A World Health Organization (WHO) panel recently conducted a systematic review of 55 interventions related to pain management around injections. The resulting position paper concluded that pain management can be effectively addressed and does not hinder efficacy of vaccinations. The paper went on to describe which methods are recommended for use and which are not.

General measures

  • Addressed healthcare worker approach to the vaccination situation:
    • Having a calm, reassuring and sincere presence
    • Using neutral words instead of words or phrases that might increase anxiety
    • Avoiding the use of false reassurances or dishonest statements
  • Discussed proper positioning for the patient, particularly children.
  • Advised against aspiration during intramuscular (IM) injections.
  • Described appropriate order for giving multiple vaccines at once:
    • Rotavirus first if one of the vaccines to be given — the sucrose content helps with pain management
    • Any other oral vaccines next if needed (OPV)
    • Practical experience should be used to determine the best sequence for injections that follow

Specific measures

  • Infants and young children:
    • Caregivers should be present
    • Children younger than 3 years of age should be held; those 3 or older should be seated, possibly in a caregiver’s lap depending on age and size.
    • Breastfeeding:
      • Offer oral vaccines then, if culturally appropriate, have mom breastfeed during injections
      • Breastfeed slightly before or during vaccination if all vaccines needed are injectable
    • Children younger than 6 years of age can be distracted with toys, conversations, etc.
  • Adults:
    • Distraction with breathing interventions (small cough or breath holding)
  • Adolescents:
    • Distractions were not found to be effective in this age group

Not recommended

  • Topical anesthetics:
    • Found to be effective, but costly in terms of price and time
    • Do not affect immune response
  • Warming vaccine (by rubbing in hands)
  • Rubbing or pinching the injection site
  • Administration of oral analgesics before or at the time of vaccination:
    • Can be offered for pain or fever during the days that follow vaccination

Review or download the report published in the Weekly Epidemiological Record, WHO, Sept. 25, 2015.

Materials in this section are updated as new information and vaccines become available. The Vaccine Education Center staff regularly reviews materials for accuracy.

You should not consider the information in this site to be specific, professional medical advice for your personal health or for your family's personal health. You should not use it to replace any relationship with a physician or other qualified healthcare professional. For medical concerns, including decisions about vaccinations, medications and other treatments, you should always consult your physician or, in serious cases, seek immediate assistance from emergency personnel.