Effective pain reduction for multiple immunization injections in young infants.
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.


METHODS
Randomized, controlled, clinical trial.


METHODS
Academic hospital-based primary care center.


METHODS
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]).


METHODS
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).


METHODS
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.
Reis
Evelyn Cohen
EC
Department of Pediatrics, University of Pittsburgh School of Medicine, Children's Hospital of Pittsburgh, Pittsburgh, PA 15213-2583, USA. evelyn.reis@chp.edu
Roth
Erika Kraus
EK
Syphan
Janet L
JL
Tarbell
Sally E
SE
Holubkov
Richard
R
D000284:Administration, Oral; D016009:Chi-Square Distribution; D003448:Crying; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D007114:Immunization; D007223:Infant; D007231:Infant, Newborn; D007267:Injections / Q000009:adverse effects*; D008297:Male; D010146:Pain / Q000209:etiology / Q000517:prevention & control*; D010147:Pain Measurement; D018709:Statistics, Nonparametric; D013395:Sucrose / Q000008:administration & dosage
D013395:Sucrose