Published online July 13, 2009
PEDIATRICS Vol. 124 No. 2 August 2009, pp. e203-e209 (doi:10.1542/peds.2007-3466)
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ARTICLE

Reducing Immunization Discomfort in 4- to 6-Year-Old Children: A Randomized Clinical Trial

F. Ralph Berberich, MD and Zachary Landman, BA

Pediatric Medical Group, Berkeley, California

OBJECTIVE: The goal was to test a multifaceted distraction method designed to reduce injection-associated pain in school-aged children.

METHODS: A clinical trial evaluated 41 children, 4 to 6 years of age, who were given 3 standard prekindergarten immunizations; 21 were assigned randomly to an office routine control group, whereas 20 received a multifaceted, discomfort-reducing intervention. The intervention added verbal suggestions of diminished sensation and a visual focusing activity to the use of ethyl chloride, an established pain-reducing measure. The distraction materials used for the intervention consisted of topical ethyl chloride spray, an improvised, plastic, multipronged arm gripper, and a vibrating instrument descending on the contralateral arm, which provided the focusing task and visual distraction.

RESULTS: According to patient and parent Faces Pain Scale-Revised scores and nonblinded, video-taped observations scored according to the face-legs-activity-crying-consolability method, the intervention group showed highly significant reductions in pain and discomfort, compared with the control group (patient self-report, P < .0013; parent report, P < .0002; observation score, P < .0001).

CONCLUSION: This multifaceted distraction intervention reduced significantly the pain and discomfort of childhood immunizations in children 4 to 6 years of age.

Key Words: distraction • hypnosis • injections • immunization • pain • anxiety

Abbreviations: FPS-R—Faces Pain Scale-Revised • FLACC—face-legs-activity-crying-consolability • MMR—measles-mumps-rubella

Accepted Mar 12, 2009.


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