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A small study of nurse vaccinators has found better use could be made of a range of effective pain management techniques - which would reduce fear and stress for young children.
Scheduled childhood immunisations protect children and communities against serious, life-threatening infectious diseases.1 However, pain during immunisation can cause distress and anxiety for babies, children and their parents. This can lead to fear of needles and other medical procedures, avoidance of health care and, in particular, non-compliance with immunisation.2,3
Research has shown a variety of strategies can ease immunisation pain. These include breastfeeding and sweet solutions for infants and topical anaesthetic agents and distraction for all ages. Despite evidence of their benefit, many of these strategies are rarely used during early childhood immunisations in Canada and Victoria, Australia.
A New Zealand study, conducted in 2013, aimed to evaluate pain management practices during childhood immunisations in this country and to compare the results with Australian research conducted in 2012. The study also aimed to find out what education New Zealand clinicians and parents/whânau needed to bring them up to date with the best researchbacked methods.
Methods backed by research
International research supports several pharmacological and non-pharmacological techniques to help reduce children's pain and distress during immunisation.
Breastfeeding infants during immunisation has been shown to be analgesic.4,5,6 There is also evidence that oral sweet-tasting solutions such as sucrose are analgesic for infants having their first three scheduled immunisations - in New Zealand this is at six weeks, three months and five months.7,8 Sucrose solution can be made with 5gm (1 teaspoon) of sugar mixed with 15ml (1 tablespoon) warm boiled water. Up to 2ml, split into two half doses, should be given via a syringe (or dropper, cup, spoon or bottle) two minutes before and then again immediately before immunisation.9
Good evidence supports the use of topical anaesthetic for reducing immunisation pain in children,10,3 especially those older than three.11 For children over one year, the required dose is 5g of topical local anaesthetic - 5g tubes of EMLA are available in New Zealand without prescription. For those under one year, accurate dosing is more difficult, as infants under three months should have a maximum of 1g, and from three to 12 months a maximum of 2g.12