Reduce the Pain from Childhood Immunizations – Some Science-Supported Tips
One can’t deny that getting vaccines at the doctor’s office can be distressing, painful, and for some children quite a traumatic experience. The well recognized condition, ‘Needle Phobia’ did not come about haphazardly. And when I think about it, given the very high number of immunizations I give routinely, I’m sure that I am responsible for more than a handful of ‘needle phobia’ diagnoses among patients in my practice. Surely vaccines can be given in a less traumatic fashion.
Thankfully this question has been quite extensively studied this past decade and good data is emerging that can help doctors and nurses change their practice in a way that lessens the pain and distress that too often accompanies receiving ones shots.
Here are 7 strategies to use – or to request that your doctor/nurse consider using when giving vaccines – that has high quality scientific support in the medical literature.
1. Feed your baby sweet-tasting solution before, during, and after the vaccination.
Most studies used sucrose water for this (reference here). With a dropper, offer a few mls at a time for the few minutes preceding the shots. Then offer during (if babe is interested) and again after the procedure. Breastfeeding, and giving expressed breastmilk are also good options. To make sucrose solution, mix 3 teaspoons of table sugar into 100 mls of water and mix unti fully dissolved.
2. When administering more than one vaccine, give the more painful one last.
Some vaccines are more painful than others. In fact some brand names for the same vaccine are more painful than other brand names. If your doctor/nurse is administering more than one vaccine in a visit, ask her/him to inject the most painful one last. Also clarify that when your health clinic orders vaccines, ask that they consider ordering the brands that hurt the least.
3. When given vaccines, allow the child to stand, or lie in mom/dad’s lap in what is the most comfortable position for her.
Vaccines hurt most when administer to a child who is lying down on her back. Two well-designed studies (references here, here) have demonstrated that it is least painful/distressing when the child is standing, or taking on the most soothing/comfortable position in her caregiver’s lap.
4. The Faster the Better.
The more rapidly the vaccine is administered, the least painful/distressing the experience (full text of study here) . Old-school methods of ‘aspiration before administration’ and pushing the plunger slowly only prolong the unpleasant experience for the child. It should take less than a second from the needle entering until the needle exiting the skin.
5. Rubbing the Skin Lessens the Pain.
Rubbing the skin with moderate intensity near the injection site both before, during and after the injection may decrease the pain of vaccines among children greater than 4 years of age. This approach makes use of the Gate Control Theory of Pain.
6. Use Topoical Anesthetics.
Topical anesthetics – such as EMLA – are medication ‘patches’ that, when applied appropriately to the skin 40 minutes before the immunization is given, effectivemly numb the skin. They have been shown to be generally safe for children and adults of all ages. Keep in mind that there are two painful components to vaccine administration: the pain of the needle puncturing the skin and the pain of the liquid entering and stretching the muscle. Topical anesthetics are very effective at reducing the pain associated with the needle pucturing the skin, but likely less so with the second component. Nonetheless, these topical anesthetics reduce the overall painful experience associated with vaccinations (systematic review of this literature here).
7. Use Age-Appropriate Distraction Techniques.
Distraction techniques are psychological interventions that divert the child’s attention away from the unpleasantness of the vaccine experience. There is good scientific evidence to support that these techniques reduce the pain and anxiety associated with medical procedures (references here and here) and more specifically, vaccine administration (references here, here, and here). Depending on the child’s age and the technique used, parent and doctor-led distraction techniques can be very helpful to decrease not only the pain of the needle, but the associated distress that goes along with the pain. Often when done succesfully, the vaccine can be administered without the child even knowing that it happened.
The above techniques have been summarized very nicely in this document entitled ‘A Guide for Parents, Caregivers and Children on How to Reduce Vaccine Injection Pain in Children‘
In an upcoming post, I will review some of the techniques that do not have sufficient scientific evidence to endorse as well as those that are unlikely to help and should not be employed.
Most of the above has been summarized from the Canadian Medical Association Journal Review Article entitled Reducing the pain of childhood vaccination: an evidence-based clinical practice guideline (summary)