Abstract
Background
Although an effective public health intervention and a routine pediatric practice,
vaccines are a common source of iatrogenic pain in childhood. Techniques, such as
exam table restraint may cause infants to struggle and heighten distress, but studies
demonstrate that breastfeeding and lap holding are effective strategies to reduce
injection pain during vaccination.
Local problem
Adoption of pain-relieving techniques into clinical practice is often underutilized.
In a pediatric clinical practice in southern Connecticut, there were no guidelines
for providing pain mitigation strategies, including breastfeeding, during infant vaccination.
Methods and interventions
The Plan-Do-Study-Act (PDSA) cycle was used for the improvement process. A clinical
protocol introduced breastfeeding as a pain-relieving strategy during vaccination;
lap holding was a second option. All clinical staff were educated on the infant pain
experience, and nurses were further trained on vaccine administration techniques during
breastfeeding.
Results
A total number of 354 infants were seen for vaccination during the 12-week project:
168 were breastfed infants, of which 53% were breastfed during vaccination; 234 were
placed on the parent/caregiver's lap during vaccination; and only 13 infants were
restrained on the exam table. There was no documentation of position for 18 infants.
Conclusions
A clinical protocol was an effective tool to guide nurses on pain-relieving options,
such as breastfeeding and lap holding, during vaccine administration. Positive experiences
during vaccination administration have the potential for short-term and long-term
benefits including, compliance with routine care and adherence to vaccination schedules.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Pediatric Nursing: Nursing Care of Children and FamiliesAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Effects of breastfeeding and heel warming on pain levels during heel stick in neonates.International Journal of Nursing Practice. 2019; 25https://doi.org/10.1111/ijn.12734
- Infant analgesia with a combination of breast milk, glucose, or maternal holding.Pediatrics. 2018; 142https://doi.org/10.1542/peds.2017-3416
- Breast-feeding analgesia in infants.The Journal of Perinatal & Neonatal Nursing. 2017; 31: 145-159https://doi.org/10.1097/jpn.0000000000000262
Centers for Disease Control [CDC] (2016). Recommended vaccines by age. Retrieved from https://www.cdc.gov/vaccines/vpd/vaccines-age.html.
Centers for Disease Control [CDC] (2019). How to hold your child during vaccination. Retrieved from https://www.cdc.gov/vaccines/parents/visit/holds-factsheet.html.
- Comparison of effect of kangaroo mother care, breastfeeding and swaddling on Bacillus Calmette-Guerin vaccination pain score in healthy term neonates by a clinical trial.The Journal of Maternal-Fetal & Neonatal Medicine. 2017; 30: 1147-1150
- Breastfeeding for procedural pain in infants beyond the neonatal period.Cochrane Database of Systematic Reviews. 2018; https://doi.org/10.1002/14651858.cd011248
LaMorte, W. (2016). The Social Cognitive Theory. Retrieved May 1, 2020, from http://sphweb.bumc.bu.edu/otlt/MPH-Modules/SB/BehavioralChangeTheories/BehavioralChangeTheories5.html.
- The fear of needles: A systematic review and meta-analysis.Journal of Advanced Nursing. 2019; 75: 30-42
- Effect of breast-feeding and maternal holding in relieving painful responses in full-term neonates.The Journal of Perinatal & Neonatal Nursing. 2015; 29: 248-254https://doi.org/10.1097/jpn.000000000000012
- The effect of maternity leave length and time of return to work on breastfeeding.Pediatrics. 2011; 127: e1414-e1427
- Children's pain and distress at a public influenza vaccination clinic: A parent survey and public observation study.Journal of Community Health. 2019; 44: 322-331https://doi.org/10.1007/s10900-018-0590-1
- ABM clinical protocol #23: Non-pharmacological management of procedure-related pain in the breastfeeding infant.Breastfeeding Medicine. 2016, November 9; 11: 425-429
- Managing pain in early immunisation.Nursing New Zealand Nursing. 2015; 21: 22-24
- Reducing the pain of childhood vaccination: An evidence-based clinical practice guideline.Canadian Medical Association Journal. 2010; 182https://doi.org/10.1503/cmaj.101720
- Inadequate pain management during routine childhood immunizations: The nerve of it.Clinical Therapeutics. 2009; 31 (May 6): S152-S167
- Physical interventions and injection techniques for reducing injection pain during routine childhood immunizations: Systematic review of randomized controlled trials and quasi-randomized controlled trials.Clinical Therapeutics. 2009; 31: S48-S76https://doi.org/10.1016/j.clinthera.2009.07.024
- Routine immunization practices: Use of topical anesthetics and oral analgesics.Pediatrics. 2007; 120: e637-e643
- Conditioning and hyperalgesia in newborns exposed to repeated heel lances.JAMA. 2002, August 21; 288: 857-861
- Reducing pain at the time of vaccination: WHO position paper, September 2015-Recommendations.Vaccine. 2016; 34: 3629-3630https://doi.org/10.1016/j.vaccine.2015.11.005
Article info
Publication history
Published online: June 10, 2020
Accepted:
May 24,
2020
Received in revised form:
May 23,
2020
Received:
May 2,
2020
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
