Parents, clinicians have limited options to alleviate pain of needles for babies

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The most effective way to minimize pain for babies getting vaccinations is a little numbing cream at the site of the shot – with some sugar water and cuddles thrown in for good measure.

That's the conclusion of a study that tried to figure out the best way to alleviate the pain of needles.

"Pain is something that distresses children and parents and sometimes leads parents to avoid or delay vaccination," said Dr. Anna Taddio, a pharmacist and senior associate scientist at the Hospital for Sick Children in Toronto.

"But, despite this, parents and health professionals aren't doing much for pain control."

The research, led by Taddio, is published in the Canadian Medical Association Journal. The study involved 352 babies between the age of two months to 12 months. Babies get up to a dozen vaccines in that first year of life (and two dozen by the age of five). The children were randomly assigned to one of four groups where:

• Parents were shown a video with techniques on how to soothe their baby, with hugs and breastfeeding, for example;
• The video was shown and the baby was given a mouthful of sugar water;
• The video was shown, the sugar water was given and the baby had an anesthetic cream containing lidocaine applied 30 minutes before the shot;
• The children received placebos – water with no sugar and cream with no numbing agent.

The children's reactions to the vaccinations were observed and ranked with commonly used pain score tools.

When all the numbers were crunched, only the group that received the cream with the active ingredient has significantly lower pain scores.

"This suggests that only the anesthetic is working," Dr. Taddio said.

While that confirms that lidocaine-based creams, which are sold under brand names such as EMLA and LMX4, can mitigate needle pain, the "findings are also a bit disappointing because they suggest the other approaches don't work that well."

Dr. Taddio cautioned, however, that approaches such as the use of sugar water and breastfeeding should not be abandoned and that education of parents is still important.

She said, for example, that the sugar content of the water may not have been strong enough to serve as a distraction.

"And if the educational video didn't help, maybe we have to make [a] better video," Dr. Taddio added.

The researcher also stressed that parents and clinicians can only do so much to mitigate pain and the manufacturers have to do their part by developing vaccines and delivery methods that are less painful, especially for babies.

Last year, Canadian researchers published guidelines for minimizing vaccine pain and the World Health Organization was inspired to do the same.

Dr. Christine Chambers, a clinical psychologist with The Centre for Pediatric Pain Research in Halifax, has also launched a social media campaign dubbed #itdoesnthavetohurt that has gone viral. She argues that children's pain has, for too long, not been taken seriously and that even minor "routine" pain such as that of needles should not be taken for granted because it causes trauma that shapes kids' perception of health care for their whole lives.