Five S's technique reduces immunization pain

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Immunization Pain Reduced Using the Five S's Technique
Immunization Pain Reduced Using the Five S's Technique

HealthDay News -- Swaddling and other forms of physical distraction reduces pain scores and crying time following routine immunizations for 2- and 4-month-old infants, study results indicated.

John W. Harrington, MD, of the Eastern Virginia Medical School in Norfolk, and colleagues investigated the effect of an intervention known as the 5 S's -- which stand for swaddling, side/stomach positioning, shushing, swinging and sucking -- on pain after vaccination during regularly scheduled well visits.

"The 5 S's appear to be a viable nonpharmacologic option for clinics to implement when providing analgesia during vaccinations," the researchers reported online in Pediatrics.

Harrington and colleagues sought to determine whether physical intervention with the five S's alone or combined with orally administered sucrose would have any analgesic effectiveness during routine immunizations. Infants were assigned to four groups and received 2 mL of water or oral sucrose solution, followed by standard-of-care comfort measures or intervention with the five S's immediately after vaccination. Pain was scored repeatedly up to five minutes post-vaccination.

The researchers found that infants in the five S's and the five S's plus sucrose groups had similar mean pain scores, which were significantly lower than the scores for those who received standard-of-care measures. Similarly low mean scores were seen over time and the same trend was found with crying.

The researchers noted that getting the infants to suck on the pacifier was the most difficult part of the intervention, complicated by either extremely uncomfortable or already calm infants and those unaccustomed to using a pacifier.

It was also harder to do with the bigger, heavier 4-month-olds, who tended to gain less benefit from the intervention (P=0.077).

"This simple physical intervention will require additional studies to see whether it is reproducible for other painful procedures and whether parents can be taught to perform the 5 S's reliably," the researchers wrote.

Harrington JW et al. Pediatrics. 2012;129:doi:10.1542/peds.2011-1607.

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