Moshe Ipp, Anna Taddio, Phd, Jonathan Sam, Bsc, Morton Goldbach, and Patricia C Parkin

Vaccine related pain: Randomized controlled trial of two injection techniques
Arch Dis Child 2007; 0: adc.2007.118695v1 [Abstract]

nicolasantoro{at}hotmail.com Nicola Santoro, et al.

Dear Editor, we read with great interest the article by Ipp et al. The authors raised an important question concerning the pain after immunisation and suggest that rapid injection is less painful than a slow standard technique. Actually, as the authors observed, the pragmatic rapid injection is a very common technique for intramuscular injections in children. Working daily in this field we experienced that, not only to perform the injection quickly, but also the immediate contact with the parent after the injection, reduces the time of crying. In the last two months we performed 357 first doses of the DTaP-IPV-HIb- HBV hexavalent vaccine (Infanrix Hexa, GSK) with a pragmatic rapid injection (mean age 2.5±0.4 months; 168 females). Two hundred thirty two children (65%) cried after the injection. The mothers were, alternatively, invited to pick up soon the child after the injection or not to pick up the child for at least one minute. Then the population was divided into two groups. A first group of children picked up into mother’s arms soon after the injection (115 children, 51 females) and a second group composed of children who were not picked up after injection for at least one minute (117 children, 48 females). One nurse took care of measuring the time of crying and record it. We observed that those children belonging to the first group had a time of crying significantly lower than those children who were not picked up soon after injection (12.1±4.9 vs 52.2± 25.5 p<.001). That is why, in addition to the use of the rapid injection technique, we propose that children should quickly picked up by parents soon after the injection in order to reduce their discomfort and, consequently, the time of crying.