Randomized clinical trial of distraction for infant immunization pain

Cohen, Lindsey L.; MacLaren, Jill E.; Fortson, Beverly L.; Friedman, Abby; DeMore, Melissa; Lim, Crystal S.; Shelton, Elisabeth N; Gangaram, Balram

doi:10.1016/j.pain.2006.05.016

Cited by 61 publications

(55 citation statements)

References 25 publications

(32 reference statements)

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“…47,48 In addition, research suggests that parents' behavior during children's procedures accounts for a great deal of the variability in children's coping and distress. 49 Specifically, adult distraction and coaching in coping behavior has been shown repeatedly to lower child dis-tress, 50 other adult behavior is positively associated with child distress (eg, criticism, apologizing, giving control), and some evidence exists that reassurance (eg, saying, "everything is okay; you are going to be alright") might cause or exacerbate child distress. 51 As such, preparing parents for their children's upcoming venous access might include informing and training them in beneficial behavior (ie, coaching to cope, distraction) and encouraging them to avoid behaviors that are not helpful (eg, excessive reassurance, criticism).…”

Section: Parentsmentioning

confidence: 99%

Behavioral Approaches to Anxiety and Pain Management for Pediatric Venous Access

2008

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Pediatric venous access causes unnecessary anxiety and pain in children and, in turn, can have detrimental consequences. Behavioral approaches to pediatric venous access distress management can be organized temporally. Specifically, preparation before the procedure includes providing children with sensory and procedural information in an age-appropriate manner and providing training in coping skills. It is important to consider the timing, format, and content of the approach to provide optimal preparation for the unique circumstances of the individual patient. In addition to the child patient, preparing parents and teaching them which specific behaviors might be most helpful to their child should prove valuable to both patient and parents. During the procedure, there are benefits to providing secure and comfortable positioning. In addition, researchers recommend that adults encourage children to cope and actively engage children in distracting activities. For infants, there is support for the distress-mitigation properties of swaddling, skin-to-skin contact, breastfeeding, and sucrose. After venous access, distraction and encouragement of coping should speed recovery. In sum, research in behavioral approaches to pediatric pain management has provided recommendations for minimizing children's anxiety and pain associated with venous access. Pediatrics 2008;122:S134-S139 P EDIATRIC PAIN FROM medical procedures results in short-term suffering, but there are recent data to indicate that there are also long-term detrimental effects. Specifically, early painful insults might have lasting negative effects on neuronal development, pain threshold and sensitivity, coping strategies, emotionality, and pain perceptions. 1,2 As an example, Bijttebier and Vertommen 3 showed that children with a history of negative medical experiences showed high anxiety before venipuncture and were distressed and uncooperative during the procedure. Childhood medical pain has also been linked to later adulthood fear, pain, and avoidance of medical care. 4 In addition, high pain at medical visits predicts missed future medical appointments and poor health care follow-up. [5][6][7] Fortunately, there is a rich body of data supporting behavioral strategies that mitigate the anxiety and pain associated with pediatric medical procedures generally, 8 and children's needle-related pain in particular. 9 Nonpharmacologic or behavioral approaches to acute pediatric pain are rooted in the gate-control theory. 10,11 The theory suggests that descending nerve impulses from the brain, such as thoughts, beliefs, emotions, and attention, can influence the ascending pain signal from the tissue damage. For example, anxiety might heighten pain experience, whereas attention focused on a pleasant activity might decrease pain. Thus, behavioral interventions typically involve teaching coping, inducing relaxation, or providing distraction. Although literature documenting the efficacy of behavioral interventions for children's acute medical pain exists, the data...

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Section: Parentsmentioning

confidence: 99%

Behavioral Approaches to Anxiety and Pain Management for Pediatric Venous Access

2008

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“…22 In three studies, video was used as the means for distraction during vaccinations. [23][24][25] In all three studies, the findings were insignificant (Luthy et 23 study ranged in age from 2 to 12 years. An evaluation tool assessed the parent's perception of the child's pain using the Wong-Baker FACES Pain Rating Scale, a Likert scale rating anxiety, and a comparison of the current vaccination experiences with the most recent vaccination experience.…”

Section: Distraction Video Distractionmentioning

confidence: 88%

“…Cohen et al 24 and Cohen 25 evaluated video distraction in children 1 month to 3 years of age. Infant pain measurements require rating behaviors such as crying, facial expressions, flailing of arms and legs, and state of arousal, as well as evaluating physiological factors such as heart rate, breathing patterns and blood pressure.…”

Section: Distraction Video Distractionmentioning

confidence: 99%

“…Infant pain measurements require rating behaviors such as crying, facial expressions, flailing of arms and legs, and state of arousal, as well as evaluating physiological factors such as heart rate, breathing patterns and blood pressure. 24 Cohen et al 24 used the Measure of Adult and Infant Soothing and Distress (MAISD) rating scale that evaluates the behaviors of infants, parents, and nurses during painful medical procedures in infants. Additionally, research assistants completed VAS scoring as another evaluation tool.…”

Section: Distraction Video Distractionmentioning

confidence: 99%

“…However, it does help relieve anxiety before and after vaccinations. [23][24][25] Music is not an effective distraction technique for younger children. 7 …”

Section: Ineffective Measures Distractionmentioning

confidence: 99%

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Minimizing pain during childhood vaccination injections: improving adherence to vaccination schedules

Eden¹,

Macintosh²,

Luthy³

et al. 2014

PHMT

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Pain experienced in childhood can lead to long-term and psychologically detrimental effects. Unfortunately, the most common pain experienced in childhood is caused by vaccinations and may lead to non-adherence to the recommended vaccination schedule. As a result, it is the health care provider's responsibility to take measures to reduce vaccination pain; however, there are a plethora of pain relieving interventions during immunizations and it is unclear which interventions are most cost efficient, timely, and effective. Studies have been conducted to investigate the efficacy of different pain management interventions during vaccinations. This review evaluates various pain relieving interventions and provide health care providers age appropriate guidance on pain relieving interventions during vaccinations. Employment of these strategies may successfully reduce vaccination-associated pain in infants, children, and adolescents, and may improve compliance with the vaccination schedule.

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