White Coat, Black Art

Don't let pain make you refuse to vaccinate your kids

Is pain one of the big reasons why some parents refuse to vaccinate their kids? @NightshiftMD says it shouldn't be.
A new study looks into ways to reduce children feel when they get vaccinations. (Fred Chartrand/Canadian Press)

Public health officials estimate that just two per cent of parents refuse to have their infants vaccinated. But as many as twenty per cent of parents are hesitant to do so. One reason is that needles can be painful. A new study offers a solution to reduce the sting.

The most effective way to reduce the pain of immunizations was the focus of a study just published in the Canadian Medical Association Journal.  Doctors from the Hospital for Sick Children in Toronto enrolled more than 350 infants in a study that tested three methods that doctors used to reduce the pain of needles. They included an anaesthetic cream slathered on the skin just before the injection, a spoonful of a sugary solution given to the infant, and an educational video given to parents on how to soothe their babies. The best way to control the infant's pain consistently was to use all three methods - video for the parents, and sugar plus topical anaesthetic for the infants. Kids treated with all three had less anxiety about needles, and did not develop hypersensitivity to painful tests. Compared to placebo, kids treated with all three were significantly more likely to accept vaccinations down the road.

The Canadian Immunization Guide has incorporated ways to manage the pain from vaccinations. But surveys of clinics have found that pain management techniques aren't used often. Some health professionals don't learn effective techniques to manage the pain. The reason I hear often is that it takes several minutes to manage pain, but just a few seconds to actually give the needle. The fact that doctors tend to give lollypops to kids after giving the shot suggests that they know it hurts, but hope that the pleasure of the lollypop will reduce the memory of the pain of the needle. 

Public health experts say they don't know how big a role untreated pain plays in vaccine hesitancy. They believe other factors play a bigger role. There has been a lot of focus on the influence of the media and the Internet playing up stories that raise safety concerns about immunizations. There are studies that suggest that adolescents are more fearful of needles and pain from injections than are infants. Teenage fears about needles could be a factor in reduced vaccination rates in that age group. The bottom line is that vaccine hesitancy is real; almost one quarter of Canadian parents say their kids have not received at least one of the recommended vaccinations.

We should be concerned about this vaccine hesitancy to the extent that it leads to tangible action. Vaccine refusal has been associated with outbreaks of H. influenza meningitis and respiratory disease, chicken pox, pneumococcal pneumonia and meningitis, measles and whooping cough. In particular, measles outbreaks have been reported in parts of the U.S. that have high rates of vaccine delay and refusal. In the case of whooping cough, vaccine refusal has also been shown to be a contributing factor to recent outbreaks, although in fairness, the whooping cough vaccine also loses its effectiveness over time. 

The authors of the study in the Canadian Medical Association Journal recommend that doctors use anesthetic cream when giving vaccinations. They say the fact the pain is fairly brief is no excuse not to try and manage it. As for addressing other sources of vaccine hesitancy, doctors and nurses should discuss childhood immunizations with parents every chance they get -- annual check ups and especially when the child is sick. As for adolescents, they are more likely than infants to see the doctor after getting injured during physical education and playing sports. 

Public health experts say that a visit for a knee or ankle injury is a perfect opportunity for doctors to discuss vaccinations, and a missed opportunity when they don't.


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