There are several things we can do to enhance comfort and decrease stress and the perception of pain during painful procedures, such as newborn screening tests and infant immunizations.
In the first hours of life, babies routinely receive at least one injection of Vitamin K and one screening blood test (more info about Quebec screening tests) requiring a heel prick blood draw. Some infants may have more heel prick blood draws done, such as for blood sugar checks or blood bilirubin checks for jaundice. These are important, but they don’t need to hurt. This is also true for infant immunizations as your baby grows as well as for later immunizations or any other painful procedure your toddler and older children may need.
The following comfort methods are supported by many research studies and have been shown to be effective in reducing the perception of pain for infants and young children. I especially want to mention the efforts of the “Be Sweet to Babies” initiative at the CHEO and the University of Ottawa, headed by Dr.Denise Harrison and her team who created and evaluated several fantastic videos to facilitate parents’ use of these comfort methods. You will find these videos and further resources at the end of this article.
Many hospitals have integrated these comfort methods into regular practice when infant’s undergo painful procedures, in recognition of the research supporting their use. However, this is less common in community clinics where your baby will likely receive their immunizations, starting at 2 months. You can take the initiative to integrate these comfort methods for yourself and your baby and be prepared for your baby’s first injection in hospital as well as their future immunization appointments.
1 – Skin-to-skin
Holding your baby skin-to-skin, also called kangaroo care, has many benefits. For comfort and to decrease the perception, it is most effective if done for 15 minutes before the procedure.
Skin-to-skin is most effective for newborn infants, small and premature babies.
Skin-to-skin decreases the secretion of stress hormones such as adrenaline and cortisol and encourages the secretion of oxytocin, the calming, loving, bonding hormone. Babies held skin-to-skin have more regular breathing, heart rate, temperature, and better oxygen saturation.
This can be done by either parent.
2 – Breastfeeding
If you are breastfeeding, you can breastfeed your baby (ideally while skin-to-skin) before, during and after the procedure. Breastfeeding is most effective for comfort if started 5 minutes before the procedure.
If your newborn baby is sleepy and not latching, you can use expressed colostrum 1-2 min. before the procedure, immediately before and again every 1-2 min. during the procedure.
Suckling has a calming effect on babies. Breastfeeding offers your baby more than the best nutrition, it is a relationship and offers them great comfort and closeness.
3 – Giving small amounts of sucrose (sugar water)
If you are feeding your baby commercial infant formula or are unable to breastfeed during the procedure, sucrose (sugar water) can be used to enhance comfort. This is most effective up to 1 year of age.
You can use a dropper, medicine syringe or medicine cup to offer your baby the sucrose 1-2 minutes before, immediately before, and every 1-2 minutes during.
Sucrose works to decrease the perception of pain through several theorized mechanisms: distraction with a sweet solution and triggered release of endorphins (the body’s natural pain killers), which leads to decreased pain perception and feeling of wellbeing (runner’s high for adults).
Suckling also has a calming effect on babies. If your baby is used to having a pacifier, you can dip the pacifier in the sweet solution and offer them the pacifier to suckle during the procedure.
How to make sugar water at home:
Use boiled water. This is the same boiled water preparation as you would do for preparing powdered commercial infant formula (water that has been brought to a rolling boil and is at least 70 degrees Celsius when the sugar is added. This is especially important for infants under 3 months age due to their immature immune systems.)
Mix 1 tsp of regular granulated sugar with 10ml of water.
Once mixed, it is good for 24 hours in the fridge. You can conserve it in a bottle or other sterilized food-safe container to then bring it with you to your appointment.
Helpful videos to bring it all together:
For newborn screening blood tests:
“Be Sweet to Babies” – Reduce your infant’s pain during newborn blood tests
Skin-to skin, breastfeeding & use of sucrose demonstrated for newborn infants
For infant immunizations:
Video – “Be Sweet to Babies” – Breastfeed to minimize vaccination pain – 2 months
Breastfeeding demonstrated during vaccination
Video – “Be Sweet to Babies” – Give sweet solutions to minimize vaccination pain
The use of sweet solution with older baby demonstrated before and during vaccination
Video – Reduce vaccination pain in babies – Part 5: Sugar Water
The use of sugar water for decreasing perception of pain in babies & instructions for how to make sugar water (sucrose) yourself at home before an appointment.
Video – “Be Sweet to Babies” – Breastfeed to minimize vaccination pain – 6 months
Resources for more info for newborns to young children:
Immunize Canada: Pain Management During Immunizations for Children
Immunize Canada: 2-page guide for parents
Immunize BC: Preparing for a positive experience