Psychological Interventions for Vaccine Injections in Children and Adolescents Randomized clinical trial of distraction for infant immunization pain Procedural and Physical Interventions for Vaccine Injections Toy-mediated distraction: clarifying the role of agent of distraction and preneedle distress in toddlers. Comparison of EMLA cream with rattles on reducing immunization pain in four months infants. Reducing infant immunization distress through distraction. Effect of distraction techniques in behaviour responses to pain among toddlers receiving immunisation.
Background : This systematic review evaluated the effectiveness of psychological interventions for reducing vaccination pain and related outcomes in children and adolescents . Design / Methods : Data base search es identified relevant r and omized and quasi-r and omized controlled trials . Data were extracted and pooled using established methods . Pain , fear , and distress were considered critically important outcomes . Results : Twenty-two studies were included ; 2 included adolescents . Findings showed no benefit of false suggestion ( n=240 ) for pain ( st and ardized mean difference [ SMD ] −0.21 [ −0.47 , 0.05 ] ) or distress ( SMD −0.28 [ −0.59 , 0.11 ] ) , or for use of repeated reassurance ( n=82 ) for pain ( SMD −0.18 [ −0.92 , 0.56 ] ) , fear ( SMD −0.18 [ −0.71 , 0.36 ] ) , or distress ( SMD 0.10 [ −0.33 , 0.54 ] ) . Verbal distraction ( n=46 ) showed reduced distress ( SMD −1.22 [ −1.87 , −0.58 ] ) , but not reduced pain ( SMD −0.27 [ −1.02 , 0.47 ] ) . Similarly , video distraction ( n=328 ) showed reduced distress ( SMD −0.58 [ −0.82 , −0.34 ] ) , but not reduced pain ( SMD −0.88 [ −1.78 , 0.02 ] ) or fear ( SMD 0.08 [ −0.25 , 0.41 ] ) . Music distraction demonstrated reduced pain when used with children ( n=417 ) ( SMD −0.45 [ −0.71 , −0.18 ] ) , but not with adolescents ( n=118 ) ( SMD −0.04 [ −0.42 , 0.34 ] ) . Breathing with a toy ( n=368 ) showed benefit for pain ( SMD −0.49 [ −0.85 , −0.13 ] ) , but not fear ( SMD −0.60 [ −1.22 , 0.02 ] ) ; whereas breathing without a toy ( n=136 ) showed no benefit for pain ( SMD −0.27 [ −0.61 , 0.07 ] ) or fear ( SMD −0.36 [ −0.86 , 0.15 ] ) . There was no benefit for a breathing intervention ( cough ) in children and adolescents ( n=136 ) for pain ( SMD −0.17 [ −0.41 , 0.07 ] ) . Conclusions : Psychological interventions with some evidence of benefit in children include : verbal distraction , video distraction , music distraction , and breathing with a toy & NA ; Distraction has been shown to be an effective technique for managing pain in children ; however , few investigations have examined the utility of this technique with infants . The goal of the current study was to investigate the effectiveness of movie distraction in reducing  infants ’ immunization distress .  Participants were 136 infants ( range = 1–21 months ; M = 7.6 months , SD = 5.0 months ) and their parents , all of whom were recruited when presenting for routine vaccinations . The parent – child dyads were r and omly assigned to either a Distraction or Typical Care control condition . Infant and adult behaviors were assessed using a visual analog scale and a behavioral observation rating scale . Results indicated parents in the Distraction group engaged in higher rates of distraction than those in the Typical Care group , whereas there was no difference in the behavior of nurses in the Distraction and Typical Care groups . In addition , infants in the Distraction group displayed fewer distress behaviors than infants in the Typical Care group both prior to and during recovery from the injection . Findings suggest that a simple and practical distraction intervention can provide some distress relief to infants during routine injections Background : This systematic review evaluated the effectiveness of physical and procedural interventions for reducing pain and related outcomes during vaccination . Design / Methods : Data bases were search ed using a broad search strategy to identify relevant r and omized and quasi-r and omized controlled trials . Data were extracted according to procedure phase ( preprocedure , acute , recovery , and combinations of these ) and pooled using established methods . Results : A total of 31 studies were included . Acute infant distress was diminished during  intramuscular injection without  aspiration ( n=313 ) : st and ardized mean difference ( SMD ) −0.82 ( 95 % confidence interval [ CI ] : −1.18 , −0.46 ) . Injecting the most painful vaccine last during vaccinations reduced acute infant distress ( n=196 ) : SMD −0.69 ( 95 % CI : −0.98 , −0.4 ) . Simultaneous injections  reduced acute infant distress compared with sequential injections ( n=172 ) : SMD −0.56 ( 95 % CI : −0.87 , −0.25 ) . There was no benefit of simultaneous injections in children . Less infant distress during the acute and recovery phases combined occurred with vastus lateralis ( vs. deltoid ) injections ( n=185 ) : SMD −0.70 ( 95 % CI : −1.00 , −0.41 ) . Skin-to-skin contact in neonates ( n=736 ) reduced acute distress : SMD −0.65 ( 95 % CI : −1.05 , −0.25 ) . Holding infants reduced acute distress after removal of the data from 1 method ologically diverse study ( n=107 ) : SMD −1.25 ( 95 % CI : −2.05 , −0.46 ) . Holding after vaccination ( n=417 ) reduced infant distress during the acute and recovery phases combined : SMD −0.65 ( 95 % CI : −1.08 , −0.22 ) . Self-reported fear was reduced for children positioned upright ( n=107 ) : SMD −0.39 ( 95 % CI : −0.77 , −0.01 ) . Non-nutritive sucking ( n=186 ) reduced acute distress in infants : SMD −1.88 ( 95 % CI : −2.57 , −1.18 ) . Manual tactile stimulation did not reduce pain across the lifespan . An external vibrating device and cold reduced pain in children ( n=145 ) : SMD −1.23 ( 95 % CI : −1.58 , −0.87 ) . There was no benefit of warming the vaccine in adults . Muscle tension was beneficial in selected indices of fainting in adolescents and adults . Conclusions : Interventions with evidence of benefit in select population s include : no aspiration , injecting most painful vaccine last , simultaneous injections , vastus lateralis injection , positioning interventions , non-nutritive sucking , external vibrating device with cold , and muscle tension BACKGROUND Distraction has recently gained attention as a technique that may help reduce acute pain in infants and toddlers ; however , results remain equivocal . It appears that these mixed results stem from a variety of method ological differences with regard to how distraction is implemented . OBJECTIVES To offer more definitive conclusions regarding the efficacy and mechanisms of distraction for pain management during infancy . Specifically , the goal was to examine whether the agent of distraction ( i.e. , the specific person conducting the distraction ) and preneedle distress behaviours impact the efficacy of distraction when toddlers were held by parents . METHODS A total of 99 toddlers were r and omly assigned to one of three conditions ( typical care , research assistant-directed distraction or parent-directed distraction ) . Toddler distress behaviours were assessed pre- and postneedle . Toddlers were further grouped according to distress behaviours preneedle ( low⁄no distress versus high distress ) . Parental soothing behaviours were also assessed as a manipulation check . RESULTS Toddler postneedle pain did not significantly differ among groups . However , toddlers who were distressed preneedle displayed significantly more pain postneedle , regardless of the treatment group . There were no significant interactions between treatment group and preneedle distress behaviours . CONCLUSIONS These results suggest that , when being held by a parent , distraction using a toy does not result in lower pain scores in the context of immunization , regardless of who offers the distraction . Furthermore , these findings raise the notion that if clinicians ensured toddlers were regulated before attempting an immunization , postneedle pain may be significantly reduced OBJECTIVE To assess the effect of Eutectic Mixture of Local Anaesthetics cream and rattle on soothing the vaccination pain on four-month-infants . METHODS The single blind r and omised clinical trial was conducted from May 2012 to February 2013 at a clinic under the Gonabad University of Medical Sciences , Iran , and comprised four-month infants who were selected r and omly and divided into three groups . In one group , 2 g of eutectic mixture of local anaesthetics cream was rubbed on the injection spot before administration ; for the other group , the rattle was shaken from 30s to 15s before injection . The last group consisted of controls . The infants were filmed after vaccination . Afterward , a pain question naire was filled out by a trained observer . SPSS 11.5 was used for statistical analysis . RESULTS Of the 50 subjects in the study 16 ( 32 % ) each were in the cream and rattle groups , while the rest ( 36 % ) were in the control group . The severity of the pain before intervention in the control , cream and rattle groups was 2.22 + /- 0.88 , 2.12 + /- 0.95 and 2.25 + /- 1.06 respectively , which were not statistically significant ( p < 0.93 ) . Likewise , the mean severity of pain at the moment of intervention in the three above groups were 8.67 + /- 0.77 , 7.12 + /- 0.5 and 7.87 + /- 0.96 respectively , which was significantly different ( p < 0.001 ) . The severity of pain 15seconds after the intervention in the groups was 5.06 + /- 1.51 , 4.87 + /- 1.31 and 4.19 + /- 1.94 respectively , which were not statistically different ( p < 0.27 ) . CONCLUSION The eutectic mixture of local anaesthetics cream and shaking rattle were effective in attenuating pain of vaccination among the infants , but the latter was not as significant as the former Infant procedural distress is largely understudied , and there is a dearth of empirically supported interventions in the child health psychology literature . This study examined nurse-directed distraction for reducing  infant immunization distress . Ninety infants and their parents were r and omly assigned to a distraction condition ( i.e. , nurses used stimuli to divert infants ' attention ) or a typical care condition . Outcome measures were an observational scale , parent and nurse ratings , and infant heart rate . Results indicated that infants engaged in distraction and that distraction reduced their behavioral distress ; however , ratings and heart rate were inconclusive . Analyses of procedural phases indicated that infants exhibited elevated distress immediately prior to and during an injection , but this distress was fleeting Pain and distress during immunisation of toddlers are reasons for non-immunisation of large number of toddlers . The present study was undertaken to assess the comparative effectiveness of distraction techniques  in the process of immunisation i.e. toy and music . ( The third group of study subjects was control group )  . It is concluded that distraction techniques are quite economical and safe in enhancing the magnitude of immunisation
BACKGROUND This systematic review evaluated the effectiveness of distraction for reducing infant distress during vaccinations in young children aged 0 to 3 years .