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Effective Pain Reduction for Multiple Immunization Injections in Young Infants
Evelyn Cohen Reis, MD;
Erika Kraus Roth, BS;
Janet L. Syphan, BS;
Sally E. Tarbell, PhD;
Richard Holubkov, PhD
Arch Pediatr Adolesc Med. 2003;157:1115-1120.
Background Infants experience undue pain with multiple immunization injections.
Objective To assess the effectiveness, feasibility, and parental acceptance of a simple combination pain reduction intervention for infants receiving multiple immunization injections.
Design Randomized, controlled, clinical trial.
Setting Academic hospital-based primary care center.
Participants Infants receiving their 2-month immunizations, consisting of 4 injections (diphtheria and tetanus toxoids and acellular pertussis vaccine, inactivated poliovirus vaccine, Haemophilus influenzae b conjugate and hepatitis B vaccine [Comvax], and heptavalent pneumococcal conjugate vaccine [Prevnar]).
Interventions Subjects were randomly assigned to the intervention or control group for administration of 4 injections. The intervention group received sucrose and oral tactile stimulation (with a pacifier or a bottle) and were held by their parents during immunization. The control group did not receive these interventions (standard practice).
Main Outcome Measures Blinded assessment of audiotaped crying, heart rate, parent preference for future use of the injection technique, and nurse-rated ease of vaccine administration.
Results One hundred sixteen infants (mean ± SD age, 9.5 ± 2.0 weeks) participated. The median (25th-75th percentile range) first cry duration was 19.0 (5.8-62.8) seconds for the intervention group compared with 57.5 (31.0-81.5) seconds for the control group (P = .002). Parents of the intervention group reported a stronger preference for future use of the injection procedure. For intervention vs control, the median (25th-75th percentile) parent preference visual analog scale score was 97.0 (82.0-100.0) vs 44.0 (5.0-77.2) (P<.001) (100 indicates definitely prefer). Nurse-rated ease of vaccine administration was equivalent for both treatment groups.
Conclusions Combining sucrose, oral tactile stimulation, and parental holding was associated with significantly reduced crying in infants receiving multiple immunization injections. Parents stated a strong preference for future use of this method, and nurses found the intervention injection technique easy to apply.
From the Department of Pediatrics, University of Pittsburgh School of Medicine (Dr Reis), the Department of Pediatrics, Children's Hospital of Pittsburgh (Dr Reis and Mss Roth and Syphan), and the Department of Epidemiology, University of Pittsburgh Graduate School of Public Health (Dr Holubkov), Pittsburgh, Pa; and the Department of Psychiatry and Behavioral Science, Feinberg School of Medicine, Northwestern University Medical School, Children's Memorial Hospital, Chicago, Ill (Dr Tarbell). Dr Holubkov is now with the Department of Family and Preventive Medicine, University of Utah, Salt Lake City.
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