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 Sugar solutions and lidocaine cream have long been among the options
some doctors use to make vaccinations less miserable for babies and
parents alike. But there’s not a lot of evidence to suggest exactly
which combinations of pain relief might work best, researchers note
in the Canadian Medical Association Journal.
To determine the most effective pain relief option, researchers
randomly assigned 352 healthy babies to one of four groups for all
of their vaccinations over the first year of life: video instruction
for parents on how to soothe infants during shots; videos for
parents and a sugary drink for babies; videos, sugary drinks and
anesthetic cream; and a control group that didn’t get any help with
pain.
“We only found a benefit from the combination of lidocaine with
sugar and the parent instructional video,” said lead study author
Dr. Anna Taddio, a pharmacy researcher at the University of Toronto.
“None of the other three treatment groups were different in terms of
the pattern of pain responses observed in the infants,” Taddio added
by email. “This suggests that the only effective pain intervention
was the lidocaine.”
For the experiment, every parent watched a video, but participants
in the control group saw a video that didn’t include any
instructions on infant pain relief.
Similarly, all babies received a drink and some cream regardless of
the group they were in. This way, participants didn’t know whether
infants actually got sugar water or lidocaine.
Researchers scored infant pain during vaccinations by observing how
much they grimaced, cried or made movements suggesting pain like
flailing their arms or kicking their legs. They also asked parents
to rate babies’ pain based on their observations of the infants
during vaccinations.
When used consistently during vaccinations over the first year of
life, only the regimen including lidocaine showed a benefit on acute
pain when compared with the other alternatives, the study found.
None of the regimens appeared to alter the time it took babies to
recover from pain after their shots.
In addition, pain changed as babies aged, steadily decreasing over
the first six months of life and then increasing at 12 months.
Because parents in all of the study groups could hold babies to
comfort them during vaccinations, it’s possible that this made it
difficult to detect any benefits associated with showing parents
instructional videos or giving babies sugar water, the authors note.
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Another limitation of the study is the potential for wide variation
in how parents implemented tips from the instructional video, which
may have made it hard to detect benefits from suggested
interventions like rhythmic breathing, cuddling and distracting
babies during shots, the authors also note.
The timing and dosing of sugar water, given all at once roughly one
to two minutes prior to shots, may have also made this option appear
less effective, said Denise Harrison, a researcher at the Children’s
Hospital of Eastern Ontario and the University of Ottawa in Canada.
“In babies beyond the newborn period, the analgesic effects wear off
quickly,” Harrison, who wasn’t involved in the study, said by email.
“The dose of sugar water needs to be given in small portions around
one minute before the procedure, then again just before each
injection,” Harrison said. “Using these recommended times in the
study may have changed the results.”
Proper pain relief during vaccinations can help avoid babies
developing negative associations with needle sticks that make shots
harder to deliver as they get older, Harrison added. It can also
make parents more likely to stick to recommended childhood
vaccination schedules.
“Although results are not compelling from this current study, we
still know what treatments help babies during vaccinations,”
Harrison said. “These include breastfeeding, sugar water, anesthetic
creams as well as distraction.”
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