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0534046001558358672.jpgFor those who regularly visit this site as I comment on children’s health, you have seen several entries regarding the advantages that immunizations bring to children specifically and the greater public generally. Unfortunately, we still have the unpleasant issue of the painful needles necessary to administer most of those treatments. Nobody likes those things. What can we do together to minimize that discomfort associated with that maximum health benefit?

First, let’s address options that are ineffective and often counter-productive:

  • Divided or half doses given more frequently will not result in a full and effective immune response and, as it requires double the actual needle sticks, actually increases the pain.
  • Warming the vaccine in one’s hands can alter the vaccine effectiveness.
  • Pre-treatment with oral analgesics like acetaminophen may also compromise vaccine immunogenicity.
  • Altering the route of administration. Intramuscular immunizations are effective only if given intramuscularly. Giving them subcutaneously may be less painful but is largely useless for the purpose of infection prevention.

Here are strategies that I recommend and try to employ:

  • Quickly inject and administer vaccine. There is no need to aspirate(pull back) on the needle–there are no large blood vessels in the belly of these muscles. Aspirating slows vaccine administration and prolongs the pain.
  • Administering analgesics like acetaminophen after injection when the child is symptomatic is certainly helpful.
  • Younger children should be held by parents during injection.
  • Allow mother to breastfeed infants during injection if she desires.
  • Allow infants to suck on a pacifier soaked with 25% sucrose solution (which I now stock)is helpful.
  • Cold compresses, like ethyl chloride solution sprayed in a cotton ball and held against the skin for 15 seconds prior to injection has been shown to be useful for children > 3 years old.
  • Topical anesthetics. Ask me for a prescription for EMLA cream to be applied for 1 hour before injection. EMLA is not covered by all insurance plans but is generally not expensive.

One more thing: as I point out often, you are your child’s best teacher. If you have a relaxed and positive attitude about immunization, confident that the pain is only a momentary and small inconvenience for a strong and useful health tool, you can convey that lesson to your child. As Aunt Catherine states in “Marty”–one of my favorite old movies, “Don’t make an opera out of this.”

Read or comment on Dr. Geneslaw’s web blog

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