Vaccination Pain In Infants Research Articles

The effect of breastfeeding on reducing pain induced by pentavalent vaccine in infants: a randomized clinical trial.

To analyze the effect of breastfeeding on reducing Pentavalent vaccination pain in infants and to identify the necessary breastfeeding interval for antinociceptive action. Open parallel randomized clinical trial. Ninety mother-infant dyads participated, distributed into intervention group 1 (n = 30), which breastfed five minutes before vaccination; intervention group 2 (n = 30), which breastfed five minutes before and during vaccination; and control group (n = 30), which did not breastfeed. The outcome variable was the pain level measured by the FLACC Scale. Data analysis was conducted using descriptive and inferential statistics, applying Fisher's Exact, Kolmogorov-Smirnov, Kruskal-Wallis and Dunn's multiple comparison tests, with 0.05 significance level. Pain induced by the Pentavalent vaccine was reduced in intervention groups 1 and 2 (mean pain of 6.06 versus 3.83, respectively) compared to the control group (mean of pain of 7.43), which was significant for intervention group 2 (p < 0.001), indicating that, to achieve lower levels of pain, breastfeeding should be carried out before and during vaccination. Longer breastfeeding, conducted five minutes before and during vaccination, reduces the pain induced by the Pentavalent vaccine. No vaccination risks were identified to outweigh the benefits. These results endorse that health professionals should encourage breastfeeding at least five minutes before and during vaccine injection for an antinociception effect. Brazilian Clinical Trials Registry: RBR-9vh37wr.

Implementing a clinical protocol using breastfeeding to mitigate vaccination pain in infants

BackgroundAlthough an effective public health intervention and a routine pediatric practice, vaccines are a common source of iatrogenic pain in childhood. Techniques, such as exam table restraint may cause infants to struggle and heighten distress, but studies demonstrate that breastfeeding and lap holding are effective strategies to reduce injection pain during vaccination. Local problemAdoption of pain-relieving techniques into clinical practice is often underutilized. In a pediatric clinical practice in southern Connecticut, there were no guidelines for providing pain mitigation strategies, including breastfeeding, during infant vaccination. Methods and interventionsThe Plan-Do-Study-Act (PDSA) cycle was used for the improvement process. A clinical protocol introduced breastfeeding as a pain-relieving strategy during vaccination; lap holding was a second option. All clinical staff were educated on the infant pain experience, and nurses were further trained on vaccine administration techniques during breastfeeding. ResultsA total number of 354 infants were seen for vaccination during the 12-week project: 168 were breastfed infants, of which 53% were breastfed during vaccination; 234 were placed on the parent/caregiver's lap during vaccination; and only 13 infants were restrained on the exam table. There was no documentation of position for 18 infants. ConclusionsA clinical protocol was an effective tool to guide nurses on pain-relieving options, such as breastfeeding and lap holding, during vaccine administration. Positive experiences during vaccination administration have the potential for short-term and long-term benefits including, compliance with routine care and adherence to vaccination schedules.

The Effect of Aromatherapy by Lavender Oil on Infant Vaccination Pain: a Double Blind Randomized Controlled Trial.

Introduction: Exposure to noxious stimuli can cause pain in infants. This study was conducted to evaluate the effects of the lavender oil inhalation on the pain resulting from the pentavalent vaccination.Methods: This clinical trial consisted of two groups: the lavender oil group with 42 infants and the placebo group with 57 infants. The healthy infants without congenital abnormalities in need of pentavalent vaccine also participated in our study. The infants started the lavender oil or placebo aromatherapy one minute before injection. The pain was assessed three times, using the Neonatal Infant pain Scale (NIPS): before vaccination, 15 s, and 5 min after vaccination. Also, the duration of crying was measured in both groups.Results: At baseline, the two groups were similar in relation to the NIPS scores. While, after 5 minutes, the NIPS score was significantly lower in the lavender group. Based on the repeated measures analysis, the NIPS score changed over time totally. However, the two groups were significantly different in relation to the NIPS score over time. The duration of crying was 75.47 (60.675) second in the lavender group and 105.22 (75.739) s in the control group. The statistical test showed a significant difference between the two groups.Conclusion: A low concentration of the lavender oil inhalation can reduce the pain and improve soothing in the infants with the pentavalent vaccine injection.

Understanding the Relative Contributions of Sensitive and Insensitive Parent Behaviors on Infant Vaccination Pain.

Parents play a critical role in supporting infants’ ability to manage strong emotions. Routine vaccinations provide an ideal context to observe the effect of parents’ behaviors on infants’ pain-related distress. Previous research in the vaccination context showed that parent sensitivity, operationalized by variables such as emotional availability and proximal soothing behaviors, is associated with infant pain-related distress behavior. However, the magnitudes of these relationships were smaller than expected given the established importance of parents in the development of distress regulation. In recent work, a reliable and valid measure to operationalize insensitive behaviors was developed. The objective of the current study was to examine the relative contribution of variables representing sensitive and insensitive behaviors to the prediction of infant pain-related distress behaviors during the reactivity and regulation phases of needle pain. Archival data was used to analyze a subsample of infants followed during their two-month, six-month, and 12-month vaccinations (n = 81). Results of regression analyses indicated that parent insensitive behaviors generally had the strongest relationships with pain outcomes across all ages, with a greater influence on regulation-phase pain-related distress behavior, rather than reactivity-phase pain-related distress behavior. Our findings support the utility of a measure of distress-promoting parent behaviors in a vaccination context, and highlight the potential value of this measure for clinicians and researchers.

Parent-led interventions in reducing infant vaccination pain after participation in a longitudinal randomized control trial.

Parent-led interventions in reducing infant vaccination pain after participation in a longitudinal randomized control trial.

Topical Lidocaine Reduces Vaccination Pain in Infants.

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Usability and knowledge testing of educational tools about infant vaccination pain management directed to postnatal nurses.

BackgroundAdapting educational tools to meet user needs is a critical aspect of translating research evidence into best clinical practices. The objectives of this study were to evaluate usability and effectiveness of educational tools about infant vaccination pain management directed to postnatal nurses.MethodsMixed methods design. A template pamphlet and video included in a published clinical practice guideline were subjected to heuristic usability evaluation and then the revised tools were reviewed by postnatal hospital nurses in three rounds of interviews involving 8 to 12 nurses per round. Nurses’ knowledge about evidence-based pain management interventions was evaluated at three time points: baseline, after pamphlet review, and after video review.ResultsOf 32 eligible postnatal nurses, 29 agreed to participation and data were available for 28. Three overarching themes were identified in the interviews: 1) utility of information, 2) access to information, and 3) process for infant procedures. Nurses’ knowledge improved significantly (p < 0.05) from the baseline phase to the pamphlet review phase, and again from the pamphlet review phase to the video review phase.ConclusionsThis study demonstrated usability and knowledge uptake from a nurse-directed educational pamphlet and video about managing infant vaccination pain. Future studies are needed to determine the impact of implementing these educational tools in the postnatal hospital setting on parental utilization of analgesic interventions during infant hospitalization and future infant vaccinations.

A Randomized Controlled Trial of Clinician-Led Tactile Stimulation to Reduce Pain During Vaccination in Infants

Clinician-led tactile stimulation (rubbing the skin adjacent to the injection site or applying pressure) has been demonstrated to reduce pain in children and adults undergoing vaccination. To evaluate the analgesic effectiveness of clinician-led tactile stimulation in infants undergoing vaccination. This was a partially blinded randomized controlled trial that included infants undergoing vaccination in a private clinic in Toronto. Infants were randomly allocated to tactile stimulation or no tactile stimulation immediately prior to, during, and after vaccination. The primary outcome was infant pain, assessed using a validated observational measure, the Modified Behavioral Pain Scale (MBPS; range = 0-10). Altogether, 121 infants participated (n = 62 tactile stimulation; n = 59 control); demographics did not differ (P > .05) between groups. MBPS scores did not differ between groups: mean = 7.2 (standard deviation = 2.4) versus 7.6 (1.9); P = .245. Tactile stimulation cannot be recommended as a strategy to reduce vaccination pain in infants because of insufficient evidence of a benefit.

A Randomized Clinical Trial to Evaluate the Impact of a Fact Sheet About Infant Vaccination Pain Management on Parental Knowledge Uptake

A Randomized Clinical Trial to Evaluate the Impact of a Fact Sheet About Infant Vaccination Pain Management on Parental Knowledge Uptake

Infant Vaccination Pain Management: Comparing the Effect of Mother's Hug and Breast Feeding, Tehran, 2009-2010

Infant's nervous system is much more sensitive to pain than adult and cause more complications. Health professionals must consider the best and low risk pain management.Aim: To compare the effect of breast feeding with being in the mother's hug on infants' immunization pain.Material and Methods: This is a controlled trial study, which was performed on 76 healthy term infants with 2- 4 months years old, during DPT vaccination in public clinics in west of Tehran (Year 2009). After signing informed consent by infants' mothers, samples by randomized collection divided to two groups (1- Breast- fed group, 2 minutes before, during, and 15 seconds after the injection, 2- Group were in their mother's hug 2 minutes before, during, and 15 seconds after the injection). Tools of this study had two main parts of personal characteristics and Modified Behavioral Pain Scale (MBPS), which assess objective changes in appearance of neonates (facial expression, cry and movements) during 5 second before immunization to 15 second after it. The scores for each behavior were calculated and compared in two groups.Results: There was no difference between ages, gender, and time of breast feeding prior to the procedure, therefore two groups had equality. Regarding to MBPS there were significant differences in behavioral pain scores of breast- fed group (4.6±1.8) and mother's hug (6.7±1.2). Also there were significant differences between each facial expression (p=0.032), cry (p=0.0001) and movements (p=0.0001) of MBPS.Conclusion: Breast- feeding may have an analgesic effect during immunization injections in healthy neonates.

Use of lidocaine-prilocaine cream for vaccination pain in infants

To determine whether use of lidocaine-prilocaine 5% cream (EMLA) decreases pain associated with diphtheria-pertussis-tetanus (DPT) vaccination in infants. Randomize, double-blind, controlled trial in outpatient pediatric practice, Toronto, Ontario, Canada. Before vaccination, parents applied 2.5 gm of EMLA or placebo to the infant's leg and covered it with an occlusive dressing for at least 60 minutes. The infant received a 0.5 ml intramuscular injection of DPT at 2 degree to 8 degree C with a 1.6 cm 25-gauge needle; the infant was videotaped. The Modified Behavioral Pain Scale (MBPS) was used to assess baseline and postvaccination pain scores. Latency and duration of infant cry were also measured. A total of 49 evaluable infants received EMLA, and 47 infants received placebo. There were no significant differences in demographic data; mean age was 5 months; and 50% of the subjects were male. The median difference in pre-vaccination and postvaccination MBPS scores was lower for EMLA than for placebo (p = 0.001). The latency to the first cry was longer for subjects who were treated with EMLA (p = 0.0004)), but the total crying time was shorter (10.3 seconds vs 25.2 seconds; p = 0.027). Of the study group, 90% (45/50) of subjects treated with EMLA and 12% (6/49) of subjects treated with placebo had local skin reactions (p < 0.0001), mainly skin blanching. Pretreatment with EMLA decreases infant pain from DPT vaccinations. Application of these data is limited to healthy infants receiving DPT vaccinations.

A Eutectic Mixture of Lidocaine and Prilocaine for Alleviating Vaccination Pain in Infants

The discomfort and pain caused by vaccination may prevent some parents from having their young children vaccinated. Immunization uptake is good among school-age children, but uptake rates average only about 70% in younger children and figures as low as 25% have been reported at 19 months.1-4 Yet it would be important to achieve as high an immunization uptake as possible, since if the vaccination coverage is good enough, even nonvaccinated individuals will be protected by the herd immunity that hinders the occurrence of epidemics.1,5 Painful procedures are frightening, especially in infancy, when children do not understand what is happening to them.