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Journal title: CLP
Article Number: 441673
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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.