From quiet, sad-eyed reluctance to a full-force temper tantrum, kids seem to have a highly developed set of skills to let their parents know they don't like getting shots at the doctor's office. A new study may arm parents and health care providers with better ways to make the needle prick more bearable for children — which also could make it more bearable when they're adults.

Researchers at the University of Toronto and the Hospital for Sick Children in Toronto looked at a number of methods to try to make vaccine injections a less painful experience. Analyzing these studies, they gave grades to the various tactics — which ranged from giving the child a little sugar water to telling the child, "This won't hurt" — and made recommendations to help improve the experience.

"There's lots of things we can do to manage immunization pain; it doesn't have to be part of the procedure," said Anna Taddio, a pharmacist and pain researcher at the University of Toronto who was the study's lead investigator. "It's not a necessary evil. You can have good health care, you can have immunization, and you can have no pain, too."

Taddio said the research focused on babies and young children because unpleasant immunization experiences in childhood can prompt people to avoid doctor's offices later in life. This can lead to skipping vaccinations and even checkups that would catch other medical issues.

"If you don't go for a blood test, you may not know you're a diabetic," Taddio said.

She said previous research has shown that as many as one quarter of all adults have some fear of needles.

"These fears usually develop when you're a child," Taddio said. "It usually happens after a traumatic experience with a procedure."

She said 10 percent to 15 percent of adults will mention needle fear as a reason for avoiding a vaccine, but she added: "We think that pain is a bigger problem than people will admit. Pain is definitely contributing to some of this noncompliance with immunization."

Katie Brewer, a senior policy analyst for the American Nurses Association, said that although many of the study's suggestions have been used in the past, the findings provide nurses with clear guidelines about what really works.

"These are really important interventions for nurses, who are typically the ones administering vaccines. Anything we can do to make this a more comfortable experience for a child and parent, we're all for," said Brewer, who previously worked in the immunization clinic of the Arlington County (Va.) Health Department.

"Most of the things that they looked at in the study — such as breastfeeding, providing a distraction, allowing the parent to hold a child — those are all things that I've been doing, so it's good to see those are evidence-based," she said.

Brewer also emphasized the importance of making vaccinations less painful for young children.

"The kids that tend to be really stressed about immunizations are those that are 4, 5, 6 years old," she said. "Those are the ones where a kid who has a really unpleasant immunization experience, that lasts."

The study also found evidence of what not to do.

"Do not tell children that it won't hurt, as this type of statement, when used alone, has been shown to be ineffective in reducing pain at the time of injection," the researchers wrote.

The researchers talked to some of the children. "Those kids said to us that they don't like it when people lie to them, because then they don't trust them," Taddio said.

The study will appear an upcoming issue of the Canadian Medical Association Journal.

Recommendations

The researchers gave these suggestions an A for showing strong evidence of being effective:

  • With infants:
    • Encourage mothers to breastfeed during infants' vaccination.
    • Give them a sugar-water solution before injection.
  • With young children:
    • If multiple vaccine brands are available, use the one associated with less pain.
    • Use topical anesthetics if available.

Some guidelines earned a B rating:

    • Have parents offer distractions. (The researchers noted the evidence is unclear for whether this helps children, but it tends to help the parents when the child is being vaccinated.)
    • Have the physician or child do something to distract from the vaccination.
    • Have the child take slow, deep breaths during the injection.

Steps to avoid:

    • Having the child lie flat while being injected.
    • Telling the child it won't hurt.