This article is more than 5 years old. Information may no longer be current.
Preparation before pediatric immunizations may reduce pain
Telling a joke, reading a book or bringing a favorite toy from home can ease anxiety about immunizations.
Click Here to Manage Email Alerts
Preparing for immunization by bringing something familiar from home can significantly reduce anxiety and pain associated with immunizations for many children, according to a recent study.
According to study results published in Pediatrics, the pain associated with immunizations is a source of anxiety and distress for the children receiving the immunizations, their parents and the providers who must administer them. Preparation of the child before the procedure seems to reduce anxiety and subsequent pain.
Telling a joke, reading a book or bringing a favorite toy from home can ease anxiety about immunizations. Other tools for distraction include blowing soap bubbles and, for babies aged younger than 6 months, using a pacifier dipped in sugar water.
Limited study research
Many studies in this area are based on experience rather than research and are scattered throughout various journals. As a result, there is presently no available evidence-based information that addresses all of the strategies that have evolved to reduce the pain of immunizations in children of all ages.
The researchers from Connecticut Children’s Medical Center received a grant from the Mayday Fund to host a consensus conference to review the existing literature and to create recommendations regarding best practices for reduction of injection pain. The immunization process was separated into multiple components, such as preparation, technique, location, needle length and local anesthetic use. The researchers then identified experts and invited those who were available to participate in the conference.
Relevant literature was distributed to all participants before the meeting. At the meeting, each expert presented a review of their assigned area, offered recommendations and detailed the evidence base supporting those recommendations.
Ways to prepare
Although there are few studies on preparation for pediatric immunizations, the literature on preparation for other painful procedures and hospitalizations allows some recommendations to be made. Parents should inform the child about the immunization by giving the reason and benefits for the procedure and the amount of pain normally associated with the immunization procedure. Techniques should also be provided to help parents coach their children through the procedure to promote coping.
“For children, the extensiveness and style of preparation should be guided by each child’s age and developmental level,” the researchers wrote. “In general, specific discussion about the immunization itself has more relevance for children older than 2 years.”
Most professional and educational organizations endorse the use of the anterolateral thigh for infants and the upper arm for children aged older than 18 months as the sites for immunizations.
“The Red Book suggests a needle length of five-eighths of an inch for newborns to 2 months of age and 1 inch for infants. For toddlers and older children, it suggests five-eighths of an inch to 1 inch if the deltoid is used and one to 1¼ of an inch if the anterolateral thigh is used. For adolescents and adults, for whom the deltoid is clearly recommended, the needle length should be 1 to 2 inches,” the researchers wrote.
The effect of properties of the injectate itself on the pain associated with intramuscular injection has also been examined. These include changing the temperature of the injectate, changing the diluent used and changing the chemical properties of the injectate.
Although all of these factors may have a role in reducing injection pain in general, few have been studied with respect to immunization pain specifically, according to the researchers.
Parental demeanor has been shown to have an effect on child behavior. The researchers said that children are often more distressed when parents are more rather than less involved. For that reason, parents should use a matter-of-fact and supportive approach. Parents should be instructed to use distraction techniques that support their personal style and their child’s age and temperament. These techniques may include storytelling, reading to the child and deep breathing.
Anesthetic uses
Although there is no perfect topical anesthetic available, selective use for children who are fearful is highly endorsed. Pressure at the site, applied with either a device or a finger, can reduce pain. If there are multiple injections, parents prefer that they be given simultaneously.
The technique for needle insertion seemed universally agreed upon by the researchers. For intramuscular injection, the skin should be held taut around the injection site and the needle darted into the skin at a 90° angle.
The vaccine is then injected under steady pressure, and the needle is withdrawn at the same angle at which it was inserted. If the vaccine is to be administered subcutaneously, then the skin around the site is typically pinched or bunched and the needle is inserted at a 45° angle.
“New research clearly is necessary to better define this area but, as in other aspects of pain management, the systematic application of already available knowledge should go a long way toward reducing pain,” according to the researchers. – by Leanor A. Pigliacelli
For more information:
- Schechter NL, Zempsky WT, Cohen LL, et al. Pain reduction during pediatric immunizations: Evidence-based review and recommendations. Pediatrics. 2007;119:e1184-e1198.