PEDIATRICS Vol. 121 No. 6 June 2008, pp. 1294-1295 (doi:10.1542/10.1542/peds.2008-0647)
LETTER TO THE EDITOR |
Analgesic Properties of Oral Sucrose During Routine Immunizations
Dilek Dilli, MDDepartment of Pediatrics
Ankara Training and Research Hospital
06120 Ankara, Turkey
To the Editor.—
I read with great interest the article by Hatfield et al entitled "Analgesic Properties of Oral Sucrose During Routine Immunizations at 2 and 4 Months of Age."1 The authors concluded that administration of 2 mL of a 24% oral sucrose solution 2 minutes before routine immunizations was effective in decreasing maximum immunization pain and shortened the time before returning to a near-normal state in infants at 2 and 4 months of age.
Sucrose water (12%–50%; typically 1 packet of sugar in 10 mL of water) or other sweet solutions, when administered just before the procedure, have been shown to decrease the pain associated with procedures in neonates.2 It was thought that sucrose is effective in the neonatal period and loses its efficacy by 4 to 6 months of age.3 However, Allen et al4 have suggested 12% sucrose to be no more effective than sterile water but more effective than no intervention in reducing crying times for 2-week-old, 9-month-old, 15-month-old, and 18-month-old children receiving a single injection.
In our busy clinic we administer multiple immunizations serially without significant time in between vaccinations. I agree with Hatfield et al when they reported that sucrose is inexpensive, short acting, nonsedating, easily administered, and noninvasive and does not require additional training. They reported that use of a weight-based volume dose calculation of 0.6 mL/kg of a 24 g/1000 mL (24%) sucrose solution significantly reduced immunization pain. In recent research we evaluated the analgesic effects of a standard dose of 2 mL of 12% sucrose solution and lidocaine-prilocaine cream during vaccination of infants aged between 6 and 48 months and compared them with a no-intervention group. We observed crying time and pain scores to be significantly higher for children in the no-intervention group than those in the sucrose and lidocaine-prilocaine group. We also found that sucrose solution was as effective as lidocaine cream for children in this age group. In addition, parental reassurance, needle length, and injection technique were associated with high pain scores during vaccination in this age group. We expanded on previous findings by demonstrating that sucrose solution at a lower concentration might reduce infant distress and is safe and clinically useful beyond 6 months of age.
REFERENCES
- Hatfield LA, Gusic ME, Dyer AM, Polomano RC. Analgesic properties of oral sucrose during routine immunizations at 2 and 4 months of age.
Pediatrics. 2008;121
(2). Available at: www.pediatrics.org/cgi/content/full/121/2/e327
[Abstract/Free Full Text] - Lewindon PJ, Harkness L, Lewindon N. Randomised controlled trial of sucrose by mouth for the relief of infant crying after immunisation.
Arch Dis Child. 1998;78
(5):453
–456
[Abstract/Free Full Text] - Barr RG, Young SN, Wright JH, et al. "Sucrose analgesia" and diphtheria-tetanus-pertussis immunizations at 2 and 4 months. J Dev Behav Pediatr. 1995;16 (4):220 –225[Web of Science][Medline]
- Allen KD, White DD, Walburn JN. Sucrose as an analgesic agent for infants during immunization injections.
Arch Pediatr Adolesc Med. 1996;150
(3):270
–274
[Abstract/Free Full Text]
PEDIATRICS (ISSN 1098-4275). ©2008 by the American Academy of Pediatrics
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