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Compliance And Immunization-associated Pain

May 12th, 2007 at 7:32 am · Allan Showalter, MD · Clinical Info · No Comments



The Problem Of Painful Pediatric Immunizations

A quote from Neil L. Schechter, MD, from the Pain Relief Program at Connecticut Children’s Medical Center in Hartford, Connecticut, and colleagues succinctly summarizes the issues:

The pain associated with immunizations is a source of anxiety and distress for the children receiving the immunizations, their parents, and the providers who must administer them. The current Centers for Disease Control and Prevention schedule recommends immunizations against 14 diseases, which translates into 14 to 20 separate injections before the age of 2 years, depending on the number of combination vaccines available. Therefore, immunizations are the most frequently occurring painful procedures performed in pediatric settings.

Consequently, a consensus conference on this topic was held to review the existing literature and generate recommendations for best practices to reduce injection pain. An evidence-based review published in the May issue of Pediatrics discusses these results.1

The Medscape article goes on to provide specific suggestions dealing with anatomical locations for injection sites, parental attitude, variations based on the age of the child, use of distraction and pressure to diminish discomfort, multiple Vs sequential injections, selective use of sucrose and topical anesthetics, preparation of the child, needle length and gauge, and specific properties of the injectate, among others.

The article concludes with (1) the observation that there has been little organized effort to address moderating the pain associated with immunizations, probably because of the abundant benefits of the procedure and (2) the sobering speculation that

…dread evoked by painful immunization procedures may create feelings of persistent tension in future clinical encounters, thereby interfering with optimal delivery of healthcare


Commentary

While any proof is lacking, I agree with the authors that it seems possible and perhaps likely that the traumatic injections received as a child could have long-term consequences that inhibit seeking needed healthcare. I have vivid childhood memories of fearing visits to the doctor because they were so closely associated with “getting a shot.” That question certainly merits further study as does the issue of of decreasing the pain of injections, a goal worthy of evidence-based methodologies if for no other reason than reducing unnecessary stress to kids, parents, doctors, and nurses.



Source:
Recommendations Issued for Reducing Pain of Pediatric Immunizations Laurie Barclay, MD Medscape May 7, 2007



CME: Valid for credit through May 7, 2008. Credits Available: Physicians - maximum of 0.25 AMA PRA Category 1 Credit for physicians; Family Physicians - up to 0.25 AAFP Prescribed credit for physicians. All other healthcare professionals completing continuing education credit for this activity will be issued a certificate of participation. To obtain CME credit, go online to article site on Medscape and follow instructions under heading, “FOLLOW THESE STEPS TO EARN CME/CE CREDIT” near bottom of page.



Footnotes

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  1. Pediatrics. 2007;119:e1184-e1198.↩

Tags: Clinical Info