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A Randomized-controlled Trial of Parent-led Tactile Stimulation to Reduce Pain During Infant Immunization Injections

Hogan, Mary-Ellen BScPhm, PharmD, MSc*; Probst, Janet RN; Wong, Karen MD; Riddell, Rebecca Pillai PhD‡,§; Katz, Joel PhD‡,∥,¶; Taddio, Anna BScPhm, MSc, PhD*,#

doi: 10.1097/AJP.0b013e318296079e
Original Articles

Objective: To determine the effectiveness of parent-led tactile stimulation for pain reduction when added to a combination of evidence-based pain-reducing interventions in infants undergoing immunization injections.

Methods: Healthy infants aged 4 to 6 months undergoing routine immunization at a primary care practice were eligible. Infants were randomized to tactile stimulation by a parent or usual care. Parents in the tactile stimulation group rubbed the ipsilateral thigh distal to the site for 15 seconds before, during, and after injections. In addition, all infants received evidence-based pain-relieving interventions including: sucrose solution, holding by a parent, and intramuscular injection without aspiration. The primary outcome was pain, measured by a validated tool, the Modified Behavioral Pain Scale (MBPS), by an observer unaware of treatment allocation using videotapes of the procedure. MBPS scores could range from 0 (no pain) to 10 (maximum pain). Parents, unaware of the study hypothesis, also rated infant pain in real time using a 100 mm visual analogue scale.

Results: One hundred twenty infants participated. Infant characteristics did not differ (P>0.05) between the tactile stimulation and control groups. Mean MBPS scores and parent visual analogue scale scores did not differ between groups (8.2 [1.1] vs. 8.0 [1.3]; P=0.57) and (60 [20] vs. 53 [22] mm; P=0.10), respectively.

Discussion: Parent-led tactile stimulation did not reduce pain in infants undergoing immunization injections when combined with other pain-relieving interventions. Potential reasons for the lack of effectiveness are discussed. Investigation of the effectiveness of clinician-led tactile stimulation in this population is recommended.

*Leslie Dan Faculty of Pharmacy, University of Toronto

Women’s College Hospital Family Practice Health Centre

Department of Psychology, York University

§Department of Psychiatry Research, Hospital for Sick Children

Toronto General Research Institute

Department of Anesthesia and Pain Management, University Health Network

#Department of Child Health Evaluative Sciences, Pharmacy, Hospital for Sick Children, Toronto, ON, Canada

M-E.H. was supported during this study by a Pain In Child Health Training Consortium award and a CIHR Frederick Banting and Charles Best Canada Graduate Scholarship—Master’s Award. R.P.R. holds a CIHR New Investigator Award and an Ontario Ministry of Research and Innovation Early Researcher Award. A.T. and R.P.R. hold a research grant from Pfizer Canada Inc. (Toronto, Canada). The remaining authors declare no conflict of interest.

Reprints: Anna Taddio, BScPhm, MSc, PhD, Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, ON, Canada M5S 3M2 (e-mail:

Received June 4, 2012

Accepted April 6, 2013

© 2014 by Lippincott Williams & Wilkins