5MinuteConsult Journal Club

Calming Childhood Vaccine Angst

Reference

Pain 2021 Jul 5. doi: 10.1097/j.pain.0000000000002399

Study Summary

This observational study of 300+ children aged 4-6 years in Toronto evaluated video tape of interactions before and after receiving their school vaccinations using a validated tool (FLACC: Face, Legs, Activity, Cry, Consolability scale) to determine what behaviors might help the child self-regulate during and after the needle. It was conducted using a video monitor of the visits with recordings scored by coders blinded to the study’s aim.

Outcomes of the study included:

-Higher child baseline distress correlated with a lower ability to calm down by 2 minutes post immunization. Thus, caregiver and provider offering discussion BEFORE vaccination did NOT help the child calm down afterwards.
-Higher “Coping Promoting” verbalizations by the caregiver in the first minute AFTER the vaccination delayed child calming.
-Higher Distress Promoting verbalizations by the caregiver in the second minute delayed child calming
-Higher “Coping Promoting” verbalizations by the caregiver in the SECOND MINUTE after the vaccination correlated with improved child calming

Conclusions

How we and caregivers interact with children before and after immunization impacts the child’s ability to calm themselves. Important among these finds is the recognition that caregiver stress in the second minute after immunization (maybe due to caregiver anxiety or frustration) can negatively impact outcomes.

Discussion

This paper was VERY HARD to read. The language of childhood pain evaluation is full of jargon most of us do not use. But, there are some real-world takeaways. For those 4-6 years of age:

1) Limit discussion about vaccinations before giving them,

2) Encourage caregiver soothing prior to vaccination,

3) ask for caregiver patience and support, e.g., holding the child or distracting them with a video (as suggested by the authors) in the minute after vaccination, then

4) encourage the caregiver to offer supportive soothing words in the second minute post vaccination.

While this may sound somewhat artificial, these steps may be worth drafting into a handout that can be offered to the parent prior to the visit to explain how best to help their child during immunization.

For us, maybe discuss and answer questions about immunizations early in the visit, then focus on the child for the rest of visit. Encourage quiet soothing during the vaccination, and model encouraging words in the second minute afterwards.

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