Reminder: How With Little Effort the Vaccination of Children Can Be Made Less Painful.
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ABSTRACT: Information provision is an important aspect of preparing children for medical procedures. Parents and health professionals are often unsure of what to tell a child about a forthcoming medical procedure, how this information should be conveyed, and when information should be provided. The current article overviews the key theories underpinning information provision, such as self-regulation theory and schema/script theories. A theoretically derived Information Provision Model is presented, which is designed to integrate the various processes involved in information provision. The literature on the content, format, and timing of information provision is reviewed. The role that individual difference factors may play in how children respond to information is described. Recommendations for clinical practice are outlined, together with an indication of the level of empirical support for each recommendation.Clinical Psychology Science and Practice 05/2007; 14(2):124 - 143. · 2.92 Impact Factor
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ABSTRACT: Evaluated a low cost and practical intervention designed to decrease children's, parents', and nurses' distress during children's immunizations. The intervention consisted of children viewing a popular cartoon movie and being coached by nurses and parents to attend to the movie. Ninety-two children, 4-6 years of age, and their parents were alternatively assigned to either a nurse coach intervention, a nurse coach plus train parent and child intervention, or a standard medical care condition. Based on previous findings of generalization of adult behaviors during medical procedures, it was hypothesized that training only the nurses to coach the children would cost-effectively reduce all participants levels of distress. Observational measures and subjective ratings were used to assess the following dependent variables: children's coping, distress, pain, and need for restraint; nurses' and parents' coaching behavior; and parents' and nurses' distress. Results indicate that, in the two intervention conditions, children coped more and were less distressed, nurses and parents exhibited more coping promoting behavior and less distress promoting behavior, and parents and nurses were less distressed than in the control condition. Although neither intervention was superior on any of the variables assessed in the study, nurse coach was markedly more practical and cost-effective. Therefore, nurses' coaching of children to watch cartoon movies has great potential for dissemination in pediatric settings.Journal of Pediatric Psychology 07/1997; 22(3):355-70. · 2.91 Impact Factor
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ABSTRACT: This research compared the effect of two forms of distraction on injection pain in a convenience sample of preschool children. A quasi-experimental study of 105 children (53 girls and 52 boys) ages 4 to 6 years needing DPT immunizations. Data were collected at three sites: two school-based immunization clinics and one public health center with a walk-in immunization program. Study children were randomly assigned to receive one of three treatments with their DTP injection: touch, bubble-blowing, or standard care. Prior to injection, a measure of medical fear was obtained (Child Medical Fear Scale) and pain was measured through use of the Oucher Scale. Planned comparisons within analysis of variance (ANOVA) tested the differences in pain scores by treatment. Factorial ANOVA was used to determine the influence of age or gender on treatment, and the effect of medical fear on pain was analyzed using correlational statistics and factorial ANOVA. Both forms of distraction, touch and bubble-blowing, significantly reduced pain perception. There were no interaction effects of either age or gender. Fear was a significant covariate, but distraction was effective even when fear was not held constant. Distraction appears to be an effective method for decreasing injection pain in young children. It is an easy, practical nursing intervention to help children cope with this common, painful experience.MCN The American Journal of Maternal/Child Nursing 01/2001; 26(2):72-8. · 0.90 Impact Factor
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XX(X) 1 –2
© The Author(s) 2012
Reprints and permission:
At present, per recommendation of the Permanent
Vaccination Commission (Impfempfehlungen der
Ständigen Impfkommission, STIKO) Germany,1 chil-
dren are vaccinated approximately 20 times with differ-
ent vaccines—annually flu shots not included—by the
time they are 18 years old. Injections are the most
unpopular devices/processes among children2 and are
often the cause of anxiety and fear.3 Furthermore, these
lead to negative doctor–child relationship. However, by
employing a few simple strategies children can be easily
vaccinated. In regular pediatric practice, because of
time constraints, pediatricians tend to vaccinate as
quickly as possible, neglecting the child’s needs. As a
child has to be vaccinated many times over the years,
the doctor needs the cooperation of the child, failing
which each injection episode becomes a big drama.
Several studies have been conducted to determine
which psychological interventions are the most effective
for reducing vaccination-associated pain. Our aim, how-
ever, is to remind pediatricians and general practitioners
how best they could vaccinate children with minimum
effort and significantly less pain. It is important that we
revise this topic more often as vaccinations are done
We searched the PubMed, BIOSIS, and ISI Web of
Science databases on literature dealing with possible
interventions for making the vaccination easier for chil-
dren. We focused on psychological interventions, as these
are cost saving and easier to implement in a practice.
We found in the literature that anything done to divert
the child’s attention helps significantly in reducing a
child’s self-reported pain. This can be done by either
using the electronic media (videotaped cartoons, music,
etc) or simply letting a nurse, who had participated in a
15-minute training program, distract the child with an
age-appropriate toy, to draw the attention away from the
pain.2,4,5 Another option involves breathing exercises,
where children are asked to inhale and exhale deeply,
possibly with the help of a whistle or bubbles.2,6,7 These
kinds of breathing exercises not only meet the intended
purpose of the intervention but are also very useful for
distraction. Furthermore, data support using hypnosis4
as a method and informing children on the upcoming
The use of suggestion as a method for reducing pain
is ineffective, because as a precondition the patient
needs to be relaxed, which is rather difficult for a child.
Another method that involves parents is ineffective as
they themselves are anxious, and they may not be able to
fully divert the child’s attention.2
The use of very simple techniques can significantly
help reduce vaccination-associated pain in children.
However, these techniques are either often forgotten or
simply not valued enough. Pediatricians and general
practitioners should use these psychological interven-
tions in their daily routine to ensure that children
receive these evidence-based pain-relieving interven-
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with
respect to the research, authorship, and/or publication of this
article. [AQ: 3]
1Ped Mind Institute, Gronau, Germany
Anne Weissenstein, Ped Mind Institute, Hindenburgring, 4, Gronau
Reminder: How With Little Effort the
Vaccination of Children Can Be Made
Anne Weissenstein1, Alexandra Straeter1, Gloria Villalon1,
Elisabeth Luchter1, and Stefan Bittmann1[AQ: 1][AQ: 2]
Clinical Pediatrics XX(X)
The author(s) received no financial support for the research,
authorship, and/or publication of this article. [AQ: 4]
1. Robert Koch Institut. Empfehlungen der Ständigen Imp-
fkommission (STIKO) am Robert Koch-Institut/Stand:
Juli 2010, 30.
2. Chambers CT, Taddio A, Uman LS, McMurtry CM; HELP-
inKIDS Team. Psychological interventions for reducing
pain and distress during routine childhood immunizations: a
systematic review. Clin Ther. 2009;31(suppl 2):S77-S103.
3. Broome M, Bates T, Lillis P, McGahee T. Children’s medi-
cal fears, coping behaviors, and pain perceptions during a
lumbar puncture. Oncol Nurs Forum. 1990;17:361-367.
4. Uman LS, Chambers CT, McGrath PJ, Kisely S. Psycho-
logical interventions for needle-related procedural pain and
distress in children and adolescents. Cochrane Database
Syst Rev. 2006;(4):CD005179. doi:10.1002/14651858.
5. Cohen LL, Blount RL, Panopoulos G. Nurse coaching
and cartoon distraction: an effective and practical inter-
vention to reduce child, parent, and nurse distress during
immunizations. J Pediatr Psychol. 1997;22:355-370.
6. Sparks L. Taking the “ouch” out of injections for children.
Using distraction to decrease pain. MCN Am J Matern
Child Nurs. 2001;26:72-78.
7. Bowen AM, Dammeyer MM. Reducing children’s immu-
nization distress in a primary care setting. J Pediatr Nurs.
8. Jaaniste T, Hayes B, Von Baeyer CL. Providing chil-
dren with information about forthcoming medical proce-
dures: a review and synthesis. Clin Psychol: Sci Pract.