title: Stress at three-month immunization: parents' and infants' salivary cortisol response in relation to the use of pacifier and oral glucose.
abstract: The aims of the present study were to investigate (1) whether the salivary cortisol response could be dampened during a routine three-month immunization if the infant received sweet-tasting solution in combination with a pacifier and (2) stress experienced by parents during immunization of the infant. Ninety-eight infants were included into one of four intervention groups: 'glucose and pacifier', 'water and pacifier', 'glucose', or 'water'. Saliva was collected before and 30 min after the immunization. Infants' crying-time and parents' self-reported stress (VAS) were measured before and after immunization. Infants in the 'pacifier and glucose' group had a significantly smaller change in salivary cortisol than infants in the other groups (F(3,72)=3.1, p<0.05). In the 'glucose and pacifier' group the median salivary cortisol levels decreased 33% after the immunization. In the 'water and pacifier', 'glucose', and 'water' group median cortisol increased with 50%, 42%, and 8%, respectively. No significant differences in crying-time were observed between the intervention groups. If the infant cried before the immunization, the crying-time during the immunization was longer (p<0.01) and cortisol increased more (p<0.05). Median cortisol levels for parents decreased after the immunization (p<0.01). Median VAS increased 50% (p<0.0001) after immunization. First time parents rated higher stress on VAS before immunization (p<0.01). Parents' change in cortisol and VAS were significantly related to infants' crying time. In conclusion, the combination of oral glucose and pacifier dampen infants' salivary cortisol in response to the three-month immunization.
authors.affiliation: Department of Molecular and Clinical Medicine, Division of Pediatrics, Linköping University Hospital, SE-581 85 Linköping, Sweden. evalotte.morelius@lio.se
authors.forename: Evalotte
authors.initials: E
authors.lastname: Mörelius
authors.forename: Elvar
authors.initials: E
authors.lastname: Theodorsson
authors.forename: Nina
authors.initials: N
authors.lastname: Nelson
mesh_terms: D003448:Crying; D003627:Data Interpretation, Statistical; D005260:Female; D005947:Glucose / Q000494:pharmacology*; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism*; D007114:Immunization / Q000009:adverse effects* / Q000523:psychology*; D007223:Infant; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D010147:Pain Measurement; D010290:Parents / Q000523:psychology*; D012463:Saliva / Q000378:metabolism; D013315:Stress, Psychological / Q000378:metabolism* / Q000523:psychology*
chemical_list: D005947:Glucose; D006854:Hydrocortisone