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The frequent visits that pediatricians have with infants are bittersweet. While they are wonderful opportunities to form lasting relationships with families, they are also times when babies suffer through the necessary pain of multiple immunizations.
The frequent visits that pediatricians have with infants are bittersweet. While they are wonderful opportunities to form lasting relationships with families, they are also times when babies suffer through the necessary pain of multiple immunizations. Researchers have examined interventions to reduce this pain; several studies have focused on the effects of sweet oral solutions. Sucrose and glucose oral solutions have been proved to effectively provide analgesia to newborns undergoing painful procedures; however, these sweet solutions have not been studied as extensively in older infants or in infants receiving immunizations.
Harrison and colleagues1 recently conducted a systematic review and meta-analysis to determine whether sweet solutions have a role in reducing the pain of immunizations in infants aged 1 to 12 months. They examined results from 14 randomized controlled trials that met their inclusion criteria. Each study used glucose or sucrose solutions of varying concentrations as well as some form of pain outcome measure. Sucrose concentrations ranged from 12% to 75%, glucose concentrations from 30% to 40%; one study applied topical anesthetic cream along with the administration of an oral glucose solution. Volumes of solutions also varied. Most of the studies offered less than 2 mL; however, one study provided 10 mL of a sucrose solution. The pain measures used included outcomes such as cry duration, cry intensity, pain scale scores, parental preference, and physiologic factors (eg, heart rate).
Crying, other pain measures reduced with use of sweet solutions. The majority of studies showed a reduction in crying and pain scores during or after immunizations when a sucrose or glucose solution was given instead of a placebo or no treatment. Many studies found reduction in pain with certain pain measures and not others. It appears that higher concentrations of either glucose or sucrose solutions were more effective than lower concentrations. Using a meta-analysis design, the authors found a small but statistically significant reduction in the proportion of crying times and in the incidence and duration of crying.
Harrison and colleagues1 note that findings of the studies were difficult to compare and interpret because of the variable factors measured. In addition to variations in solution concentration, solution volume, and outcome measures among the studies, some studies included other interventions, such as maternal holding or distraction and the use of topical anesthetic cream. The authors also did not take into consideration the type of immunizations being given or the order in which they were injected.
Dose, timing of administration need clarification. Although the results of the Harrison study are encouraging, further research is needed before pediatricians can routinely provide sweet solutions with immunizations. With clarification of the solution volume and concentration and the timing of its administration, we may soon have an effective method of making immunizations a little less painful for all involved.
1. Harrison D, Stevens B, Bueno M, et al. Efficacy of sweet solutions foranalgesia in infants between 1 and 12 months of age: a systematic review. ArchDis Child. 2010;95:406-413.