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About Sickkids
About SickKids

November 26, 2010

New guidelines may help health-care providers minimize immunization pain in children

A newly-released guideline for pain management during childhood immunization aims to help reduce pain, and ultimately, the fear of needles.   A multidisciplinary panel of experts led by Dr. Anna Taddio, Adjunct Scientist and Pharmacist at The Hospital for Sick Children (SickKids) and Associate Professor in the Leslie Dan Faculty of Pharmacy at the University of Toronto, has developed a new evidence-based clinical practice guideline to help doctors, health-care providers and parents reduce the pain and distress of immunization in children. The guidelines are published in the November 22 issue of the Canadian Medical Association Journal.  

It is estimated that 25 per cent of adults have a fear of needles, and in most cases this fear developed in childhood. Children receive immunization injections multiple times throughout childhood and adolescence.

“ These vaccinations are the most common source of physician-induced pain, often causing distress and even anxiety,” says Taddio. “If these feelings go unaddressed, this pain can cause not only a fear of needles, but also an avoidance of future medical procedures and vaccinations.” 

The guidelines are based on 71 studies that include more than 8,000 children.  The goal is to create a national standard that will assist health-care professionals in managing children’s pain and distress during immunization.  Some of the recommendations include breastfeeding during vaccination, use of the least painful brand of vaccine, topical anaesthetics, and various distraction techniques.  It is also helpful to consider body positioning; for example, it is recommended that children do not lie down on their backs during vaccination.   These techniques can help prevent distress, development of needle fears and consequently health care avoidance. 

Most of the recommendations simply require new training and remain cost-neutral for parents and the health-care system.  The next step is to ensure that these recommendations translate into clinical practice.