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.
- 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
- 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.
- 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.
- Distraction with breathing interventions (small cough or breath holding)
- Distractions were not found to be effective in this age group
- 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.