A randomized trial of rotavirus vaccine versus sucrose solution for vaccine injection pain.

OBJECTIVE: Sucrose solutions are analgesic in infants. Oral rotavirus vaccine contains sucrose, however, it is not known if it possesses analgesic properties. The objective was to compare the analgesic effectiveness of rotavirus vaccine to sucrose solution when administered prior to injectable vaccines. METHODS: Infants 2-4 months of age receiving oral rotavirus vaccine and two separate injectable vaccines on the same day were randomized to rotavirus vaccine (Rotarix) first followed by the injectable vaccines and sucrose (Tootsweet) afterwards, or vice versa. Pain was assessed by blinded raters using the Numerical Rating Scale (NRS, range 0-10) (parents, clinicians), or Modified Behavioural Pain Scale (MBPS, range 0-10) and cry duration (observers). Data were analyzed using t-tests or χ(2)-tests; Bonferroni correction was applied to correct for multiple comparisons, as appropriate. RESULTS: Altogether, 120 infants participated: 60 were randomized to rotavirus vaccine first. Groups did not differ in demographics, including; age (p=0.448) and sex (p=0.464). The mean pain score (standard deviation) for both vaccine injections did not differ between infants given rotavirus vaccine first versus sucrose solution first: observer MBPS, parent NRS and clinician NRS scores were 7.4 (1.6) vs. 7.7 (1.6), 4.9 (2.1) vs. 5.8 (2.1), and 4.2 (2.1) vs. 4.6 (2.2), respectively. Similarly, there was no difference between groups in cry duration. CONCLUSION: Rotavirus vaccine did not differ from sucrose solution in reducing injection-induced pain. Based on the findings, it is recommended that rotavirus vaccine be administered prior to injectable vaccines in infants aged 2 and 4 months.

Impact of parent-directed education on parental use of pain treatments during routine infant vaccinations: a cluster randomized trial.

Educating parents about ways to minimize pain during routine infant vaccine injections at the point of care may positively impact on pain management practices. The objective of this cluster randomized trial was to determine the impact of educating parents about pain in outpatient pediatric clinics on their use of pain treatments during routine infant vaccinations. Four hospital-based pediatric clinics were randomized to intervention or control groups. Parents of 2- to 4-month-old infants attending the intervention clinics reviewed a pamphlet and a video about vaccination pain management on the day of vaccination, whereas those in the control clinics did not. Parent use of specific pain treatments (breastfeeding, sugar water, topical anesthetics, and/or holding of infants) on the education day and at subsequent routine vaccinations 2 months later was the primary outcome. Altogether, 160 parent-infant dyads (80 per group) participated between November 2012 and February 2014; follow-up data were available for 126 (79%). Demographics did not differ between groups (P > 0.05). On the education day and at follow-up vaccinations, use of pain interventions during vaccinations was higher in the intervention group (80% vs 26% and 68% vs 32%, respectively; P < 0.001 for both analyses). Educating parents about pain management in a hospital outpatient setting leads to higher use of pain interventions during routine infant vaccinations.

From the mouth of babes: Getting vaccinated doesn't have to hurt.

BACKGROUND: Analgesic interventions are not commonly administered during childhood vaccination, despite the fact that two-thirds of children are afraid of needles and one-tenth are noncompliant with immunization. OBJECTIVE: To explore children's experiences of vaccination and preferences for analgesia. METHODS: A total of 17 children (four to 14 years of age) at an independent school in Toronto (Ontario) participated in three focus-group interviews. The majority had previous experience with pain management interventions during vaccination. Thematic content analysis was used to analyze interview transcripts. RESULTS: THE FINDINGS WERE CATEGORIZED INTO THREE MAIN THEMES: experience of vaccination; roles and responsibilities regarding pain management; and impact of pain management. Children easily recalled previous vaccinations and discussed fear and distress experienced by themselves and others. Children believed that parents and immunizers should prepare them ahead of time and use interventions to manage and monitor pain. They also wanted adults to support their efforts to lead pain management. Children discussed benefits of managing pain, including reduced unnecessary suffering, improved vaccination experience, reduced risk of developing needle fears and reduced noncompliant behaviours. They were knowledgeable about strategies for reducing pain including distraction, topical anesthetics and injection techniques. They contrasted vaccination with and without pain management, and indicated a preference for pain management. CONCLUSION: Children reported that managing vaccination pain is important and that analgesic interventions should routinely be used. Incorporating pain management in the process of vaccination has the potential to improve children's experiences with vaccination and promote more positive attitudes and behaviours.

HISTORIQUE: Les interventions analgésiques ne sont pas fréquentes pendant la vaccination des enfants, même si les deux tiers des enfants ont peur des seringues et que le dixième ne se fait pas vacciner. OBJECTIF: Explorer l'expérience les enfants vis-à-vis de la vaccination et leurs préférences en matière d'analgésie. MÉTHODOLOGIE: Au total, 17 enfants (de quatre à 14 ans) d'une école indépendante de Toronto, en Ontario, ont participé à trois entrevues au sein de groupes de discussion. La majorité avait déjà profité d'interventions de gestion de la douleur pendant la vaccination. Les chercheurs ont utilisé l'analyse thématique du contenu pour dépouiller la transcription des entrevues. RÉSULTATS: Les résultats ont été classés en trois grands thèmes : l'expérience de la vaccination, les rôles et responsabilités relatives à la gestion de la douleur et les conséquences de la gestion de la douleur. Les enfants se rappellent facilement les vaccins qu'ils ont déjà reçus et parlent de la peur et de la détresse qu'eux ou d'autres ont ressenties. Les enfants pensaient que les parents et les vaccinateurs devraient les préparer d'avance et recourir à des interventions pour gérer et surveiller la douleur. Ils voulaient également que des adultes les aident dans leurs efforts pour diriger la gestion de la douleur. Les enfants ont parlé des avantages de gérer la douleur, y compris la diminution de souffrances inutiles, une meilleure expérience de la vaccination, la diminution des risques de craindre les seringues et la diminution de la non-adhérence à la vaccination. Ils connaissaient les stratégies pour réduire la douleur, y compris la distraction, les anesthésiques topiques et les techniques d'injection. Ils ont comparé la vaccination accompagnée ou non d'une gestion de la douleur et indiqué leur préférence pour la gestion de la douleur. CONCLUSION: Les enfants ont souligné l'importance de gérer la douleur de la vaccination et d'utiliser systématiquement des interventions analgésiques. L'intégration de la gestion de la douleur au processus de vaccination pourrait améliorer l'expérience des enfants vis-à-vis de la vaccination et favoriser des attitudes et comportements plus positifs.

A randomized controlled trial of clinician-led tactile stimulation to reduce pain during vaccination in infants.

BACKGROUND: 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. OBJECTIVE: To evaluate the analgesic effectiveness of clinician-led tactile stimulation in infants undergoing vaccination. METHODS: 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). RESULTS: 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. CONCLUSION: Tactile stimulation cannot be recommended as a strategy to reduce vaccination pain in infants because of insufficient evidence of a benefit.