PAIN AND ANXIETY REDUCTION
Injectable vaccines are source of significant pain and anxiety which may be mitigated to some extent by some simple and effective evidence-based strategies as follows:
• HCW should be calm, reassuring and well-trained to deal with young kids.
Phrases which raise the anxiety, e.g. here comes the sting, or promote distrust, e.g. it will not hurt or will hurt only for a second, must be avoided.• Mother must be allowed to remain present during vaccination to reassure the child and hold him/her in desired position.
• Infants may be breast-fed during or shortly after the vaccination.
• Feeding small volume of sweet liquids, e.g. 1-2 ml Sugar solution before or soon after the injection might help to distract the infant and cope with the discomfort.
• Distraction measures, e.g. toys, video, music, conversation to divert attention away from pain to something more pleasant are often useful.
• Multiple vaccines, if necessary in same session, must be administered in a sequence, starting with oral ones, then less painful ID or SC injections and lastly the more painful IM injections. WHO recommended sequence of multiple vaccines in same sitting, if required, is as follows - RV gt; OPV gt; BCG gt; Penta V gt; MR/MMR gt;JE.
• Local cooling of the injection site by a topical refrigerant spray immediately before vaccination or application of a topical anesthetic 15-30 minutes before the injection has been proven to reduce the pain though cannot be used for mass immunization sessions due to logistic issues.
• Plunger should not be withdrawn after insertion of the needle to aspirate and check for blood as process may cause pain due to longer contact time and lateral movement of the needle.
• Warming the vaccine by rubbing between palms, vigorous rubbing at the injection site or prophylactic administration of an analgesic before injection is not recommended due to lack of evidence of painmitigation effectiveness or potential for altering vaccine effectiveness.
• Oral analgesics, e.g. paracetamol may be used to mitigate pain and/or fever after the vaccination. However, studies in children with previous febrile seizures have not demonstrated antipyretics to be effective in the prevention of febrile seizures after vaccination.
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