your blood work requires fasting, talk to your doctor for guidance.)

If you start to feel faint, you can also try crossing your legs, making a fist, squeezing your leg muscles or putting your hands together and pulling them apart. Sometimes these techniques — called “counter-pressure maneuvers” — can raise your blood pressure and prevent fainting.

But sometimes vasovagal syncope is just how your body responds.

If I’ve fainted while getting a shot or while having blood drawn, what should I do next time I have a needle procedure?

The most important thing you can do is tell your technician or doctor. Vasovagal syncope isn’t dangerous, but falling can be — so it’s important for us to know you’ve had it. Then we can use a special table, have you lie down for your procedure, and have some water or juice on hand.

Don’t be embarrassed to mention it. Our labs deal with this all day and we're very equipped to handle it. It's not a dangerous medical issue and we have all the resources to make sure you're OK.

Can the contents of a vaccine itself cause fainting?

No — vasovagal syncope is a physiological response to the needle and has nothing to do with the ingredients of the vaccine. It happens during blood draws, too.

When anxiety is the problem

What can I do if needles give me anxiety?

Experiment and see what helps you: Some prefer to look away as the needle goes in, and for some it’s helpful to watch. If you’re nervous about the pain, we can use an over-the-counter topical lidocaine gel prior to your shot or blood draw to block pain.

If you’re willing to tackle your anxiety, seeing a therapist who uses cognitive behavioral therapy would be the first-line treatment. Some of my patients have had success with that.

Very rarely, someone has such bad anxiety that they need medication to get through needle procedures. I don’t recommend it as the first thing we try, but it’s something you can talk to your doctor about if that's the only way you can get things done.

How can parents help kids deal with needle anxiety?

Tell kids in advance that they’ll have to get a shot or blood draw — but don’t tell them too far ahead, or they’ll perseverate on it for days. With my own two kids, I’ll say something like, “Tomorrow, we’re going to your checkup and you’re going to get a shot or a needle poke that will keep you healthy.”

A few other tips:

• Pretend to give one another “shots” with a toy doctor kit at home to get them more familiar with the process.
• Bring a favorite stuffed animal or blanket for comfort.
• Consider queueing up their favorite show on a phone or tablet if they’re scared.

If your child has struggled with needles in the past, we can use over-the-counter topical lidocaine gel to reduce their pain. We can also do their blood draw in our clinic so they don’t have to go to an unfamiliar lab.

If your child has special needs like autism or severe anxiety and we can’t accomplish things safely in our office, we may refer them to a clinic that specializes in providing care for kids with those needs.

After your child gets a shot, acknowledge their bravery and positively reinforce them: “Hey, you were super brave out there. It was scary, but you did it.”