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Efficacy of sweet solutions for analgesia in infants between 1 and 12 months of age: a systematic review
  1. Denise Harrison1,2,3,
  2. Bonnie Stevens1,2,
  3. Mariana Bueno2,4,
  4. Janet Yamada1,2,
  5. Thomasin Adams-Webber1,
  6. Joseph Beyene1,5,
  7. Arne Ohlsson6
  1. 1The Hospital for Sick Children, Toronto, Canada
  2. 2Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
  3. 3Department of Neonatology, Royal Children's Hospital, Melbourne, Australia
  4. 4School of Nursing, University of Sao Paulo, Sao Paulo, Brazil
  5. 5Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
  6. 6Departments of Paediatrics, Obstetrics and Gynaecology and Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
  1. Correspondence to Denise Harrison, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada; denise.harrison{at}


Objective To compare the efficacy of oral sweet solutions to water or no treatment in infants aged 1–12 months during immunisation.

Methods Randomised controlled trials (RCTs) were retrieved through internet searches or manual searches of reference lists. Search terms included newborn, infant, pain, sucrose and alternative names for sweet solutions. Summary estimates with 95% CIs were calculated and included relative risk (RR), risk difference (RD) and number needed to treat to benefit (NNTB) for dichotomous outcomes, and weighted mean differences (WMD) for continuous outcomes. Where pooling of results was not possible, a narrative summary of study results is presented.

Results Of the 695 studies identified, 14 RCTs with 1674 injections met the inclusion criteria. Sucrose or glucose, compared to water or no treatment decreased crying during or following immunisation in 13 of the 14 studies. Infants receiving 30% glucose (three trials, 243 infants) had a decreased RR in crying incidence following immunisation (typical RR 0.80, 95% CI 0.69 to 0.93; RD −0.17, 95% CI −0.29 to −0.05; NNTB 6, 95% CI 3 to 20). With sucrose or glucose, there was a 10% WMD reduction in proportion of crying time (95% CI −18 to −2) and a 12 s reduction in crying duration (95% CI −23 to −0.7 s). An optimal dose of sucrose or glucose could not be ascertained due to the varied volumes and concentrations used.

Conclusion Infants aged 1–12 months administered sucrose or glucose before immunisation had moderately reduced incidence and duration of crying. Healthcare professionals should consider using sucrose or glucose before and during immunisation.

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  • Funding The first author, Denise Harrison was supported by The Pain in Child Health Strategic Training Initiative (STP53885) and CIHR Team Grant in Children's Pain (CTP-79854 and MOP-86605) while undertaking this review. Canadian Institutes of Health Research (CIHR) Knowledge Synthesis Grant Funding (reference number: KRS91774) financially supported this review.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.