Analgesia no farmacológica en la vacunación. Valoración de pediatras, pacientes y tutores / Nonpharmacological pain management in vaccination. Perception of paediatricians, patients and guardians

Introducción: La utilización de medidas no farmacológicas para disminuir el dolor en la vacunación se ha estudiado extensamente en lactantes, pero hay menos estudios sobre su efectividad en niños mayores y sobre la valoración de los padres del dolor observado en los niños. Metodología: Estudio multicéntrico, de intervención, cuasiexperimental con grupo control. Pacientes: Lactantes de 2 y 11meses, y niños de 4años que acuden para vacunación sistemática. Ámbito: Atención primaria. Intervención durante la inmunización: Los lactantes recibieron lactancia materna. Los niños de 4años soplaron un matasuegras. El grupo control siguió la práctica habitual. Medición: escala NIPS (Escala de dolor infantil y neonatal) y duración del llanto en los lactantes. Dibujos faciales de Wong-Baker para los niños mayores y padres. Resultados: Participaron 125 niños (60 intervención; 65 control). Hubo una disminución significativa de la sensación de dolor en los grupos de intervención: puntuación NIPS en lactantes (3,8±1,1 frente a 5,2±0,7 [p<0,001]). Escala de Wong-Baker a los 4años (3,3±1,7 frente a 4,2±1,6 [p=0,042]). Esas mismas diferencias a favor de la intervención se observan en la valoración de los padres (3,4±1,3 frente a 4,5±1,5 [p<0,001]). La correlación de las puntuaciones de niños y padres fue altamente positiva: 0,7 (IC95%: 0,59-0,78). Sin embargo, el tiempo de duración del llanto fue mayor en el grupo intervención. Conclusiones: La utilización de medidas distractoras consigue la disminución del dolor en los niños y la percepción del dolor de los padres disminuye, lo que aumenta la satisfacción de estos con el procedimiento. (AU)

Introduction: The use of nonpharmacological measures to reduce pain during vaccination has been studied extensively in infants, but there are fewer studies on its effectiveness in older children and on the parental perception of pain in children. Methods: We conducted a multicentre, quasi-experimental interventional study with a control group. Patients: Infants aged 2 and 11 months and children aged 4 years that attended routine vaccination appointments. Setting: Primary care. Intervention during vaccination: infants were breastfed and 4-year-old children blew a party horn. Control: vaccination performed following routine practice. Measurement: NIPS (Neonatal Infant Pain Scale) and duration of crying in infants, Wong−Baker FACES pain rating scale in older children and parents. Results: The study included 125 children (intervention: 60; control: 65). There was a significant decrease in perceived pain in the intervention groups: NIPS score in infants, 3.8±1.1 compared to 5.2±0.7 (P<.001); Wong−Baker FACES score at 4 years of 3.3±1.7 compared to 4.2±1.6 (P=.042). These same differences in support of the intervention were reflected in the parental assessments (3.4±1.3 vs 4.5±1.5; P<.001). The correlation between child and parent scores was strongly positive: 0.7 (95% CI, 0.59–0.78). However, the duration of crying was longer in the intervention group. Conclusions: The use of distraction techniques reduces pain in children and the pain perceived by parents in their children, thus increasing their satisfaction with the procedure. (AU)

Nonpharmacological pain management in vaccination. Perception of paediatricians, patients and guardians.

INTRODUCTION: The use of nonpharmacological measures to reduce pain during vaccination has been studied extensively in infants, but there are fewer studies on its effectiveness in older children and on the parental perception of pain in children. METHODS: We conducted a multicentre, quasi-experimental interventional study with a control group. PATIENTS: infants aged 2-11 months and children aged 4 years that attended routine vaccination appointments. SETTING: Primary care. Intervention during vaccination: infants were breastfed and 4-year-old children blew a party horn. CONTROL: vaccination performed following routine practice. MEASUREMENT: NIPS (Neonatal Infant Pain Scale) and duration of crying in infants, Wong-Baker FACES pain rating scale in older children and parents. RESULTS: The study included 125 children (intervention: 60; control: 65). There was a significant decrease in perceived pain in the intervention groups: NIPS score in infants, 3.8 ± 1.1 compared to 5.2 ± 0.7 (P < .001); Wong-Baker FACES score at 4 years of 3.3 ± 1.7 compared to 4.2 ± 1.6 (P = .042). These same differences in support of the intervention were reflected in the parental assessments (3.4 ± 1.3 vs 4.5 ± 1.5; P < .001). The correlation between child and parent scores was strongly positive: 0.7 (95% CI, 0.59-0.78). However, the duration of crying was longer in the intervention group. CONCLUSION: The use of distraction techniques reduces pain in children and the pain perceived by parents in their children, thus increasing their satisfaction with the procedure.

Assessment of Two Nutritional Screening Tools in Hospitalized Children.

AIM: to evaluate validity and concordance of Screening Tool for the Assessment of Malnutrition in Pediatrics (STAMP) and Screening Tool for Risk On Nutritional status and Growth (STRONGkids) screening tools for assessment of nutritional risk in pediatric inpatients. METHODS: Prospective longitudinal observational multicenter study in children aged 1 month or older admitted as inpatients. Weight, height, cause of admission, demographic data, length of stay, and nutritional interventions were recorded. STAMP and STRONGkids were applied within the first 72 h of admission. Anthropometric measurements were recorded again 12-18 months after admission. RESULTS: Eighty-one patients with median age of 4.1 years completed the study. Agreement between tools was moderate (κ = 0.47). STAMP had a greater tendency to classify patients as high risk (12.3% vs. 2.5%). Both tools showed very weak correlation with height for age. All undernourished patients at the beginning and the end of the study were classified as medium or high risk by STAMP and STRONGkids (100% sensitivity), although specificity was below 50% in all cases. There were no differences in length of stay based on nutritional risk with any of the tools. CONCLUSIONS: STAMP and STRONGkids demonstrated moderate agreement, with high sensitivity but low specificity for the diagnosis of undernutrition. Further studies are required to analyze cost-effectiveness of these tools and nutritional interventions derived from them.