Effective Pain Reduction for Multiple Immunization Injections in Young Infants

Evelyn Cohen Reis*, Erika Kraus Roth, Janet L. Syphan, Sally E. Tarbell, Richard Holubkov

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

63 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)1115-1120
Number of pages6
JournalArchives of Pediatrics and Adolescent Medicine
Issue number11
StatePublished - Nov 2003

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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