Vaccination is the most common procedure performed in infancy. Children receive 24 injections by the age of 2 years. (Hatfield, Gusic, Dyer, & Polomano) Parents have increasing concerns regarding the enormous amount of vaccines, the efficacy and pain level associated with each injection. Another growing concern is anxiety and the induced trauma associated with the increased amount of injections per doctor visit. Oral sucrose prior to administration of vaccine has been effective in decreasing short term pain and distress. Although this intervention has been studied before, this is the first study to examine pain in infants and young children using all three pain outcomes together: MBPS pain score, video recording of crying time, and salivary levels as a bio-marker of pain and stress (Kassab, Almomani, Nuseir, & Alhouary, 2019) .
Hatfield LA., Gusic ME, Dyer A., Polomano RC. (2008) Analgesic Properties of Oral Sucrose During Routine Immunizations at 2 and 4 months of Age. Pediatrics, 121 (2008) p327-334.
Kassab M., Almomani B., Nuseir K. & Alhouary A. (2019). Efficacy of Sucrose in Reducing Pain during Immunization among 10-to-18 month-Old Infants and Young Children: A Randomized Controlled Trial. Journal of Pediatric Nursing, 50(2020) pp55-61.
Hello Johnny,
Your study shows some promise as it concluded that there was a significant reduction in in behavioral and crying when sucrose was used which in turn will decrease stress in the parents. Vaccines are necessary and needles are always going to cause pain. As you, and your article stated, pain is the 5th vital sign, and nursing/healthcare professionals are an important part to managing and controlling pain. The journal article “Canadian Medical Association Journal” (CMAJ). says that pain associated with childhood immunizations can lead to pre-procedural anxiety in the future, needle fears and health care avoidance behaviors, including non-compliance with vaccinations. CMAJ says that 25% of adults have a fear of needles that began in childhood. CMAJ supported sucrose in infant immunizations unless they were breast-fed and then they favored that over the sucrose. CMAJ gave some examples of other ways to minimize the stress/pain of immunizations. Some being: breast-feeding, brand of vaccine, positioning of the child, IM technique, order of injections, tactile stimulation and parent-led interventions.
Johnny, have you or do you, at your allergy clinic, seen any interventions that have helped? In my personal nursing experience I have just given newborns immunizations and also drawn labs where we did use the sucrose. I didn’t do it enough to have any real opinion as to if I thought it helped or not, but there was at least one of my colleagues that swore by it. I do see enough adults that have a fear of needles and makes it very hard to do IV starts, epidurals or injections. How young of patients have you seen for allergy injections?
Thanks for sharing,
Loretta Gayle Bergman
Unfortunately no, I would like to create an intervention, assessment for various age groups, where with injections and testing that non pharmaceutical methods could be considered. Most of the time we administer immunizations, allergy injections, and skin testing without assessing their pain levels. Occasionally we use shot blockers and with doctor order lidocaine which helps with our younger and elderly patients.
Our clinic sees both pediatric and adult populations. I recently performed an allergy skin test on a 6 day old, sucrose would have had benefits.
I’m curious about the 6 day old. Can you explain how the testing goes on the baby? Why did they think 6 day old had allergies? What allergies were they testing for? Did the baby have any? Just Curious!!!
Gayle
The baby came in because of a break out in hives, the mother noticed after feedings that he was breaking out more. The allergist ordered a skin test. A skin test is small needles, the tip contains the allergen, we prick the patients back and let sit for 15 minutes. The procedure was the same for the baby, he was upset, we relied on the mom for lots of support. We are always prepared for any type of reaction, but for pain we don’t do much. We ended up testing the mother’s breast milk, soy and cow milk. He ended up not being allergic to any of the allergens tested for, the physician sent him down for blood work and I do not know results. It is really interesting to see how people react to various tests.
I think it is very interesting how sucrose relieves the pain in children. I saw this in action during my clinical rotation in the NICU when an IV was being placed on a premature newborn. It was amazing to watch the reaction of pain almost go away entirely over such a simple intervention. I found an article that discusses a few different vaccine administration routes that are in clinical trials right now that will hopefully cause less stress for children and parents and therefore increase compliance with vaccines (The Indian Journal of Pediatrics, 2018). There is already a nasal flu vaccination that I have seen, however they are testing transdermal, oral and nasal versions of other vaccines and testing for efficacy. I enjoyed your journal article topic!
Reference:
Garg, N., & Aggarwal, A. (1970, January 01). Advances towards painless vaccination and newer modes of vaccine delivery. Retrieved February 28, 2020, from https://link.springer.com/article/10.1007/s12098-017-2377-2
Thanks for the response, the use of oral sucrose has been one of the most studied intervention for this population. The interventions you mentioned sound like they would be beneficial for pain management in pediatrics. I found your article interesting I am hopeful they are successful and able to be utilized in the near future.
It is amazing to me that sucrose would have such an effect on pain. It makes me wonder why this isn’t implement in more places that provide vaccinations. One review included thirty-eight studies. There were no major adverse reactions with the administration of sucrose and only a few minor adverse events such as choking or gagging. They did identify the need for additional research to determine the minimal effective dosage as the dosage amounts between studies varied. Thank you for showing me something new!
Stevens, B., Yamada, J., & Ohlsson, A. (2016). Sucrose for analgesia in newborn infants undergoing painful procedures. Cochrane Database of Systematic Reviews, (7). doi: 10.1002/14651858.CD001069.pub5
Hi Tammy!
I agree their has been a lot of studies on this topic. The results are positive, I am concerned why this is not used in all areas of pediatrics. It seems as if it would be a low cost, effective measure to reduce pain. I would like to see a study that examines how sucrose actually effects the brain in a scenario such as vaccines. What is the chemical compound that is actually reducing the pain?
I worked in Maternal Child for a short period of time and we would give the infant sucrose during circumcisions. It seemed to help calm the child and they tolerated the procedure better.
“We concluded that sucrose is an effective analgesic intervention for infants up to 12 months of age”.
Taddio, A., Appleton, M., Bortolussi, R., Chambers, C., Dubey, V., Halperin, S., Hanrahan, A., Ipp, M., Lockett, D., MacDonald, N., Midmer, D., Mousmanis, P., Palda, V., Pielak, K., Riddell, R. P., Rieder, M., Scott, J., & Shah, V. (2010). Reducing the pain of childhood vaccination: an evidence-based clinical practice guideline. CMAJ : Canadian Medical Association journal = journal de l’Association medicale canadienne, 182(18), E843–E855. https://doi.org/10.1503/cmaj.101720
Before a vaccine is ever given to people, FDA oversees extensive lab testing of the vaccine that can take several years to make sure it is safe and effective. After the lab, testing in people begins, and it can take several more years before the clinical studies are complete and the vaccine is licensed. This goes to show that vaccines are not just something that people come up with one day and we give to patient’s the next.
As for anxiety in children related to vaccines. There are devices out there such as the Buzzy to help lessen the pain and anxiety of vaccines. It is shaped like a bee and the wings of the bee are ice packs. The body of the bee vibrates so that the child does not feel the pain as much and thus is distracted by the vibrating motion. If it is between short term pain or long term illness, my child will have short term pain.
Making the Vaccine Decision: Common Concerns. (2019, August 5). Retrieved March 1, 2020, from https://www.cdc.gov/vaccines/parents/why-vaccinate/vaccine-decision.html