Table 2:
Recommendations to reduce pain during vaccine injections in children*
| Clinical question | Recommendation | Level of evidence† | Grade of recommendation† |
|---|---|---|---|
| Infants | |||
| Among infants undergoing vaccination, does breastfeeding during the procedure reduce pain at the time of injection? | To reduce pain at the time of injection, encourage breastfeeding mothers to breastfeed their infants during vaccination | I | A |
| Among infants undergoing vaccination, does administration of sweet-tasting solutions reduce pain at the time of injection? | To reduce pain at the time of injection among infants up to 12 months of age who cannot be breastfed during vaccination, administer a sweet-tasting solution during vaccination | I | A |
| Injection procedure | |||
| Among children undergoing vaccination, does administering one commercial brand of a vaccine rather than another commercial brand of the same vaccine cause less pain at the time of injection? | If more than one commercial brand of a vaccine is available, and the brands are interchangeable, inject the least painful brand during vaccination of children, to reduce pain at the time of injection | I | A |
| Among children undergoing vaccination, does positioning the child in a supine position result in more pain at the time of injection? | To reduce pain at the time of injection, do not place children in a supine position during vaccination | I | E |
| Among children undergoing intramuscular injection of vaccine, should slow injection with aspiration be avoided to reduce pain at the time of injection? | To reduce pain at the time of injection, administer intramuscular vaccines to children using a rapid injection technique without aspiration | I | B |
| Among children receiving multiple vaccine injections at a single vaccination visit, does injecting the most painful vaccine last decrease pain at the time of injection? | When administering multiple vaccine injections to children sequentially, inject the most painful vaccine last to reduce pain at the time of injection | I | B |
| Among children undergoing vaccination, does rubbing the skin near the injection site before and during the procedure result in less pain at the time of injection? | To reduce pain at the time of injection among children aged ≥ 4 years, offer to rub or stroke the skin near the injection site with moderate intensity before and during vaccination | II-1 | B |
| Parent-led interventions | |||
| Among children undergoing vaccination, does use of (1) parent-led distraction or (2) parent coaching result in less pain and pain-related distress at the time of injection? | Although there is insufficient evidence for or against the use of parent-led distraction or parent coaching during vaccination of children as a way to reduce pain at the time of injection, clinicians may offer this intervention to parents to reduce pain-related distress | I | B |
| Pharmacotherapy | |||
| Among children receiving intramuscular and subcutaneous injection of vaccines, does application of topical anesthetics on the skin before the injection reduce pain at the time of injection? | To reduce pain at the time of injection, encourage parents to use topical anesthetics during vaccination of children | I | A |
| Psychological interventions | |||
| Among children undergoing vaccination, does use of clinician-led distraction result in less pain at the time of injection? | To reduce pain at the time of injection, use clinician-led distraction techniques during vaccination of children | I | B |
| Among children undergoing vaccination, does use of child-led distraction result in less pain at the time of injection? | To reduce pain at the time of injection among children aged ≥ 3 years, use child-led distraction techniques during vaccination | I | B |
| Among children undergoing vaccination, does slow, deep breathing or blowing performed by the child result in less pain at the time of injection? | To reduce pain at the time of injection, have children aged ≥ 3 years engage in slow, deep breathing or blowing during vaccinations | I | B |
| Among children undergoing vaccination, does use of combined psychological interventions (i.e., interventions that include at least one cognitive and one behavioural intervention) result in less pain and distress at the time of injection? | To reduce pain at the time of injection among children aged ≥ 3 years, use combined psychological interventions during vaccination | I | B |
| Among children undergoing vaccination, does suggesting that “it won’t hurt” result in less pain at the time of injection? | Do not tell children that “it won’t hurt,” as this type of statement, when used alone, has been shown to be ineffective in reducing pain at the time of injection | I | D |
*
There is some evidence that combining strategies improves pain relief.
†
Levels of evidence and grades of recommendation are defined in Table 1.