Annotated abstracts*1

Abstract

1Reis, E.C., Roth, E.K., Syphan, J.L., Tarbell, S.E., & Holubkov, R. (2003). Effective pain reduction for multiple immunization injections in young infants. Archives of Pediatrics & Adolescent Medicine, 157, 1115-1120. The most common painful medical procedures of childhood are the multiple injections received for immunization. Infants now receive up to 20 injections in the first two years of life. The immediate response of an infant to an immunization is obvious behavioral distress, which in turn is upsetting for the health provider responsible for administering the painful injection and the infant's parents who try to comfort the infant. In addition, research has shown that pain, even pain of short duration, may have a long-term impact. Recent research has shown that there are pharmacological and nonpharmacological interventions for infants and children that are effective in reducing pain associated with medical procedures. For infants, swaddling, holding, oral sucrose, and sucking have all been effective in reducing the infant's pain response. This study randomized 116 infants, 6 to 16 weeks of age, who were receiving their two-month immunizations, to either an intervention group or a control group. Each infant received four injections: diphtheria and tetanus toxoids and acellular pertussis vaccine, inactivated poliovirus vaccine, Haemophilus influenza B conjugate and hepatitis B vaccine, and heptavalent pneumococcal conjugate vaccine. Infants in the intervention group were given a bottle with 25% sucrose (prepared by mixing one standard packet of table sugar with 10 mL of tap water) two minutes before their injections. After drinking the sucrose, the infants continued to suck on either a pacifier or bottle of formula throughout the injections and after. In addition, parents held the infants cross-cradled on their lap, with their upper bodies close to the parent and the infants' anterior thighs available for injection.The results of this study showed that the infants in the intervention group cried less than the infants in the control group, and that the parents in the intervention group preferred to have the same intervention for their infant in the future significantly more than the control group wanted. Infants in the control group received standard care, which meant being placed on the examining table for the injections with no specific comfort measures provided to the infant from the parent. The outcomes measured were the duration of the infant's crying, heart rate, vaccination time, ease of administration, and parent preference for use of the same intervention during future injections. The results of this study showed that the infants in the intervention group cried less than the infants in the control group, and that the parents in the intervention group preferred to have the same intervention for their infant in the future significantly more than the control group wanted. Vaccination time was statistically significantly longer (five seconds) for the intervention group compared to the control group, but the nurses reported no differences in ease of administration between the two groups. No differences in heart rate were found between the two groups. Pediatric practitioners recognize that immunization injections are painful for young children and want to provide simple interventions such as this to alleviate the children's pain. The authors recommend that this effective, convenient, and inexpensive intervention be used as standard practice for all infant immunization. The use of oral sucrose, sucking, and parental holding could easily be incorporated into the practice of PNPs and pediatricians in primary health care settings.