Sucrose as an analgesic agent for infants during immunization injections.

OBJECTIVE: To assess the effectiveness of sucrose as an analgesic agent during routine immunization injections for infants (age range, 2 weeks to 18 months). STUDY DESIGN: Double-blind, randomized control trial. SETTING: Ambulatory care clinic of a large tertiary care center. PARTICIPANTS: A consecutive sample of 285 infants were randomly assigned to one of three treatment groups. INTERVENTION: Subjects received either no intervention or drank 2 mL of sterile water or 2 mL or a 12% sucrose solution 2 minutes before administration of the immunization. MAIN OUTCOME MEASURE: Infants were videotaped during immunization for later interval recording of pain-induced vocalizations. RESULTS: Results were analyzed by using two-way repeated measure analyses of variance. Two-week-old infants who received either the sterile water or sucrose solution cried significantly less than infants who received no intervention (F=5.92,P<.005). For older infants, those who received water or sucrose cried significantly less only if they were administered one injection rather than two injections (F=3.36,P<.05). CONCLUSIONS: We found that when infants drank sucrose or sterile water, significantly fewer pain vocalizations were produced, but only for 2-week-old infants. For older infants, differences were found only when the number of injections was included in the analysis. We expand on previous findings by demonstrating that both the age of the child and the number of painful exposures can attenuate calming effects. In addition, the results suggest that in the absence of nonnutritive sucking, the actual analgesic effects of sucrose may be nonspecific. Further study is needed of the possible analgesic effects of sucrose.

Enhancing refusal skills: identifying contexts that place adolescents at risk for unwanted sexual activity.

Refusal skills training is one approach to reducing school-age pregnancy and sexually transmitted disease. The generalization of these skills is dependent, in part, on the relevance to participants of the training scenarios. We identified and cross-validated relevant contexts for inclusion in scenarios for refusal skills training. Fifty-six sexually active female adolescents identified 59 contexts associated with unwanted sexual activity. Fifty-one additional subjects rated these on 9-point Likert scales according to how common and difficult each was for them. Unsupervised activity where alcohol is present or feeling an obligation to engage in sexual activity emerged as high risk contexts. The most common and difficult contexts provide points of departure for the development of relevant training scenarios for refusal skills training, thereby contributing to generalization of these skills and reducing the risk of unwanted sexual activity within this population.

Clinical perspectives in primary nocturnal enuresis.

Primary nocturnal enuresis (PNE) is prevalent among the pediatric population, but not all professionals are aware of the current research regarding the etiology and treatment of this disorder. This paper presents a broad overview of PNE, including etiology and evaluation, with a specific emphasis on treatment issues. The most current treatments (imipramine, desmopressin acetate arginine vasopressin, enuresis alarms) are discussed, including recent research on their effectiveness. In considering the recent data on long-term efficacy, overall cost, and safety, the treatment of choice appears to be the enuresis alarm for those families who are capable of following protocols. Desmopressin acetate arginine vasopressin is a safe alternative that has the advantage of quick response and ease of administration.

Pharmacists' poison prevention advice to the elderly.

Up to 36% of childhood ingestions take place in grandparents' homes. We surveyed the 1544 registered pharmacists in the state of Nebraska by a mailed anonymous questionnaire concerning their poison prevention practices with the elderly. Of the 26% respondents, 75% always or usually gave older adults a choice of child-resistant containers but estimated that 65% chose non-child-resistant containers. Fifty-two percent reported that they asked older adults about children who could possibly ingest medications, and 59% reported that they had poison prevention material available. However, over 50% of pharmacists reported that they neither actively counseled nor handed out poison prevention material to the elderly, and only 9% reported that they specifically advise older adults about poison prevention. If all pharmacists targeted poison control education to the elderly, childhood poisoning by drugs could be reduced by one-third.