Order of vaccination affects pain in infants

Research shows that pain impacts parental decision on vaccination
Research shows that pain impacts parental decision on vaccination
Sequence matters when you administer multiple vaccinations to infants, Canadian pediatricians have found. Babies who receive the combination vaccine for diphtheria, polio, tetanus, pertussis, and Hemophilus influenzae type b (DPTaP-Hib) before being given the pneumococcal conjugate vaccine (PCV) appear to experience less pain from the shots.

In a double-blind trial conducted in an outpatient clinic, 120 healthy infants aged 2-6 months were undergoing routine immunization. Half were given the PCV shot first; the remainder received DPTaP-Hib first (Arch Pediatr Adolesc Med. 2009;163:469-472).

Inoculations were videotaped, and pain was assessed using the Modified Behavioral Pain Scale (MBPS). Parents rated their child's pain on a 10-point visual analog scale (VAS). The presence or absence of crying was also noted.

Mean pain scores were significantly lower on both scales when PCV followed DPTaP-Hib (MBPS score, 7.6 vs. 8.2 for PCV given first; parent VAS score, 4.2 vs. 5.6). Consequently, the study authors recommend starting the double shots with DPTaP-Hib.

The report mentions U.S. research showing that pain has an impact on parental decisions regarding infant vaccination (Am J Prev Med. 2004;26:11-14). More than 90% of pediatricians surveyed reported at least one parent in their practice refused to have a child vaccinated—“most commonly as a result of pain from multiple vaccines.”

“Varying the order of vaccine administration to reduce pain is a strategy [to address this concern] that is simple, effective, cost-free, and easily incorporated into clinical practice,” the authors note.
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