Original article
Interventions to Reduce Pain during Vaccination in Infancy

https://doi.org/10.1016/j.jpeds.2008.08.037Get rights and content

Objective

To investigate interventions that affect pain reduction during vaccination in infants and children attending a well-child unit.

Study design

A consecutive sample of 243 children between age 0 and 48 months receiving their routine vaccinations was randomly assigned to 1 of the study groups. A total of 158 infants under age 6 months were randomly assigned to breast-feeding or no breast-feeding during immunization, and 85 children age 6 to 48 months were randomly assigned to receive 12% sucrose solution, lidocaine-prilocaine cream, or no intervention. All children were evaluated for crying time and pain score by a pediatrician using the Neonatal Infant Pain Scale (NIPS) for those under age 12 months and the Children's Hospital of Eastern Ontario Pain Scale (CHEOPS) for those over age 12 months.

Results

Breast-feeding in infants under age 6 months and use of sucrose or lidocaine-prilocaine in children age 6 to 48 months significantly reduced crying time and pain scores compared with controls. No difference in outcome was seen between the sucrose and lidocaine-prilocaine treatment groups.

Conclusions

Here we expand on previous findings by demonstrating that breast-feeding may have an analgesic effect up to age 6 months and that in older children, both sucrose and lidocaine-prilocaine reduce vaccination pain.

Section snippets

Methods

Approval to perform the study was granted by the Ethics Committee of Ankara Training and Research Hospital. The aim, risks, and possible benefits of the study were explained to the mothers, and informed consent was obtained from each.

Results

Demographic and clinical characteristics of the study subjects are summarized in Table I. A total of 243 children were enrolled, of whom 158 were younger than 6 months, 142 (58.4%) were male, and 101 (41.6%) were female. Of the 158 infants under age 6 months, 73 (46%) were breast-fed during vaccination. Crying time and NIPS score were significantly higher in the control group (Table II).

In the infants age 6 to 12 months, crying time and NIPS score were significantly higher in the control group

Discussion

The pain experienced by infants and young children often is underestimated and undertreated.25, 26 This prospective controlled study has demonstrated effective pain reduction during routine vaccination from breast-feeding in infants up to age 6 months and from administration of 12% sucrose solution in children age 6 to 48 months. In the latter group, both sucrose and lidocaine-prilocaine provided better pain reduction than no intervention. The lack of statistical difference between the 2

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    The authors declare no funding support or conflicts of interest.

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