Vaccines: there are a lot of them in childhood! And often, despite the fact we know they are uncomfortable, we often don't think what we can do about pain. But pain is important because pain itself may act as a deterrent to future vaccinations.

Now, a new Canadian guideline focuses on pain during vaccination and how it can be minimized in both children and adults. The guideline, published in CMAJ (Canadian Medical Association Journal) is targeted at all health care providers who administer vaccines.

This expanded and updated guideline includes recommendations for both children and adults whereas the 2010 guideline focused on children only.

The interventions can be divided into the so called 5 P's:

These are:

PROCEDURAL

PHYSICAL

  • Body position comfortable and have a sense of control
  • breast feeding
  • sucrose

PHARMACOLOGICAL

  • topical anesthetic

PSYCHOLOGICAL

  • distraction techniques
  • blow bubbles
  • spin pin wheels

PROCESS-EDUCATION

Key recommendations:

All ages:

  • Aspiration should not be used during intramuscular injections in people of all ages.
  • Inject most painful vaccine last for more than one vaccination.

Children:

  • Breast- or formula-feed infants under age 2 years during vaccination or give sugar solutions before injection.
  • Hold children aged 0-3 years during injections to provide comfort.
  • An upright position children and adults over age 3 years
  • Restraining children is not recommended.
  • Apply topical pain analgesics before injection in children under age 12 years.
  • Parents of children aged 10 years and under should be present during vaccination to lower the child's distress levels.

The authors also recommend educating parents, older children and adults about what to expect with a vaccination, how it might feel and what they can do to manage any pain.

Efforts should focus on making school vaccination campaigns a more positive health care experience for children.