Pain at the time of vaccine injection is a common concern amongst parents worldwide. Fear of vaccination pain can contribute to vaccine hesitancy, lowering immunisation coverage and increasing the risk of vaccine preventable disease. Parents expect health providers to make vaccination less painful and want advice on how they can help. The World Health Organization (WHO) recommends that vaccinators are taught pain mitigation strategies and, in turn, teach caregivers and vaccinees.
Overall goal: Provide a calm vaccination experience
- Avoid aspiration when injecting vaccines. This reduces pain by less contact time with the needle and less chance for movement.*
- Administer the most painful vaccine last, if known. More research is needed for this recommendation.*
- Encourage breastfeeding before and during vaccine injection, if this is culturally acceptable.*
- Hold baby during injection (preferably by the parent/caregiver) to help soothe them. Avoid laying baby on his/her back on abed or table.
- Give the oral RotaTeq® vaccine before the injected vaccines at the 6 week, 3 month and 5 month visits. RotaTeq® has a high sucrose content; over 25 years of research has shown that sweet solutions can provide short-term pain relief.
- Use neutral verbal cues*
- Avoid anxiety provoking language.
- Avoid excessive reassurance.
- Avoid false suggestions about pain.
- Discuss management of discomfort so caregivers can participate – encourage them to think about what may help before the appointment and bring their child’s favourite toy, book, game, etc.
- Encourage an anxious parent/caregiver to use relaxation strategies for themselves, such as abdominal breathing, or engage the assistance of another family member.
- Tell a child aged 4 years or older about the vaccination process in advance. On the day, sit them upright and use a ‘comfort hold’, not restraint.
- Provide distraction to suit the child during injection:
- Deep abdominal breathing with counting, a stress ball, singing.
- Book, tablet, toy.
- Bubbles, held by the child during injection.
- Consider the use of anaesthetic cream for distressed children, if the cost is acceptable to the family (over the counter pharmacy cost varies).
- Ensure those involved are calm and prepared.
*These four strategies are strongly recommended by the World Health Organization.
- Place one hand on the chest and the other on the abdomen.
- Breathe in through the nose for a count of three, feel the abdomen expand.
- Breathe out through the mouth for a count of three, feel the abdomen deflate.