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Barbara T. Felt, MD; Eileen Mollen, PhD; Sumac Diaz, MD; Elizabeth Renaud, MD; Mark Zeglis; Gloria Wheatcroft; Delores Mendelow, MD

Arch Pediatr Adolesc Med. 2000;154:719-724.

Objective  To assess the effectiveness of simple behavioral interventions at immunization on behavioral and biochemical indicators of distress in infants and parents in a primary care setting.

Design  Subjects were enrolled sequentially to control (standard care) and intervention groups. Intervention parents (n=57) were provided information about techniques to help their infants at immunization. Standard care parents (n=45) did not receive this information. Immunizations were videotaped and coded for infant and parent behaviors. Using a visual analog scale, parents rated their infant's and their own comfort at study enrollment, immediately after immunization, and at checkout. Saliva samples collected from infants and parents at study enrollment and at 15, 30, and 60 minutes after immunization were assayed for cortisol concentration by standard radioimmunoassay. Data were analyzed using ², analysis of variance, and general linear modeling. Patterns of salivary cortisol change after immunization were analyzed using hierarchical linear modeling.

Setting  A single, urban pediatric practice during 2 summers (1997 and 1998).

Subjects  Infants 2 to 24 months of age (n=102) and their parents.

Main Outcome Measures  Duration of infant distress (in seconds); parent use of behavioral intervention; infant and parent salivary cortisol concentrations (in nanomoles per liter).

Results  Intervention parents were more likely to use a behavioral technique with their infants before immunization (P<.05). Total infant distress was shorter for intervention infants at immunization (P<.01), and these infants were rated as more comfortable by their parents (P<.001) immediately after immunization. Salivary cortisol levels were lower for intervention infants at 15, 30, and 60 minutes after immunization (P<.05).

Conclusion  Simple behavioral interventions before immunization are associated with reductions in behavioral and biochemical indicators of infant distress.

From the Center for Human Growth and Development (Dr Felt and Ms Wheatcroft), the Division of General Pediatrics (Drs Felt, Mollen, and Mendelow), and the School of Medicine (Drs Diaz and Renaud and Mr Zeglis), University of Michigan, Ann Arbor.

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