Parents and health-care providers can take several steps to help reduce the pain of childhood immunizations, new Canadian guidelines say.

Vaccinations are the most common source of children's pain in health care, the researchers said.Five-year-old Kara Nguyen of Silver Spring, Md., clutches at her father's hand in October 2009 before receiving the H1N1 vaccine last October. Canadian experts developed guidelines on reducing pain from childhood immunizations. (Jacquelyn Martin/Associated Press)

Studies suggest that up to 25 per cent of adults have a fear of needles, and most of those fears develop in childhood.

Pain from vaccine injections need to be addressed at an early age to prevent needle fears and anxiety from building. An estimated 10 per cent of the population avoids vaccination and other such procedures because of fear of needles.

A panel of Canadian experts in immunization, pediatrics, pain, evaluating medical research, education and other fields developed the guidelines, which were published in Monday's Canadian Medical Association Journal.

The approaches combine pharmacological, physical and psychological factors.

After reviewing 71 studies involving more than 8,000 children, the experts suggested ways to reduce pain, including:

• Breastfeeding infants during immunization.
• Using the least painful brand of vaccine.
• Vaccinating rapidly in children.
• Using topical anesthetics.

The strategies can be combined and apply to healthy children receiving immunization injections worldwide, said guideline author Dr. Anna Taddio, a pharmacist at the Hospital for Sick Children and an associate professor in the Leslie Dan Faculty of Pharmacy at the University of Toronto.

"The education of all primary stakeholders involved in childhood immunization, including parents, children and health-care providers, is fundamental to any improvements in the delivery of vaccine injections in children," the guideline's authors concluded.

New technologies to give vaccines, such as microneedles, and needle-free techniques like nasal sprays are other alternatives that need to be researched, the authors said.

Several Canadian health-care groups, including the Canadian Pediatric Society, Canadian Family Practice Nurses Association and Canadian Pharmacists Association, have endorsed the guideline.