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Effective pain reduction for multiple immunization injections in young infants.
Arch Pediatr Adolesc Med 2003; 157(11):1115-20AP

Abstract

BACKGROUND

Infants experience undue pain with multiple immunization injections.

OBJECTIVE

To assess the effectiveness, feasibility, and parental acceptance of a simple combination pain reduction intervention for infants receiving multiple immunization injections.

DESIGN

Randomized, controlled, clinical trial.

SETTING

Academic hospital-based primary care center.

PARTICIPANTS

Infants receiving their 2-month immunizations, consisting of 4 injections (diphtheria and tetanus toxoids and acellular pertussis vaccine, inactivated poliovirus vaccine, Haemophilus influenzae b conjugate and hepatitis B vaccine [Comvax], and heptavalent pneumococcal conjugate vaccine [Prevnar]).

INTERVENTIONS

Subjects were randomly assigned to the intervention or control group for administration of 4 injections. The intervention group received sucrose and oral tactile stimulation (with a pacifier or a bottle) and were held by their parents during immunization. The control group did not receive these interventions (standard practice).

MAIN OUTCOME MEASURES

Blinded assessment of audiotaped crying, heart rate, parent preference for future use of the injection technique, and nurse-rated ease of vaccine administration.

RESULTS

One hundred sixteen infants (mean +/- SD age, 9.5 +/- 2.0 weeks) participated. The median (25th-75th percentile range) first cry duration was 19.0 (5.8-62.8) seconds for the intervention group compared with 57.5 (31.0-81.5) seconds for the control group (P =.002). Parents of the intervention group reported a stronger preference for future use of the injection procedure. For intervention vs control, the median (25th-75th percentile) parent preference visual analog scale score was 97.0 (82.0-100.0) vs 44.0 (5.0-77.2) (P<.001) (100 indicates definitely prefer). Nurse-rated ease of vaccine administration was equivalent for both treatment groups.

CONCLUSIONS

Combining sucrose, oral tactile stimulation, and parental holding was associated with significantly reduced crying in infants receiving multiple immunization injections. Parents stated a strong preference for future use of this method, and nurses found the intervention injection technique easy to apply.

Authors+Show Affiliations

Department of Pediatrics, University of Pittsburgh School of Medicine, Children's Hospital of Pittsburgh, Pittsburgh, PA 15213-2583, USA. evelyn.reis@chp.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

14609903

Citation

Reis, Evelyn Cohen, et al. "Effective Pain Reduction for Multiple Immunization Injections in Young Infants." Archives of Pediatrics & Adolescent Medicine, vol. 157, no. 11, 2003, pp. 1115-20.
Reis EC, Roth EK, Syphan JL, et al. Effective pain reduction for multiple immunization injections in young infants. Arch Pediatr Adolesc Med. 2003;157(11):1115-20.
Reis, E. C., Roth, E. K., Syphan, J. L., Tarbell, S. E., & Holubkov, R. (2003). Effective pain reduction for multiple immunization injections in young infants. Archives of Pediatrics & Adolescent Medicine, 157(11), pp. 1115-20.
Reis EC, et al. Effective Pain Reduction for Multiple Immunization Injections in Young Infants. Arch Pediatr Adolesc Med. 2003;157(11):1115-20. PubMed PMID: 14609903.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effective pain reduction for multiple immunization injections in young infants. AU - Reis,Evelyn Cohen, AU - Roth,Erika Kraus, AU - Syphan,Janet L, AU - Tarbell,Sally E, AU - Holubkov,Richard, PY - 2003/11/12/pubmed PY - 2003/12/17/medline PY - 2003/11/12/entrez SP - 1115 EP - 20 JF - Archives of pediatrics & adolescent medicine JO - Arch Pediatr Adolesc Med VL - 157 IS - 11 N2 - BACKGROUND: Infants experience undue pain with multiple immunization injections. OBJECTIVE: To assess the effectiveness, feasibility, and parental acceptance of a simple combination pain reduction intervention for infants receiving multiple immunization injections. DESIGN: Randomized, controlled, clinical trial. SETTING: Academic hospital-based primary care center. PARTICIPANTS: Infants receiving their 2-month immunizations, consisting of 4 injections (diphtheria and tetanus toxoids and acellular pertussis vaccine, inactivated poliovirus vaccine, Haemophilus influenzae b conjugate and hepatitis B vaccine [Comvax], and heptavalent pneumococcal conjugate vaccine [Prevnar]). INTERVENTIONS: Subjects were randomly assigned to the intervention or control group for administration of 4 injections. The intervention group received sucrose and oral tactile stimulation (with a pacifier or a bottle) and were held by their parents during immunization. The control group did not receive these interventions (standard practice). MAIN OUTCOME MEASURES: Blinded assessment of audiotaped crying, heart rate, parent preference for future use of the injection technique, and nurse-rated ease of vaccine administration. RESULTS: One hundred sixteen infants (mean +/- SD age, 9.5 +/- 2.0 weeks) participated. The median (25th-75th percentile range) first cry duration was 19.0 (5.8-62.8) seconds for the intervention group compared with 57.5 (31.0-81.5) seconds for the control group (P =.002). Parents of the intervention group reported a stronger preference for future use of the injection procedure. For intervention vs control, the median (25th-75th percentile) parent preference visual analog scale score was 97.0 (82.0-100.0) vs 44.0 (5.0-77.2) (P<.001) (100 indicates definitely prefer). Nurse-rated ease of vaccine administration was equivalent for both treatment groups. CONCLUSIONS: Combining sucrose, oral tactile stimulation, and parental holding was associated with significantly reduced crying in infants receiving multiple immunization injections. Parents stated a strong preference for future use of this method, and nurses found the intervention injection technique easy to apply. SN - 1072-4710 UR - https://www.unboundmedicine.com/medline/citation/14609903/Effective_pain_reduction_for_multiple_immunization_injections_in_young_infants_ L2 - https://jamanetwork.com/journals/jamapediatrics/fullarticle/vol/157/pg/1115 DB - PRIME DP - Unbound Medicine ER -