Impact of parent-directed education on parental use of pain treatments during routine infant vaccinations

Abstract

Educating parents about ways to minimize pain during routine infant vaccine injections at the point of care may positively impact on pain management practices. The objective of this cluster randomized trial was to determine the impact of educating parents about pain in outpatient pediatric clinics on their use of pain treatments during routine infant vaccinations. Four hospital-based pediatric clinics were randomized to intervention or control groups. Parents of 2- to 4-month-old infants attending the intervention clinics reviewed a pamphlet and a video about vaccination pain management on the day of vaccination, whereas those in the control clinics did not. Parent use of specific pain treatments (breastfeeding, sugar water, topical anesthetics, and/or holding of infants) on the education day and at subsequent routine vaccinations 2 months later was the primary outcome. Altogether, 160 parent-infant dyads (80 per group) participated between November 2012 and February 2014; follow-up data were available for 126 (79%). Demographics did not differ between groups (P > 0.05). On the education day and at follow-up vaccinations, use of pain interventions during vaccinations was higher in the intervention group (80% vs 26% and 68% vs 32%, respectively; P < 0.001 for both analyses). Educating parents about pain management in a hospital outpatient setting leads to higher use of pain interventions during routine infant vaccinations.

Are Parents Really That Important To Managing Vaccination Pain During Infancy?

“…For example, interventions that simply provide information immediately prior to the procedure have not been found to be effective [17]. However, studies that involve a more targeted and focused intervention such as a short video and a pamphlet have been found to be effective in reducing pain-related distress [18]. The majority of studies also attempt to coach and provide parents with information right before the painful procedure, a time where parents may be particularly stressed or distracted.…”

Effectiveness of a hospital-based postnatal parent education intervention about pain management during infant vaccination: a randomized controlled trial

“…pamphlet and video together in prenatal classes and outpatient clinics, and documented increased parental use of pain mitigation interventions at future infant vaccinations. 14,15 However, the findings of these previous studies have limited generalizability owing to impractical implementation, including delivery methods, and selection bias. Separately, we showed minimal effects when only the pain pamphlet was inserted into the postnatal discharge package given to all new parents in the hospital after the birth of an infant.…”

“…21 Our findings add to work aimed at increasing uptake of a national clinical practice guideline for management of vaccination pain. [13][14][15][16] In 2 studies that delivered the same tools using a more active educational approach, either featuring the pamphlet and video in prenatal classroom teaching or in an outpatient pediatric clinic (including looping the video on the clinic's reception-area television and mounting posters on the wall), higher uptake rates were reported for pain interventions (absolute increase 17% and 26%, respectively). 14,15 Conversely, in a hospital-based study, the effect was limited when the pain pamphlet was passively disseminated in the hospital postnatal discharge information package.…”

“…A followup telephone interview was conducted by a different research assistant, who was unaware of treatment allocation, after the randomized follow-up time to collect outcome data using a standardized questionnaire adapted from previous studies. [14][15][16]…”

Four Steps to Eliminate or Reduce Pain in Children Caused by Needles (Part 1)

“…The children in our hospital told us in a system-wide survey that the least well-controlled and most distressing pain was caused by needles [8]. We then found strong evidence to offer four modalities [9][10][11][12][13] concurrently to eliminate or reduce needle pain, modalities we now call 'the four non-negotiables'. Using this evidence, we became the first hospital which system wide not only offers those four modalities to every child for elective needle procedures, including for vaccinations, blood draws, intravenous cannulation and injections without exception, but also audits this regularly [6].…”