Your daughter needs to feel reassured. An unpleasant experience when she's already afraid is only going to make things even harder next time. But on the other hand, if you can make this easier for her than she anticipates, then next time may be less traumatic.
Talk to the doctor. Make it clear that a solution has to be found or the problems will get worse and the doctor is going to find later experiences much more traumatic (for the doctor, too).
Also shop around for a pathology collection place (for future reference) which will be tolerant and supportive. I didn't know to insist last time difficult child 3 had to have blood taken, and as a result the experience was far worse than it needed to be, simply because the pathology technician was in too much of a hurry to use the EMLA cream I asked for. Believe me, that wasted far more time than if she'd used the cream and we'd waited (she could have done other patients while the EMLA did its magic). We did eventually convince the technician, but too late for difficult child 3.
Tell the doctor that if difficult child needs sedating, it must be considered. Something to calm her at the very least. I don't know if EMLA is going to be much help - the tetanus shot stings like h*** for a number of reasons and EMLA only works on the skin surface (a contact thing). ANY injection into the muscle is forcing that volume of liquid into interstitial tissue which hasn't got space to accommodate it. Remember from school science - liquid is incompressible. So something has to give - and it's your body tissue that gets pushed aside to make room for the shot fluid. The site feels bruised for good reason - it is, in a way. It stings the most while the injection is actually being given and for a few seconds afterward, then the fluid is finally in the body and your body begins the job of slowly absorbing it. But the tissue where it was injected has been insulted and is going to let you know about it until it recovers (a few days).
Whatever you do, she is probably going to have a sore spot at the injection site.
Several things can be done, though, to minimise the pain at time of injection, and afterwards. You need your doctor well and truly on side for this. You also need your daughter as still and relaxed as possible - tense muscles will make this worse.
The trick - inject it s-l-o-w-l-y. The slower you inject it, the less the insult to body tissues because the tissues begin to distribute the fluid moderately quickly. The other trick - use a LARGER diameter needle. I know it sounds crazy, but it's effective. I know, from personal experience, because the only antibiotic treatment I can have now (short of going into hospital on a drip) is an intramuscular injection of antibiotic, 12 mls in volume. Nasty. For the non-metric, one ml is the volume of a cube, 1 cm per side. Imagine 12 such cubes, packed into your gluteus maximus. According to my calculator, 12 mls is the equivalent to two cubic inches in volume. I've had about a dozen or more of these shots with varying degrees of pain (the tissues of my rear end were not designed to have two cubic inches of fluid forced into them). And what has worked best is when the nurse used a larger bore needle (size 21 preferably, certainly nothing smaller than a 23 - that's the gauge of the needle) and took several minutes to steadily inject it.
A tetanus shot is a much smaller volume. It shouldn't take as long. But for this to work, the best thing needed is for difficult child's muscles (the ones receiving the shot) to be as relaxed and still as possible. No squirming permitted, because if you move, it hurts a lot more. So if she's sedated thoroughly, PLUS the doctor uses a large needle and injects very slowly, there should be little or no after-pain.
My regular nurse didn't know the trick of using the large needle. She would inject slowly but with the smallest needle she could manage, on the mistaken belief that it's the hole in your skin that hurts. Yes, it does hurt a little, but the worst pain of i.m. is the fluid packing in where it's not welcome. And if you use a narrow needle, the fluid will squirt out under a much greater pressure (Pascall effect, I think it is). To demonstrate, play with some straws. Suck up a mouthful of liquid and squirt it out through a straw. Then find a much narrower straw and do it again - you will find the stream goes further. Whereas if you just spit the liquid, you can't get the same pressure.
An i.m. shot in the rear end also is supposed to hurt less than the arm - fewer nerve endings. You shouldn't need the round part of the
, the best place is higher up, just inside the top of the pelvic hip bone but slightly more to the back. This way she is less likely to lie on it in bed, or sit on it, so it shouldn't hurt as much afterwards. It also means less affronted dignity (in terms of exposed private areas).
The remaining problem - a reaction to the tetanus shot - can't really be avoided, if it's going to happen. It is after all a stimulus to the immune system, she may feel feverish, aching like flu and generally miserable for a few days. All you can do with this is treat the symptoms. It doesn't always happen, she could be fine. Just keep plenty of analgesics on hand and be prepared to coddle her a bit if she feels lousy.
There must be many other situations where these things have to be considered - kids with poor understanding of what is going on, for example, coupled with being big and strong enough to fight off the doctor. Or a patient with advanced Alzheimer's. How do they cope?
Try to organise something well ahead of time with the doctor, and if it's going to be handled gently, reassure difficult child that you're doing everything you can (and so is the doctor) to make it easy on her. Never say it won't hurt, just that you're doing everything you can think of so it will be as gentle as possible.
My last shot - it actually didn't hurt, apart from the first split-second of the jab. And afterwards - I really couldn't feel where the nurse injected it. I was absolutely amazed. And it was because she followed those two rules - use a larger needle, and inject very, very slowly.
husband has to have regular injections too, he went through a lot of pain and bruising until his doctor discovered the trick of using the larger needle. Plus, husband's injections are in oil, not saline, which is much nastier to try to inject because of its viscosity.
You're not being foolish in wanting to make sure this is handled as gently as possible. A doctor neighbour of mine always makes sure her own children get EMLA cream before a blood draw. She knows enough to make sure she gets the care she asks for. After talking to her, I know better too.