Cry Duration Research Articles

Effects of automatic heel lancet on invasiveness in neonates: A systematic review and meta-analysis.

We conducted a meta-analysis comparing the invasiveness of automatic lancet devices, which can collect adequate amount of blood at shallow puncture depths, with conventional manual lance devices (lancet or needle) to statistically identify less invasive instruments for neonatal heel lance. We searched PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL, and Ichushi databases for studies comparing the invasiveness between automatic lancet and manual lancet or needle in term and preterm neonates in neonatal intensive care unit. This review included 9 out of 449 searched articles, with 673 neonates. Automatic lancet had significantly lower pain scores (standardised mean difference: -2.0, 95% confidence interval: -3.3 to -0.7), heart rate (mean difference: -8.0, 95% confidence interval: -13.8 to -2.1), cry duration (mean difference: -21.5, 95% confidence interval: -32.5 to -10.4), number of punctures (mean difference: -0.6, 95% confidence interval: -1.1 to -0.2), and duration of procedures (mean difference: -37.7, 95% confidence interval: -75.2 to -0.2) than manual lancet or needle. Furthermore, peripheral oxygen saturation was significantly higher in automatic lancet than in manual lancet or needle (mean difference: 4.5, 95% confidence interval: 0.5-8.5). Automatic heel lancet devices were less invasive than manual heel lance devices (lancet or needle).

The Effect of Yakson Touch on Pain and Physiological Parameters of the Newborn

Background: The stressors faced by the newborn can directly affect the newborn’s sensory development, brain development and organization by causing pain in the newborn. Yakson touch, a traditional Korean cultural practice, is known to reduce the pain in the newborn. Aims: The aim of this study is to examine the effect of Yakson touch applied to the newborn on pain and physiological parameters during the heel prick procedure. Methods: The study was conducted using a randomized controlled trial design (experimental, control). The study sample consisted of 80 newborns (experimental group = 40, control group = 40), all born between 35-40 gestational weeks and considered suitable for clinical conditions. Yakson touch is a technique that involves warm, pressure less, slow, and compassionate touch, following a fixed fifteen-minute protocol. The Yakson touch protocol was initiated for the experimental group before the heel prick procedure. Research data were obtained using the Parent and Baby Information Form, Physiological Parameters Observation Form and Newborn Baby Pain Scale. Data analysis was performed using IBM SPSS V23 and the significance level was taken as p < .05. Results: There was no difference between the experimental and control groups in terms of neonatal oxygen saturation, heart rate, and pain score before, during, and after the procedure (p > .05). There was no difference in cry duration between the two groups before and after the heel prick procedure, but the newborns in the experimental group cried less during the heel prick procedure compared to the control group (p = .007). Conclusion: The newborns in the experimental group, who receives Yakson touch during the heel pricking procedure, had shorter crying times than those in the control group. Therefore, it is recommended to include Yakson touch in nursing interventions during this procedure.

Oral Sucrose in Infants Undergoing Flexible Nasolaryngoscopy: A Blinded Randomized Pilot Study.

Flexible nasolaryngoscopy (FNL) is a common, uncomfortable procedure performed to assess the upper airway in infants. Oral sucrose is used during various painful procedures in infants but has not been used during FNL. Our objective was to understand the impact of oral sucrose on discomfort in infants undergoing FNL. Infants (<12-months-old) undergoing FNL in the otolaryngology clinic were randomized to treatment (0.5 mL 24% oral sucrose) or standard management (no sucrose). Sucrose was administered <2 min prior to FNL performed by a single endoscopist. Outcome measures included: EVENDOL pain scale and cry duration and visit duration. Infant discomfort was measured by a second observer who was blinded to treatment group. Forty-seven infants were included, 23 were treated with sucrose and 24 with standard management. The median (IQR) age was 3.0 (2-5.7) months. There were no significant differences in age, weight, or sex across groups. The median (IQR) duration of FNL was 35.2 (26.5-58.4) and 36.4 (28.9-51.8) seconds for treatment and standard management groups, respectively. Mean (SD) EVENDOL scores were significantly lower in the sucrose group [4.9 (2.0)] than standard group (6.7 [2.1]) (p = 0.003). Mean cry duration after FNL was significantly shorter in the sucrose group (29.9 [20.4] seconds) than the standard group (52.7.0 [40.6] seconds) (p = 0.02). Median (IQR) visit duration did not differ across groups (1.1 [0.9-1.3] vs. 1.1 [0.7-1.4] h [p = 0.15]). Oral sucrose given before FNL reduced EVENDOL scores and cry duration after FNL and did not prolong clinic visits in this randomized pilot study. 2 Laryngoscope, 134:3826-3831, 2024.

Analgesic Effect of Low-Level Laser Therapy before Heel Lance for Pain Management in Healthy Term Neonates: A Randomized Controlled Trial.

Currently, the prevention, assessment, and management of procedural pain in neonates continues to challenge clinicians and researchers. Objective. To investigate the analgesic effect of low-level laser therapy (LLLT) during heel lance compared to breast milk (BM) feeding in healthy term neonates. In this randomized controlled trial, healthy term neonates who underwent heel lance were randomly assigned to an LLLT or a BM group. The LLLT group received laser therapy to the heel lance site for 20 s before heel lance. The BM group received 5 mL expressed BM via a syringe before heel lance. The primary outcomes were behavioral responses. The secondary outcomes were physiological responses and levels of salivary cortisol and α-amylase. A total of 125 neonates were included, of whom 55 in the LLLT group and 59 in the BM group completed the study. There were no significant differences in latency to first cry and cry duration between the two groups. The squeeze time was significantly shorter in the LLLT group than in the BM group (p = 0.047). There were no significant differences in pain scores, heart rate, respiratory rate, oxygen saturation, and blood pressure before and after heel lance between the two groups. There were no significant differences in salivary cortisol and α-amylase levels in the LLLT group before and after heel lance; however, the differences were significant in the BM group. These findings suggest that the analgesic effect of LLLT is similar to that of BM during heel lance in healthy term neonates. LLLT has potential as an analgesic treatment.

Effectiveness of different bathing methods on physiological indexes and behavioral status of preterm infants: a systematic review and meta-analysis

BackgroundBath is an external stimulus for preterm infants. Currently, three methods are used for preterm infants to bath. It is important to choose the best way for them. The objective of this meta-analysis is to evaluate the effectiveness of different bath methods on physiological indexes and behavioral status of preterm infants.MethodsThis systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses [PRISMA] guidelines and was registered in PROSPERO(CRD42022377657). PubMed, Embase, Cochrane Library, Web of Science, CINAHL, Sino Med, China National Knowledge Internet (CNKI) and Wan-Fang database were systematically searched for randomized controlled trials on the effects of different bath methods for preterm infants. The retrieval time was from the establishment of the database to February 2023. According to the inclusion and exclusion criteria, the literature was screened, quality evaluated and the data was extracted. Reman Version 5.4 was used for meta-analysis and Stata 16.0 software for publication bias Egger’s test. ResultsA total of 11 RCTs with 828 preterm infants were included. The results of meta-analysis showed that the body temperature and oxygen saturation of preterm infants in the sponge bath group were lower than those in conventional tub bath group (SMD = -0.34; 95%CI -0.56 to -0.12; I2 = 0; p < 0.01), (MD = -0.39; 95%CI -0.76 to -0.02; I2 = 39%; p = 0.04), while the heart rates were higher than those in conventional tub bath group(MD = 5.90; 95%CI 0.44 to 11.35; I2 = 61%; p = 0.03). Preterm infant’s body temperature and blood oxygen saturation of in swaddle bath group were higher than those in conventional tub bath group (MD = 0.18; 95%CI 0.05 to 0.30; I2 = 88%; p < 0.01), (MD = 1.11; 95%CI 0.07 to 2.16; I2 = 86%; p = 0.04), respiratory rates were more stable compared with infants in conventional tub bath group (MD = -2.73; 95%CI -3.43 to -2.03; I2 = 0; p < 0.01). The crying duration, stress and pain scores of preterm infants in swaddle bath group were lower than those in conventional tub bath group (SMD = -1.64; 95CI -2.47 to -0.82; I2 = 91%; p < 0.01), (SMD = -2.34; 95%CI -2.78 to -1.91; I2 = 0; p < 0.01), (SMD = -1.01; 95%CI -1.40 to -0.62; I2 = 49%; p < 0.01). Egger's test showed no publication bias in body temperature, respiratory rate, oxygen saturation, and crying duration.ConclusionsSwaddle bath is the best bathing method than conventional tub bath and sponge bath in maintaining the stability of preterm infant’s body temperature, blood oxygen saturation and respiratory rate. In addition, swaddle bath also plays a role in reducing cry duration, stress scores, and pain levels of preterm infant compared with conventional tub bath and sponge bath. However, due to the important heterogeneity in some outcomes, future studies with larger sample size and more appropriately design are needed to conduct before recommendation.Trial registrationProspero CRD42022377657

EXCESSIVE CRYING IN CHILDREN WITH CEREBRAL PALSY AND COMMUNICATION DEFICITS

Introduction: Pain/discomfort is an under-suspected/underdiagnosed cause of Excessive Crying in Children with Cerebral Palsy and Communication Decits [ECCCPCD] (due to their age or different ability). A vicious cycle of spasm-pain-spasm sets in due to the delay in treatment. To study epidemiology, theObjectives: response of ECCCPCD to drug therapy and a drug taper after 250 days. This was a xed-sequence crossover study ofMethods: 131 consecutive subjects &lt;15 years with&gt;7.5 hours crying duration/day for 30 straight days. Outcome measures: 1. Epidemiological data. 2. Means of total and unexplained cry durations (TECCCPCCD and UECCCPCD) in hours while on the placebo (M1) and four measurements while on treatment (M2-M5). The effect of drug taper was measured (M4). Results: Wilcoxon test between TECCCPCCD of M1-M2 yielded medians of 9.98 (95% CI 9.73 to 10.16), p&lt;0.0001, and 6.27 (95% CI 6.24- 6.28), p&lt;0.0001; between UECCCPCCD yielded medians of M1-M2, 8.22 (95% CI 8.02-8.39), p&lt;0.0001, and 5.14 (95% CI 5.12 to 5.16), p&lt;0.0001, between TECCCPCCD of M1-M5, yielded medians of 9.98 (95% CI 9.73 to 10.16) and 2.67 (95% CI 2.53 to 2.82), p&lt;0.0001, between UECCCPCCD of M1-M5, yielded medians of 8.22 (95% CI 8.02 to 8.39) and 2.16 (95% CI 2.04 to 2.28), ps&lt;0.0001. The dosage could be tapered after 250 days in 67/131 (51%) participants. Secondary outcomes were improvements in swallowing and drooling in 65.12% (56/86). Treatment of spasticity, dystonia, visceral, and neuropathic painConclusions: reduced crying. The drug requirement was less after 250 days of treatment. Parents/caregivers reported simultaneous improvement in dysphagia/drool.

Crying in the first 12months of life: A systematic review and meta-analysis of cross-country parent-reported data and modeling of the "cry curve".

Crying is an ubiquitous communicative signal in infancy. This meta‐analysis synthesizes data on parent‐reported infant cry durations from 17 countries and 57 studies until infant age 12 months (N = 7580, 54% female from k = 44; majority White samples, where reported, k = 18), from studies before the end Sept. 2020. Most studies were conducted in the United States, the United Kingdom, and Canada (k = 32), and at the traditional cry “peak” (age 5–6 weeks), where the pooled estimate for cry and fuss duration was 126 mins (SD = 61), with high heterogeneity. Formal modeling of the meta‐analytic data suggests that the duration of crying remains substantial in the first year of life, after an initial decline.

Effectiveness of breastfeeding for pain relief in infants during vaccination at Bharatpur

Background: Vaccination is an integral part of childhood development since it protects children from a variety of diseases. It is, however, the most common cause of pain in children. Breastfeeding is effective tool for reducing pain in infants during vaccinations. The objective of the study was to determine the effectiveness of breastfeeding for pain relief in infants during vaccination.Methods: A true experimental pretest and posttest design was conducted at Maternal and Child Health Clinic at Bharatpur, Nepal among 140 infants receiving pentavalent vaccines (Diphtheria, Pertussis, Tetanus, Hepatitis B and Hemophilus influenzae B). A structured interview schedule was used to collect socio-demographic information of mothers and infants. Bio physiologic method was used to determine biological and physical status of the infants. Modified behavioral pain scale was used to measure the level of pain in infants in both the control and experimental groups.Results: The study revealed that the total modified behavioral pain scale (mean ±SD after vaccination was 8.74±0.53 in control and 8.23±1.07 in experimental respectively. The study showed that breastfeeding had significantly lowered pain level (p&lt;0.001) and lessened duration of cry (p=0.002) in infants in experimental group than in control group after vaccination. However, related to injectable vaccination, the study showed that breastfeeding did not significantly stabilized heart rate in infants in both the groups (p=0.122).Conclusions: The study concluded that the infants who were breastfed experienced less pain than those who were not breastfed during vaccination.

Assessment of perceived distress due to nasopharyngeal swab collection in healthy Indian infants participating in a clinical trial.

Routinely children are exposed to various procedures as a part of clinical care and/or research participation. Public health strategies to contain current COVID‐19 pandemic demanded massive nasopharyngeal swab testing but limited data exist to confirm the extent of the pain and distress that result from this procedure. These data could help clinicians to formulate mitigation strategies, influence public health directives, and inform review boards/ethics committees to decide on risk‐benefit ratio of the procedure. Hence, an observational study to assess perceived distress was nested in a phase IV alternate and reduced dose schedule trial of the pneumococcal conjugate vaccine (PCV) in which nasopharyngeal swab (NPS) was used to collect nasopharyngeal secretions as part of the study procedure. Out of 805 infant participants enrolled in the main study, a total of 425 infants were enrolled and observed for procedural distress at 18 weeks and 10 months of age using the Face Leg Activity Cry and Consolability (FLACC) Scale. The FLACC score and duration of cry were recorded. The mean FLACC score changed substantially from preprocedural to procedure in both age groups (from 0.08 to 5.8 at 18 weeks and from 0.5 to 7.007 at 10 months. P = <.0001). The proportion of infants experiencing higher FLACC scores (7‐10) indicating severe distress increased significantly from 22% (n = 95) at 18 weeks to 61% (n = 248) at 10 months (P < .0001). The mean duration of cry was significantly increased from 23.03 seconds at 18 weeks to 52.6 seconds at 10 months (P = .00). Nasopharyngeal swab collection produced substantial distress which increased with age. Adequate training of sample collectors and supporting parent engagement during procedure could help in reducing the distress.

Be Sweet to Hospitalized Toddlers During Venipuncture: A Randomized Controlled Trial of Sucrose Compared With Water.

High-quality evidence demonstrates analgesic effects of sweet-tasting solutions for infants during painful procedures. However, evidence of the analgesic effects of sucrose beyond 12 months of age is less certain. The aim of this study was to ascertain the efficacy of oral sucrose in hospitalized toddlers (ages 12 to 36 mo) compared with placebo (water) during venipuncture. Blinded, 2-armed randomized controlled trial including hospitalized toddlers aged 12 to 36 months. Toddlers were randomized to either 25% sucrose or water before venipuncture, stratified by age (12 to 24 mo and more than 24 to 36 mo). Standard of care included topical anesthetics for both groups. Pain assessment included cry duration and FLACC (Face, Legs, Activity, Cry, Consolability) scores. Descriptive statistics and linear models were used to report the percentage of time crying and mean differences in FLACC scores. Data analysis was performed using R, version 3.6.3. A total of 95 toddlers were randomized and 85 subsequently studied. The median percentage of time spent crying between insertion of the first needle and 30 seconds after the end of procedure in both groups was 81% (interquartile range=66%). There was no significant difference in crying time and FLACC scores between groups (P>0.05). When examining effects of sucrose for the younger toddlers (less than 24 mo of age) there was a reduction in crying time of 10% and a 1.2-point reduction in mean FLACC scores compared with the toddlers older than 24 months. Findings highlight that toddlers become highly distressed during venipuncture, despite the standard care of topical anesthetics. In addition, sucrose does not effectively reduce distress especially in the older group of toddlers.

Acoustic Features of Cry of Deaf and Hard-of-Hearing Infants.

Previous research has demonstrated differences in the acoustic features of crying signals between deaf and typical hearing (TH) infants. This study aims at comparing the acoustic parameters of cries of infants with different degrees of deafness versus TH infants. About 110 infants aged 6-12months (61 TH infants, 34 infants with bilateral deafness of variable degrees and 15 infants with unilateral deafness) were enrolled in the study. Results indicated that the most important acoustic parameters to demonstrate the difference between the crying of TH infants and deaf and hard-of-hearing (DHH) infants as well as between the crying of infants with different degrees of deafness are F0, cry duration, intensity, F2, and F4. In terms of accuracy, the parameter that showed the highest accuracy to differentiate between TH infants and DHH infants was F0 (74.5%). The accuracy of the combined acoustic parameters (F0, cry duration, intensity, and F4) was 70%. F0 was considered the best predictor and F4 the second best predictor of severity of deafness.

Use of Lidocaine Cream for Pain Management During Immunizations of Infants at an Urban Health Clinic

Background: Immunizations are a common source of pain and anxiety within the pediatric population. Implementation of lidocaine 4% cream, which has a short onset of action, as a standard of care for immunization practices may be feasible. Objective: The objective of this study was to assess the efficacy of lidocaine 4% cream as pain management during immunizations and to evaluate satisfaction of caregivers and nursing staff. Methods: This study was a prospective, randomized, placebo-controlled trial in an urban clinic, which included patients who were ≤ 14 months old accompanied by a caregiver who witnessed the patient receiving an immunization within the previous 7 months. Patients were randomized to receive either lidocaine 4% cream or placebo cream prior to vaccination. Time to cry and duration of cry were recorded. Caregivers completed surveys evaluating attitudes toward pain associated with immunizations as well as their satisfaction with the immunization process through Likert Scale ratings. Nurses completed a questionnaire assessing efficacy and feasibility of lidocaine 4% cream for pain management. Results: A total of 44 patients were included in the analysis in order to achieve 80% power with a p-value < 0.05. Mean duration of cry in patients receiving lidocaine 4% cream was 48.6 seconds in comparison to 65.9 seconds in patients receiving placebo (95%CI, −33.97 seconds to −0.48 seconds; p < 0.05). Conclusions: Lidocaine 4% cream decreased total duration of cry following vaccinations in comparison to placebo with both caregivers and nurses willing to utilize lidocaine 4% cream in a clinic setting if available

Development and Technical Validation of a Smartphone-Based Cry Detection Algorithm.

Introduction: The duration and frequency of crying of an infant can be indicative of its health. Manual tracking and labeling of crying is laborious, subjective, and sometimes inaccurate. The aim of this study was to develop and technically validate a smartphone-based algorithm able to automatically detect crying.Methods: For the development of the algorithm a training dataset containing 897 5-s clips of crying infants and 1,263 clips of non-crying infants and common domestic sounds was assembled from various online sources. OpenSMILE software was used to extract 1,591 audio features per audio clip. A random forest classifying algorithm was fitted to identify crying from non-crying in each audio clip. For the validation of the algorithm, an independent dataset consisting of real-life recordings of 15 infants was used. A 29-min audio clip was analyzed repeatedly and under differing circumstances to determine the intra- and inter- device repeatability and robustness of the algorithm.Results: The algorithm obtained an accuracy of 94% in the training dataset and 99% in the validation dataset. The sensitivity in the validation dataset was 83%, with a specificity of 99% and a positive- and negative predictive value of 75 and 100%, respectively. Reliability of the algorithm appeared to be robust within- and across devices, and the performance was robust to distance from the sound source and barriers between the sound source and the microphone.Conclusion: The algorithm was accurate in detecting cry duration and was robust to various changes in ambient settings.

The effect of Aromatherapy Parent Education in Alleviating Injection Pain Among Children Submitting to Vaccination

Background: Aromatherapy parents’ education about pain alleviation during child vaccinations supports family-centered care and has the potency to progress pain care management in children. Aim of the study: evaluate the effect of aromatherapy parent education intervention (massage with lavender oil) in alleviating injection pain among children submitting to vaccination. Subject and methods: Quasi experimental design two groups have been utilized in this study at vaccination clinics in El-Demerdash health office affiliated to Abbasis zone and Elkhalij Elmasry primary health center in Hadayek Elkobba Zone, governmental medical centers, Ministry of Health and Population, Cairo, Egypt. It included 120 children Submitting to Vaccination selected by purposive sampling technique according to inclusion criteria, and randomly designate into two groups; register either in control (60) or study (60) group. The data was collected by using 1) Structured interviews questionnaire in Arabic to assess personal data characteristic of children and parent; 2) knowledge assessment tool (pre/post) to assess parent’s knowledge regarding aromatherapy treatment and pain management after children vaccination;3) beliefs and attitudes of parent assessment tool;4) procedural pain assessment tools which included two parts, the first portion was Modified Behavioral Pain Scale (MBPS) , developed by (Taddio et al, 1995)and the second portion was Cry duration in seconds. The data was collected between a period of august 2019 and January 2020. Results: A significant improvement was in total knowledge about aroma treatment and pain management after vaccination among children’s parent in posttest as compared to pretest assessment (p < 0.0001). A significant improvement was in total mean scores of MBPS components in study group with lavender oil massage during five minutes after vaccine injection as compared to control group with highly statistically significant (p < 0. 001). A significant improvement was in the total mean cry duration in study group as compared to control group with highly statistically significant (p < 0. 001). Conclusion: Aromatherapy parents’ education, leg massage by lavender oil was found efficient in alleviating vaccine injection pain. Recommendation: Applying Aromatherapy Education programs for new parents in all pediatric primary health care centers to increase parents’ awareness about vaccine injection pain alleviation.

Effect of Breastfeeding on Relieving Pain during Immunization in Infant

Background Advantages due to immunization are numerous and cannot be avoided but at the same time pain inflicted on babies needs to be addressed when possible. Pain associated with immunization injections has often been overlooked when remedies are available. Objective To find out the effect of breastfeeding on relieving pain during immunization injection in infants. Method An experimental study was conducted at Immunization clinic of B.P. Koirala Institute of Health Sciences (BPKIHS). Total 124 subjects were divided randomly into two groups. Experimental subjects were allowed to breastfeed for 5-10 minutes before immunization while control group was immunized without breastfeeding. Interview Questionnaire was used to obtain demographic variables and measurements were obtained. Measures of pain was recorded using duration of cry and Modified Behavior Pain Scale, by Taddio et al. Data was analyzed by using SPSS 20.0 where variables were assessed with frequency tables, Pearson's Chi-Square test, independent t test and Mann Whitney U test. Result The mean pain score in experimental group was 7.10 and in control group 7.56 which was statistically significant (p=0.001). The median duration of cry was significantly shorter in experimental group i.e. 25 seconds (IQR: 20-30) than control group 42.5 seconds (IQR: 30-61.5) (p < 0.001). Conclusion Breastfeeding before immunization is effective in reducing pain in infants.

Comparison of preadministered and coadministered lidocaine for treating pain and distress associated with intranasal midazolam administration in children: A randomized clinical trial.

ObjectivePain and distress associated with intranasal midazolam administration can be decreased by administering lidocaine before intranasal midazolam (preadministered lidocaine) or combining lidocaine with midazolam in a single solution (coadministered lidocaine). We hypothesized coadministered lidocaine is non‐inferior to preadministered lidocaine for decreasing pain and distress associated with intranasal midazolam administration.MethodsRandomized, outcome assessor–blinded, noninferiority trial. Children aged 6 months to 7 years undergoing laceration repair received intranasal midazolam with preadministered or coadministered lidocaine. Pain and distress were evaluated with the Observational Scale of Behavioral Distress—Revised (OSBD‐R) (primary outcome; non‐inferiority margin 1.8 units) and the Children's Hospital of Eastern Ontario Pain Scale (CHEOPS) and Faces, Legs, Activity, Cry, Consolability (FLACC) scales and cry duration (secondary outcomes). Secondary outcomes also included adverse events, clinician and caregiver satisfaction, and pain and distress associated with intranasal lidocaine administration.ResultsFifty‐one patients were analyzed. Mean OSBD‐R scores associated with intranasal midazolam administration were 6.4 (95% confidence interval [CI] 5, 7.8) and 7 (95% CI 5.2, 8.9) units for preadministered and coadministered lidocaine, respectively. The difference of 0.6 (95% CI –1.7, 2.8) units represented an inconclusive non‐inferiority determination. CHEOPS and FLACC scores and cry duration were similar between groups. OSBD‐R, CHEOPS, and FLACC scores and cry duration associated with intranasal lidocaine administration were 3.8, 9.9, and 6 units, and 56 seconds, respectively. Clinicians considered coadministered lidocaine easier to administer.ConclusionPain and distress associated with intranasal midazolam administration were similar when using coadministered or preadministered lidocaine, but our non‐inferiority determination was inconclusive. Administration of intranasal lidocaine by itself was associated with a measurable degree of pain and distress.Keywords: intranasal, midazolam, anxiolysis, sedation, emergency department, emergency medicine, pain, distress, pediatric, lidocaine, laceration

Effect of Lavender Oil Inhalation on Injection Pain Intensity Among Children Undergoing Vaccination

Background: Pain control and management are the most critical aspects of basic needs, human rights, and nursing care in children. Aim: to evaluate the effect of lavender oil inhalation on injection pain intensity among children undergoing vaccination Design: A quasi experimental research design was utilized to fit the aim of the study. Setting : the study was conducted in selected governmental, ministry of health and population pediatric primary health centers (health offices). Sample: A purposive sample of 100 child, who attended primary health care centers to receive vaccination injections were enrolled either in control (50) or intervention (50) group randomly. Data collection tools: 1) Structured interview questionnaire, related to the personal characteristics of vaccinated children and nurses who give the vaccine; 2) The Modified Behavioral Pain Scale (MBPS) developed by Taddio et al. (1995). 3) cry duration measured in seconds. Results: There was a highly significant difference between the total pain scores and cry duration of control and intervention group immediately and five minutes after injection with p.≤ 0.05. There was a highly significant positive correlation between total scores of MBPS immediately and five minutes after injection with cry duration in control group. While there was a highly significant correlation between total scores of MBPS five minutes after injection and cry duration in intervention group (P ≤ 0.001). Conclusion: children who were in the intervention group and received lavender oil inhalation after the injection showed lower pain scores using the MBPS scale and shorter cry duration after vaccination injection than those who were in the control group. Recommendation : pediatric nurses need to conduct more strict experimental randomized trials on larger representative samples to evaluate effect of lavender oil inhalation on injection pain reduction among children. Keywords: pain, vaccination, children, pediatric nurses, lavender oil inhalation DOI: 10.7176/JHMN/73-08 Publication date: April 30 th 2020

Parental use of 'cry it out' in infants: no adverse effects on attachment and behavioural development at 18months.

Leaving infant to cry it out has been the subject of discussion among researchers and parents. Nevertheless, there is paucity of empirical research investigating the association between leaving infant to cry it out and consequent crying duration and frequency, mother-infant attachment and behavioural development. The sample with complete longitudinal data comprised 178 infants and their caretakers. Parental use of 'leaving infant to cry out' and cry duration were assessed with maternal report at term, 3, 6 and 18months, and frequency of crying was assessed at term, 3 and 18months of age. Attachment was measured at 18months using the strange situation procedure. Behavioural development of the infant was assessed with two observational measures and a parent-report questionnaire at 18months. The use of 'leaving infant to crying' was rare at term and increased over the next 18months. 'Leaving infants to cry it out' at term was associated with a decrease in crying frequency at 3months. Furthermore, leaving infants to cry it out a few times at term and often at 3months was associated with shorter fuss/cry duration at 18months of age. No adverse impacts of leaving infants to cry it out in the first 6months on infant-mother attachment and behavioural development at 18months were found. Contemporary practice of some parents in the United Kingdom to occasionally or often 'leaving infant to cry it out' during the first 6months was not associated with adverse behavioural development and attachment at 18months. Increased use of 'leaving to cry it out' with age may indicate differential responding by parents related to infant self-regulation.

Vestibular stimulation with Indian hammock versus music intervention in the prevention of infantile colic in term infants: Anopen-labelled, randomized controlled trial.

Background and ObjectivesTo determine whether vestibular stimulation offered by Indian hammock and music intervention are useful in reducing the occurrence of infantile colic in term infants.MethodsThis open-labelled randomized clinical trial was conducted among 465 term neonates who were randomly assigned to one of three groups: music group, hammock group and control group. The music intervention was given for a cumulative duration of at least 4 h a day with one stretch of at least 1 h. In the hammock group, babies were put to sleep inside the Indian hammock and were swung gently until they sleep, and were allowed to sleep in it, until they wake up. For the control group, routine pre-discharge counselling was given. All parents were provided a cry log and were instructed to record the log of cry events and duration. The primary outcome measure was occurrence of infantile colic episode as defined by ROME IV criteria. The infants were followed up from birth until the age of 3.5 months, and the cry log was collected during each follow-up visit.ResultsOf the 435 term neonates who completed follow-up, 59 infants developed infantile colic (13.6%). The prevalence of infantile colic in the control group, music group and the Indian hammock group was 25.6%, 5.4% and 9.6% respectively; there was a significant reduction in the prevalence of infantile colic in the intervention groups as compared to the control group.ConclusionsVestibular stimulation by Indian hammock and music intervention individually reduced the occurrence of infantile colic.

Repeated painful stimuli may affect pain response in neonates of more than 34 weeks post-conceptional age: A case control study

Objective: To evaluate the effect of repeated painful stimuli on pain response in neonates of more than 34 weeks post conceptional age. Method: A case control study was done. Cases comprised neonates more than 34 weeks gestational age having more than ten repeated painful procedures. Controls include age and sex matched neonates with less than three painful procedures. The outcome variables were the duration of cry and Modified Facial Coding Score (MFCS) after intramuscular injection. Results: A total of 100 neonates were enrolled (50 as cases and 50 as controls). Median (interquartile range) of duration of cry in case and control groups was 26 (20-48 seconds) and 30.5 (20-78 seconds) respectively (p >0.05). MFCS score at immediate, 1 and 3 minutes was not statistically significant in the two groups (p >0.05). Conclusions: Exposure to frequent painful stimuli in early neonatal life may not significantly alter pain response in neonates more than 34 weeks post conceptional age. Sri Lanka Journal of Child Health, 2019; 48(3): 251-255