Table 1.
Recommended interventions to reduce injection-site pain or prevent syncope associated with preteen and teen vaccinationa
| Technique | Description |
|---|---|
| Pain reduction19,23,25 | |
| Preparation | In advance, give the patient an information sheet that discusses the steps of the vaccination procedures and what to expect |
| Breathing exercises | Tell the patient to take slow breaths and focus on deep breathing from the diaphragm rather than the chest (eg, pretend to inflate or deflate a tire through inhaling/exhaling) |
| Distraction techniques | Use techniques that take attention away from pain to specific counteractivities |
| Order of injections | When 2 vaccines are being given during the same visit, administer the vaccine associated with the most injection-site pain last |
| Positioning | Ask the patient to sit upright or stand against the examination table during vaccination |
| Rapid injection of vaccine | Give vaccination quickly |
| Tactile stimulation | Rub or stroke the arm near the injection site before and during vaccine injections |
| Topical anesthetic agents | Apply a topical agent containing pain reliever on the skin where the vaccine will be injected ahead of time (up to 1 hour ahead at home or on arrival to the appointment) |
| Syncope prevention | |
| Patient education32 | Before visit: Provide an educational brochure about ways to prepare for the visit and prevent potential symptoms of faintness or dizziness During visit: Ask about history of fainting with medical procedures; discuss concerns and how to prevent future reactions |
| Water consumption28,29,31–33 | Tell the patient to drink 500 mL (approximately 16 oz) of water 30 min before vaccination |
| Sodium consumption32,33 | Suggest that the patient eat salty food or take a salt tablet (sodium chloride) before vaccination |
| Caffeine consumption26 | Recommend consuming 250 mg of caffeine (equivalent to about 2.5 cups of coffee) 45 min to 1 h before vaccination |
| Applied muscle tension22,28,32–34 | Examples include the patient gripping and contracting a rubber ball with the hand of the nonvaccinated side, tensing of the nonvaccinated arm, or leg crossing/tensing |
| Reclining during and after vaccination | Advise the patient to sit or lie down while the shot is given and for 15–20 min after |
| Social support30 | Have a medical assistant, parent, or friend provide encouragement and reassurance and make small talk during the vaccination |
a
This list was developed using a literature review that identified interventions used to reduce pain and syncope among children during vaccination and among blood donors. Interventions were included if they were contained in the scientific literature, although the size of the effect of the intervention on outcomes was not considered.