New guidelines aim to reduce vaccination pain in children and adults

By Katie Grandin

Pain commonly experienced from vaccinations can cause fear and hesitation about getting future injections – and not only in children, in adults, too. This can result in future avoidance of vaccinations, putting people at risk of contracting infectious diseases that are largely preventable through vaccination.

A new Canadian guideline, published online in CMAJ (Canadian Medical Association Journal) on Aug. 24, aims to help minimize pain and distress from vaccinations in both children and adults. It outlines a variety of proven interventions that can reduce the pain that has historically been considered a necessary part of immunization.

Expanded from a 2010 guideline which focused on children only, the updated guideline was developed by HELPinKids&Adults, a multidisciplinary group from across the country with expertise in pain, fear, vaccines, nursing, epidemiology and other related fields. The team reviewed the latest literature on pain management for immunization to develop the guideline, including adults for a more comprehensive overview. The guideline is targeted at all healthcare providers who administer vaccines.

The project was led by Dr. Anna Taddio, Pharmacist and Senior Associate Scientist at The Hospital for Sick Children (SickKids) and Professor in the Leslie Dan Faculty of Pharmacy at the University of Toronto.

“While no single intervention in this guideline is expected to prevent all pain, individual interventions can be combined, as appropriate, to improve pain relief,” says Dr. Taddio. “For young and school-age children who experience high levels of distress with vaccine injections and have a higher potential for long-term harm such as needle fear and healthcare avoidance, a more comprehensive and consistent approach is needed.”

The guideline suggests that for people of all ages, aspiration (pulling back on the syringe to ensure it is not in the blood vessel) should not be used during intramuscular injections. They also advise injecting the most painful vaccine last rather than first during visits with more than one vaccination.

When vaccinating infants and toddlers, the guidelines recommend breast or formula feeding infants less than two years of age, or giving them a sugar solution prior to the injection. It also suggests holding children under the age of three during injections to provide them with a sense of comfort.

When administering a vaccination to children over the age of three, an upright position is recommended as it provides a sense of control and decreases fear. Parents of children aged 10 years and under should be present during vaccine injections to lower their child’s distress levels, and topical analgesics should be applied before injection in children under 12. The authors also recommend educating parents, older children and adults about what to expect with a vaccination and methods to manage any pain.

“Many of these recommendations can be used in a variety of settings where vaccines are delivered, whether in a physician’s office, a school or a workplace,” says Dr. Taddio.

The project was funded by the Canadian Institutes of Health Research (CIHR). To learn more about the new guidelines, please visit CMAJ’s press release and podcast.