Distracting Kids Helps Ease Pain from Vaccinations
MADISON - The sound of music has been heard at UW Health clinics for the past several months, but nobody's auditioning for American Idol.
Instead, just in time for flu-shot season, a UW Health team executed a detailed plan to help kids overcome the fear and pain associated with getting vaccinations.
Some parents say they don't get their children immunized because they don't want to inflict pain and anxiety on the youngsters due to the shot.
A recent quality-improvement project involving 800 UW Health pediatric patients has found that using a form of distraction, such as singing, really does reduce pain from immunizations for common childhood diseases such as measles and chickenpox in some age groups.
Amy Plumb, MD, a pediatrician and associate professor at the University of Wisconsin School of Medicine and Public Health, and Peggy Riley, clinical nurse specialist, implemented the project. They believe the distraction techniques will prove very useful with vaccinations for the H1N1 virus on the horizon.
"We are doing this to make the experience better for kids, so they don't have to worry and experience pain from getting a shot," says Plumb. "The West Clinic nurses are singing. In other cases, parents are singing 'Happy Birthday' or 'Row, Row, Row Your Boat' to their kids."
Before their project began, Plumb and Riley collected baseline (initial) data at each of eight UW Health clinics. The clinic staff were then educated on the use of distraction and treatments such as ice and LMX4, a topical cream that numbs the skin and reduces pain from the needle.
Preliminary results of the study showed a significant reduction in pain with some kind of intervention, and according to Riley, distraction was the most commonly used method to reduce pain.
"Theoretically, the brain can only interpret so many signals at one time," says Riley. "The more senses that are involved, the less likely the pain signal will reach the brain. By having kids think about the letters of the ABC Song, having them say them out loud and pat their leg at the same time, you have activated three different senses at the same time."
"Distraction has always been recommended, but implementation has been variable," she adds. "Some people have believed it is very complex and difficult to do for such a simple, quick procedure. While we know it works and we encourage staff to use it, its actual use is pretty low. Same is true of some parents. They don't know what to do to make these procedures better for their child."
Reading, watching television, and listening to music are other methods that have been useful to keep the child at ease, especially for those who are older and may have a fear of needles.
"We've had teenagers faint," says Plumb. "The HPV vaccine in teenaged girls (to guard against cervical cancer) is very painful. The girls do OK with the first one, but get worried about the next one because it's going to be painful. By the time kids become teenagers, they may have needle phobia, because they know what's happening to them. When they are much younger, they are less aware of the process."
Overall, Plumb and Riley hope the use of distraction and other pain-reduction methods are used more frequently to help during painful procedures.
"The important point from this study is that when parents and pediatric clinics both work together to provide simple, inexpensive, easily available techniques for children to reduce pain with immunizations, we see a reduction in their pain ratings," says Riley. "Most of the techniques recommended are already available in their homes or in the clinic, and they just need to be used."
Plumb and Riley plan to submit their findings for publication.
Date Published: 10/20/2009