Immunisation is a powerful defence against childhood disease that is safe, proven, and effective. Due to the success of vaccination programs, most parents in the United States have never witnessed the devastating effects that diseases such as measles, polio, or whooping cough can have on a family or the community in general.
While the risk of these diseases may not be immediately visible, they still exist. In fact, it has been shown that when vaccination rates fall in a community, there is an increased risk of a disease outbreak.
Although measles is not particularly common in the U.S., the Centers for Disease Control and Prevention (CDC) report that in 2014, a record number of measles cases occurred. This outbreak was due to people who were unvaccinated becoming infected while abroad and bringing measles back into the country. After entry to the US, measles spread rapidly among unvaccinated people.
While some children may experience complications including ear infections and diarrhea from measles, others may experience severe and life-threatening complications such as pneumonia and encephalitis. One or two children in every 1,000 will die from measles.
‘Gaps in knowledge about alleviating vaccination pain’
Doctors and researchers alike are currently trying to dispel myths that have arisen about vaccination safety and address other worries that parents may have. There are many reasons why parents may choose not to vaccinate their child, and potential injection pain is one of them.
Vaccines can cause short-term pain at the injection site. Children can become upset and anxious, and parents do not like to see their child suffering, which can have a domino effect leading to anxiety, fear, and refusal to keep up with vaccination schedules.
“Vaccinations cause acute distress for both infants and their parents, contributing to vaccination avoidance,” says Dr. Anna Taddio, a pharmacist and senior associate scientist at The Hospital for Sick Children (SickKids) and professor at Leslie Dan Faculty of Pharmacy, the University of Toronto, in Ontario, Canada. “However, there are gaps in knowledge about what is the best way to alleviate pain during vaccination.”
Researchers have taken on board the importance of pain management for parents and have investigated measures that could be put in place to assist with pain relief for infants during immunisations.
Guidelines suggest that strategies that may help with vaccination pain for children age 2-12 months include breastfeeding, sucrose (sugar) solution, anesthetic creams, and distractions using toys, bubbles, and singing.
Investigators put some of these methods to the test in a clinical trial to determine the best way to prepare parents for vaccinations and minimize pain for infants during and after injections.
Lidocaine cream put to the test against placebo
A total of 352 healthy infants were included in the trial from three paediatric outpatient clinics. All of the infants were receiving scheduled vaccinations from birth until 12 months of age. All parents watched a video to prepare them for the vaccination, and all infants received an oral solution and cream to put on the location of the injection. The infants were split into four groups.
Depending on which group they were in, the infants either received an oral sugar solution or placebo, or lidocaine anesthetic cream or placebo. The parents received a video instruction guide of how to soothe their baby or a “placebo” video with statements rather than advice. These groups were compared with a control group that received all placebo intervention.
The team discovered that with injections that took place during a baby’s first year, only the group that received the anaesthetic cream showed any relief from injection pain. They also found that up to 6 months of age, the infant’s response to pain decreased and then increased again at 12 months. The authors write:
“We found that, when used consistently during vaccine injections in the first year of life, only liposomal lidocaine combined with parental video instruction and orally administered sucrose showed a benefit on acute pain when compared with placebo, video alone, and video and sucrose together.”
“The effects of consistent pain management on the development of preprocedural anxiety (fear), hypersensitivity to pain and compliance with future vaccination warrant future investigation,” they recommend.