Vaccination: quick and (almost) painless

Following on from my last blog regarding the HPV vaccination and how it has benefits for both boys and girls, it is interesting to see that new guidelines have been developed to help doctors and nurses who inject children.  These guidelines focus on how we can reduce distress for the child.
As a parent, and a GP, I am very familiar with the stress that comes with having one of your children vaccinated.  There’s no escaping the fact that for a brief moment, the jab is going to cause a prick or a sting, and all we can do is comfort our children and distract them if possible, safe in the knowledge that we have acted in their very best interests.  It is always over very quickly and soon forgotten, but the lead up to vaccination day can be a source of anxiety.  Mums and Dads sometimes find the process too tough to handle, and we frequently see the task delegated to Grandparents or one parent in particular, no doubt after much personal deliberation!

Why are the guidelines important?
I hope it will be encouraging to hear that a great deal of thought and investigation has gone in to how a child receives their vaccination.  What on the surface may appear to be a quick jab, actually involves some considered thought on how we can make the process as free from distress as possible. The guidelines I mentioned have been prepared by the Royal Australian College of General Practitioners.  They provide a focused reminder for healthcare workers on how to give the best service in this important role. 
Knowledge of pain prevention and management techniques has been shown in clinical studies to reduce pain, fear and distress in the child.  What’s more, being armed with some information as the parent, and involving older children in some discussion prior to the vaccine, can also improve the experience.

The Guidelines
The guidelines begin with a reminder that vaccination is the most common cause of iatrogenic (ie caused by the doctor) pain in childhood.  What follows is a list of the recommendations and the strength of evidence available for each. I have summarised the recommendations below with some brief explanation:

The Process of Injecting
Avoid aspirating
Typically when a nurse or doctor injects, we will insert the needle and then draw back a little to make sure the tip is not inside a blood vessel.  The aim is to place the vaccine fluid in the muscle where it is absorbed. However, this takes a little longer and causes slightly more pain.  As long as the needle is correctly placed, it is not needed in childhood vaccination.

Simultaneous injecting
As alarming as it may sound, it is less distressing for a young child to have 2 needles at once rather than one after another.  This usually means one needle in each thigh provided by 2 practitioners, but is not always practically possible.

Leave the worst until last
It is known that unfortunately some vaccines are a little more uncomfortable than others.  Whether young or old it has been shown that the best process is to leave the most painful jab until last.

Where to inject
Up to one year of age the thigh is generally better tolerated than the upper arm.

Physical considerations
Sitting upright and being held
In children over three years, sitting upright provides more comfort than lying flat.  In younger children, holding close during the injection, and rocking or patting afterwards reduces distress.  These often seem natural and occur without prompting in many cases.

Skin to skin contact
For the very youngest babies, this most natural situation is most effective, typically with the baby in a nappy held to the upper chest.

Sucking
Either with a dummy, bottle or even breast feeding, reduces pain and distress.

Distraction
The final advice provided focuses on the benefit of distraction.  This should be appropriate to the age of the child.  Video and toy distractions work well with young children, whereas breathing techniques, music and verbal distraction may yield better results with older children.  Babies tend to benefit from a sweet solution in addition to other distractions, with breast feeding being the ultimate example of this.

So there we have it.  Some of the recommendations are common sense and occur naturally during the vaccination process, however preparation and knowledge of these techniques has the potential to reduce distress significantly.  Rest assured we keep these in mind whenever we see a child for their vaccination as our goal is the same as yours – make it quick and (almost) painless.

With best wishes

Dr James Hunt

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