title: Reducing immunization discomfort in 4- to 6-year-old children: a randomized clinical trial.
abstract: OBJECTIVE
  The goal was to test a multifaceted distraction method designed to reduce injection-associated pain in school-aged children.
  
  
  METHODS
  A clinical trial evaluated 41 children, 4 to 6 years of age, who were given 3 standard prekindergarten immunizations; 21 were assigned randomly to an office routine control group, whereas 20 received a multifaceted, discomfort-reducing intervention. The intervention added verbal suggestions of diminished sensation and a visual focusing activity to the use of ethyl chloride, an established pain-reducing measure. The distraction materials used for the intervention consisted of topical ethyl chloride spray, an improvised, plastic, multipronged arm gripper, and a vibrating instrument descending on the contralateral arm, which provided the focusing task and visual distraction.
  
  
  RESULTS
  According to patient and parent Faces Pain Scale-Revised scores and nonblinded, video-taped observations scored according to the face-legs-activity-crying-consolability method, the intervention group showed highly significant reductions in pain and discomfort, compared with the control group (patient self-report, P < .0013; parent report, P < .0002; observation score, P < .0001).
  
  
  CONCLUSIONS
  This multifaceted distraction intervention reduced significantly the pain and discomfort of childhood immunizations in children 4 to 6 years of age.
authors: Pediatric Medical Group, Berkeley, California 94705, USA. dr.berberich@pediatricsuggestions.net
authors: F Ralph
authors: FR
authors: Berberich
authors: Zachary
authors: Z
authors: Landman
mesh_terms: D000779:Anesthetics, Local; D001288:Attention; D002648:Child; D002675:Child, Preschool; D015721:Diphtheria-Tetanus-Pertussis Vaccine / Q000008:administration & dosage*; D005018:Ethyl Chloride / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular / Q000523:psychology*; D007699:Kinesthesis; D008297:Male; D022542:Measles-Mumps-Rubella Vaccine / Q000008:administration & dosage*; D010146:Pain / Q000523:psychology*; D010147:Pain Measurement; D011054:Poliovirus Vaccine, Inactivated / Q000008:administration & dosage*; D011446:Prospective Studies; D013404:Suggestion; D014611:Vaccination / Q000523:psychology*
chemical_list: D000779:Anesthetics, Local; D015721:Diphtheria-Tetanus-Pertussis Vaccine; D022542:Measles-Mumps-Rubella Vaccine; D011054:Poliovirus Vaccine, Inactivated; D005018:Ethyl Chloride