Pain reduction during pediatric immunizations: Evidence-based review and recommendations

Pediatrics

Volumn 119, Issue 5, 2007, Pages

  Schechter, Neil L ^a,b,c   Zempsky, William T ^b,c   Cohen, Lindsey L ^d   McGrath, Patrick J ^e,f   McMurtry, C Meghan ^e,f   Bright, Nancy S ^a,c  

^a Farmington   (United States)

^b UNIVERSITY OF CONNECTICUT SCHOOL OF MEDICINE   (United States)

^c SAINT FRANCIS HOSPITAL AND MEDICAL CENTER   (United States)

^d GEORGIA STATE UNIVERSITY   (United States)

^e IWK HEALTH CENTRE   (Canada)

^f DALHOUSIE UNIVERSITY   (Canada)

Author keywords

Clinical practice; Immunizations; Injection; Pain control

Indexed keywords

BENZATHINE PENICILLIN; CEFTRIAXONE; CHICKENPOX VACCINE; DILUENT; DIPHTHERIA PERTUSSIS TETANUS HAEMOPHILUS INFLUENZAE TYPE B VACCINE; EMLA; HAEMOPHILUS INFLUENZAE TYPE B VACCINE; LIDOCAINE; LMX4; LOCAL ANESTHETIC AGENT; MEASLES MUMPS RUBELLA VACCINE; MMR II; POLIOMYELITIS VACCINE; SUCROSE; TETRACAINE; UNCLASSIFIED DRUG;

ANXIETY; BACTERIAL INFECTION; CHICKENPOX; CHILD BEHAVIOR; CHILD SAFETY; CLINICAL TRIAL; DIPHTHERIA; DISTRACTIBILITY; DISTRESS SYNDROME; DRUG DOSAGE FORM COMPARISON; DRUG EFFICACY; EVIDENCE BASED MEDICINE; HAEMOPHILUS INFLUENZAE TYPE B; HUMAN; INJECTION PAIN; INJECTION SITE CONTUSION; INJECTION SITE ERYTHEMA; INJECTION SITE PAIN; INJECTION SITE REACTION; INTERMETHOD COMPARISON; MEASLES; MEDICAL RESEARCH; MUMPS; NEEDLE; PAIN ASSESSMENT; PARENTAL BEHAVIOR; PERTUSSIS; POLIOMYELITIS; PRIORITY JOURNAL; REVIEW; RUBELLA; TEMPERATURE DEPENDENCE; TETANUS;

CHILD; CHILD, PRESCHOOL; EVIDENCE-BASED MEDICINE; HUMANS; IMMUNIZATION; INFANT; INFANT, NEWBORN; PAIN;

EID: 34247327083     PISSN: 00314005     EISSN: 02105721     Source Type: Journal    
DOI: 10.1542/peds.2006-1107     Document Type: Review

References (144)

1. American Academy of Pediatrics. Active and passive immunization. In: Pickering LK, Baker CJ, Long SS, McMillan JA, eds. Red Book: 2006 Report of the Committee on Infectious Diseases. 27th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2006:1-98
2. Fassler D. The fear of needles in children. Am J Orthopsychiatry. 1985;55:371-377
3. Menke E. School-aged children's perception of stress in the hospital. Child Health Care. 1981;9:80-86
4. Hamilton JG. Needle phobia: a neglected diagnosis. J Fam Pract. 1995;41:169-175
5. Ornstein P, Manning EL, Pelphrey KA. Children's memory for pain. J Dev Behav Pediatr. 1999;20:262-277
6. Craig KD, McMahon RJ, Morison JD, et al. Developmental changes in infant pain expression during immunization injections. Soc Sci Med. 1984;19:1331-1337
7. Cohen LL, Blount RL, Cohen RJ, McClellan CB, Bernard RS, Ball CM. Children's expectations and memories of acute distress: the short- and long-term efficacy of pain management interventions. J Pediatr Psychol. 2001;26:367-374
8. Weisman SJ, Bernstein B, Schechter NL. Consequences of inadequate analgesia during painful procedures in children. Arch Pediatr Adolesc Med. 1998;152:147-149
9. Schechter NL, Bernstein BA, Beck A, et al. Individual differences in children's response to pain: role of temperament and parental characteristics. Pediatrics. 1991;87:171-177
10. Chen E, Craske MG, Katz ER, Schwartz E, Zeltzer LK. Pain-sensitive temperament: does it predict procedural distress and response to psychological treatment among children with cancer? J Pediatr Psychiatry. 2000;25:269-278
11. Lee LW, White-Traut RC. The role of temperament in pediatric pain response. Issues Compr Pediatr Nurs. 1996;19:49-63
12. Meyerhoff AS, Weniger BG, Jacobs J. Economic value to parents of reducing the pain and emotional distress of childhood vaccine injections. Pediatr Infect Dis J. 2001;20(suppl):S57-S62
13. Abbotts B, Osborn LM. Immunization status and reasons for immunization delay among children using public health immunization clinics. Am J Dis Child. 1993;147:965-968
14. Woodin KA, Rodewald LE, Humiston SG, et al. Are children becoming pincushions from immunizations? Arch Pediatr Adolesc Med. 1995;149:845-849
15. Reis EC. Multiple scheduled injections contribute to missed opportunities to immunize during well care visits. Ambul Child Health. 1997;3:172
16. Schechter NL, Sullivan CM, Costa L, et al. The ouchless place: no pain, children's gain. Pediatrics. 1997;99:890-894
17. Ramsay DS, Lewis M. Developmental change in infant cortisol and behavioral response to inoculation. Child Dev. 1994;65:1491-1502
18. Bachanas PJ, Blount RL. The Behavioral Approach-Avoidance and Distress Scale: an investigation of reliability and validity during painful medical procedures. J Pediatr Psychol. 1996;21:671-681
19. Schechter NL, Berde CB, Yaster M. Pain in Infants, Children, and Adolescents. Philadelphia, PA: Lippincott Williams & Wilkins; 2003
20. Young KD. Pediatric procedural pain. Ann Emerg Med. 2005;45:160-171
21. McMahon S, Koltzenburg M. Melzack and Wall's Textbook of Pain. Edinburgh, Scotland: Churchill Livingstone; 2005
22. Claar RL, Walker LS, Barnard JA. Children's knowledge, anticipatory anxiety, procedural distress, and recall of esophagogastroduodenoscopy. J Pediatr Gastroenterol Nutr. 2002;34:68-72
23. Margolis JO, Ginsberg B, Dear GD, Ross AK, Goral JE, Bailey AG. Paediatric preoperative teaching: effects at induction and postoperatively. Paediatr Anaesth. 1998;8:17-23
24. Kolk AM, van Hoof R, Riedeldij Dop MJ. Preparing children for venepuncture: the effect of an integrated intervention on distress before and during venepuncture. Child Care Health Dev. 2000;26:251-260
25. Melamed BG, Yurcheson R, Fleece EL, Hutcherson S, Hawes R. Effects of film modeling on the reduction of anxiety-related behaviors in individuals varying in levels of previous experience in the stress situation. J Consult Clin Psychol. 1978;43:511-521
26. Kain ZN, Caldwell-Andrews AA. Preoperative psychological preparation of the child for surgery: an update. Anesth Clin North Am. 2005;23:597-614
27. Stashinko EE, Goldberger J. Test or trauma? The voiding cystourethrogram experience of young children. Issues Compr Pediatr Nurs. 1998;21:85-96
28. Eland JM. Minimizing pain associated with prekindergarten intramuscular injections. Issues Compr Pediatr Nurs. 1981;5:361-372
29. Cohen LL. Reducing infant immunization distress through distraction. Health Psychol. 2002;21:207-211
30. Megel ME, Hesner R, Matthews K. Parents' assistance to children having immunizations. Issues Compr Pediatr Nurs. 2002;25:151-165
31. Duff AJA. Incorporating psychological approaches into routine paediatric venepuncture. Arch Dis Child. 2003;88:931-937
32. Peterson L. Coping by children undergoing stressful medical procedures: some conceptual, methodological and therapeutic issues. J Consult Clin Psychol. 1989;57:380-387
33. Suls J, Wan CK. Effects of sensory and procedural information on coping with stressful medical procedures and pain: a meta-analysis. J Consult Clin Psychol. 1989;57:52-64
34. Melamed BG, Ridley-Johnson R. Psychological preparation of families for hospitalization. J Dev Behav Pediatr. 1988;9:96-102
35. Kain ZN, Mayes LC, Caramico LA. Preoperative preparation in children: a cross-sectional study. J Clin Anesth. 1996;9:508-514
36. Ross SA. Impending hospitalization: timing of preparation for the school-aged child. Child Health Care. 1984;12:187-189
37. Malamed BG, Meyer R, Gee C, Soule L. The influence of time and type of preparation on children's adjustment to hospitalization. J Pediatr Psychol. 1976;1:31-37
38. Royal College of Paediatrics and Child Health. Position statement on injection technique, March 2002. Available at: www.rcpch.ac.uk/publications/ recent_publications/injections1.pdf. Accessed March 8, 2007
39. World Health Organization. Expanded Programme on Immunization. Geneva, Switzerland: World Health Organization; 1998
40. County of Los Angeles Department of Public Health. Immunizations: minimizing pain and maximizing comfort. Public Health. 2001;1:3
41. Centers for Disease Control and Prevention. National Immunization Project. Available at: www.cdc.gov/nip. Accessed March 8, 2007
42. Ipp MM, Gold R, Goldebach M, et al. Adverse reactions to diphtheria, tetanus, pertussis-polio vaccination at 18 months of age: effect of injection site and needle length. Pediatrics. 1989;83:670-682
43. Colorado Department of Public Health and Environment, Advisory Committee on Immunization Practices. Administration techniques. In: Colorado Immunization Manual. Denver, CO: Colorado Department of Public Health and Environment; 2005;§9:1-22
44. Cook IF, Murtagh J. Comparative reactogenicity and parental acceptability of pertussis vaccines administered into the ventrogluteal area and anterolateral thigh in children aged 2, 4, 6, and 18 months. Vaccine. 2003;21:3330-3334
45. Cook IF, Murtagh J. Ventrogluteal area: a suitable site for intramuscular vaccination of infants and toddlers. Vaccine. 2006;24:2403-2408
46. Greenway K. Using the ventrogluteal site for intramuscular injection. Nurs Stand. 2004;25:39-42
47. Small SP. Preventing sciatic nerve injury from intramuscular injections: literature review. J Adv Nurs. 2004;47:287-296
48. Wong D. Ventrogluteal site for intramuscular injections. Available at: www.mosbysdrugconsult.com/WOW/fyi04.html. Accessed March 8, 2007
49. Thompson MK. Needling doubts about where to vaccinate. BMJ. 1988;297:779-780
50. MacDonald NE, Marcuse EK. Neurologic injury after vaccination: buttocks as injection site. Can Med Assoc J. 1994;150:326
51. Zuckerman JN. The importance of injecting vaccines into muscle: different patients need different needle sizes. BMJ. 2000;321:1237-1238
52. Bergeson PS, Singer SA, Kaplan AM. Intramuscular injections in children. Pediatrics. 1982;70:944-948
53. Diggle L, Deeks J. Effect of needle length on incidence of local reactions to routine immunization in infants aged 4 months: randomized controlled trial. BMJ. 2000;321:931-933
54. Davenport JM. A systematic review to ascertain whether the standard needle is more effective than a longer or wider needle in reducing the incidence of local reaction in children receiving primary immunization. J Adv Nurs. 2004;46:66-77
55. Cook IF, Murtagh J. Needle length required for intramuscular vaccination of infants and toddlers. Aust Fam Physician. 2002;31:295-297
56. Groswasser J, Kahn A, Bouche B, et al. Needle length and injection technique for efficient intramuscular vaccine delivery in infants and children evaluated through an ultrasonographic determination of subcutaneous and muscle layer thickness. Pediatrics. 1997;100:400-403
57. Diggle L. Practical aspects of paediatric immunization. Pract Nurs. 2000;19:202-206
58. Bartfield JM, Crisafulli KM, Raccio-Robak N, Salluzzo RF. The effects of warming and buffering on pain of infiltration of lidocaine. Acad Emerg Med. 1995;2:254-257
59. Maiden MJ, Benton GN, Bourne RA. Effect of warming adult diphtheria-tetanus vaccine on discomfort after injection: a randomized controlled trial. Med J Aust. 2003;178:433-436
60. Schichor A, Bernstein B, Weinerman H, et al. Lidocaine as a diluent for ceftriaxone in the treatment of gonorrhea: does it reduce the pain of injection? Arch Dis Pediatr Adolesc Med. 1994;148:72-75
61. Amir J, Ginat S, Cohen YH, et al. Lidocaine as a diluent for the administration of benzathine penicillin G. Pediatr Infect Dis J. 1998;17:890-893
62. Lyons R, Howell F. Pain and measles, mumps, and rubella vaccination. Arch Dis Child. 1991;66:346-347
63. Ipp M, Cohen E, Goldbach M, Macarthur C. Effect of choice of measles-mumps-rubella vaccine on immediate vaccination pain in infants. Arch Pediatr Adolesc Med. 2004;158:323-326
64. Bartfield JM, Ford DT, Homer PJ. Buffered versus plain lidocaine for digital nerve blocks. Ann Emerg Med. 1993;22:216-219
65. Frank NC, Blount RL, Smith AJ, Manimala MR, Martin JK. Parent and staff behavior, previous child medical experience, and maternal anxiety as they relate to child distress and coping. J Pediatr Psychol. 1995;20:277-289
66. Blount RL, Corbin SM, Sturges JW, Wolfe VV, Prater JM, James LD. The relationship between adults' behavior and child coping and distress during BMA/LP procedures: a sequential analysis. Behav Ther. 1989;20:585-601
67. Bush JP, Cockrell CS. Maternal factors predicting behaviors in the pediatric clinic. J Pediatr Psychol. 1987;12:505-518
68. Cohen LL, Manimala R, Blount RL. Easier said than done: what parents say they do and what they do during children's immunizations. Child Health Care. 2000;29:79-86
69. Manimala M, Blount RL, Cohen LL. The influence of parental reassurance and distraction on children's reactions to an aversive medical procedure. Child Health Care. 2000;29:161-177
70. Broome ME, Endsley RC. Parent and child behavior during immunization. Pain. 1989;37:85-92
71. Sweet SD, McGrath PJ, Symons D. The roles of child reactivity and parenting context in infant pain response. Pain. 1999;80:655-661
72. Cohen LL, Bernard RS, McClellan CB, MacLaren JE. Assessing medical room behavior during infants' painful medical procedures: the measure of adult and infant soothing and distress (MAISD). Child Health Care. 2005;34:81-94
73. Sweet SD, McGrath PJ. Relative importance of mothers' versus medical staffs' behavior in the prediction of infant immunization pain behavior. J Pediatr Psychol. 1998;23:249-256
74. Cohen LL, Bernard RS, Greco LA, McClellan CB. A child-focused intervention for coping with procedural pain: are parent and nurse coaches necessary? J Pediatr Psychol. 2000;27:749-757
75. Cohen LL, Blount RL, Panopoulos G. Nurse coaching and cartoon distraction: an effective and practical intervention to reduce child, parent, and nurse distress during immunizations. J Pediatr Psychol. 1997;22:355-370
76. Blount RL, Powers SW, Cotter MW, Swan S, Free K. Making the system work: training pediatric oncology patients to cope and their parents to coach them during BMA/LP procedures. Behav Modif. 1994;18:6-31
77. Broome ME, Endsley RC. Maternal presence, childrearing practices, and children's response to an injection. Res Nurs Health. 1989;12:229-235
78. Blount RL, Piira T, Cohen LL. Management of pediatric pain and distress due to medical procedures. In: Roberts MC, ed. Handbook of Pediatric Psychology. 3rd ed. New York, NY: Guilford Press; 2003:216-233
79. DeMore M, Cohen LL. Distraction for pediatric immunization pain: a critical review. J Clin Psychol Med Settings 2005;12:281-291
80. Melzack R. Pain and stress: a new perspective. In: Gatchel RJ, Turk DC, eds. Psychosocial Factors in Pain: Critical Perspectives. New York, NY: Guilford Press; 1999:89-106
81. Melzack R, Wall PD. Pain mechanisms: a new theory. Science. 1965;150:971-979
82. Bantick SJ, Wise RG, Ploghaus A, Clare S, Smith SM, Tracey I. Imaging how attention modulates pain in humans using functional MRI. Brain. 2002;125:310-319
83. Frankenstein UN, Richter W, McIntyre MC, Remy F. Distraction modulates anterior cingulate gyrus activations during the cold pressor test. Neuroimage. 2001;14:827-836
84. Petrovic P, Petersson KM, Ghatan PH, Stone-Elander S, Ingvar M. Pain-related cerebral activation is altered by a distracting cognitive task. Pain. 2000;85:19-30
85. McCaul KD, Mallot JM. Distraction and coping with pain. Psychol Bull. 1984;95:516-533
86. Cohen LL, Blount RL, Cohen RJ, Schaen ER, Zaff J. Comparative study of distraction versus topical anesthesia for pediatric pain management during immunizations. Health Psychol. 1999;18:591-598
87. Gonzalez JC, Routh DK, Armstrong FD. Effects of maternal distraction versus reassurance on children's reactions to injections. J Pediatr Psychol. 1993;18:593-604
88. Pringle B, Hilley L, Gelfand K, et al. Decreasing child distress during needle sticks and maintaining treatment gains over time. J Clin Psychol Med Settings. 2001;8:119-130
89. Hoffman HG, Patterson DR, Magula J, et al. Water-friendly virtual reality pain control during wound care. J Clin Psychol. 2004;60:189-195
90. Vessey J, Carlson K, McGill J. Use of distraction with children during an acute pain experience. Nurs Res. 1994;43:369-372
91. Sparks L. Taking the "ouch" out of injections for children: using distraction to decrease pain. Am J Matern Child Nurs. 2001;26:72-78
92. Mason S, Johnson MH, Woolley C. A comparison of distractors for controlling distress in young children during medical procedures. J Clin Psychol Med Settings. 1999;6:239-248
93. Fowler-Kerry S, Lander JR. Management of injection pain in children. Pain. 1987;30:169-175
94. Kleiber C, Harber DC. Effects of distraction on children's pain and distress during medical procedures: a meta-analysis. Nurs Res. 1999;48:44-49
95. MacLaren JE, Cohen LL. A comparison of distraction strategies for venipuncture distress in children. J Pediatr Psychol. 2005;30:387-396
96. Cassidy KL, Graham JR, McGrath PJ, et al. Watch needle, watch TV: audiovisual distraction in preschool immunization. Pain Med. 2002;3:108-118
97. Blount RL, Bachanas PJ, Powers SW, et al. Training children to cope and parents to coach them during routine immunizations: effects on child, parent, and staff behaviors. Behav Ther. 1992;23:689-705
98. Jay S, Elliott CH, Fitzgibbons I, Woody PA. Comparative study of cognitive behavior therapy versus general anesthesia for painful medical procedures in children. Pain. 1995;62:3-9
99. Manne SL, Redd WH, Jacobsen PB, Gorfinkle K, Schorr O, Rapkin B. Behavioral intervention to reduce child and parent distress during venipuncture. J Consult Clin Psychol. 1990;58:565-572
100. Cramer-Berness L, Friedman A. Behavioral interventions for infant immunizations. Child Health Care. 2005;34:95-111
101. Felt BT, Mollen E, Diaz S, Renaud E, Zeglis M, Wheatcroft G, Mendelow D. Behavioral interventions reduce infant distress at immunization. Arch Pediatr Adolesc Med. 2000;154:719-730
102. Kazak AE, Penati B, Boyer BA, Himelstein B. A randomized controlled prospective outcome study of a psychological and pharmacological intervention protocol for procedural distress in pediatric leukemia. J Pediatr Psychol. 1996;21:615-631
103. Piira T, Hayes B, Goodenough B, von Baeyer C. Pain tolerance in children: effects of age, attentional direction, and coping style. Presented at: annual meeting of the American/Canadian Pain Society; May 6-9, 2004; Vancouver, British Columbia, Canada
104. Lewindon PJ, Harkness L, Lewindon N. Randomised controlled trial of sucrose by mouth for the relief of infant crying after immunisation. Arch Dis Child. 1998;78:453-456
105. Barr RG, Young SN, Wright JH, et al. Sucrose analgesia and diphtheria-tetanus-pertussis immunizations at 2 and 4 months. J Dev Behav Pedatr. 1995;16:220-225
106. Kracke GR, Uthoff KA, Tobias JD. Sugar solution analgesia: the effects of glucose on expressed μ opioid receptors. Anesth Analg. 2005;101:64-68
107. Anseloni VC, Ren K, Dubner R, Ennis M. A brainstem substrate for analgesia elicited by intraoral sucrose. Neuroscience. 2005;133:231-243
108. Gibbins S, Stevens B. Mechanisms of sucrose and non-nutritive sucking in procedural pain management in infants. Pain Res Manag. 2001;6:21-28
109. Bo LK, Callaghan P. Soothing pain-elicited distress in Chinese neonates. Pediatrics. 2000;105(4). Available at:www.pediatrics.org/cgi/content/ full/105/4/e49
110. Blass EM, Watt LB. Suckling and sucrose induced analgesia in human newborns. Pain. 1999;83:611-623
111. Reis EC, Roth EK, Syphan JL, Tarbell SE, Holubkov R. Effective pain reduction for multiple immunization injections in young infants. Arch Pediatr Adolesc Med. 2003;157:1115-1120
112. Gray L, Miller LW, Phillipp BL, Blass EM. Breastfeeding is analgesic in healthy newborns. Pediatrics. 2002;109:590-593
113. Allen K, White D, Waburn JN. Sucrose as an analgesic agent for infants during immunization injections. Arch Pediatr Adolesc Med. 1996;150:270-274
114. Ramenghi LA, Webb AV, Shevlin PM, Green M, Evans DJ, Levene MI. Intra-oral administration of sweet-tasting substances and infants' crying response to immunization: a randomized, placebo-controlled trial. Biol Neonate. 2002;81:163-169
115. Lindh V, Wiklund U, Blomquist HK, Hakansson S. EMLA cream and oral glucose for immunization pain in 3-month-old infants. Pain. 2003;104:381-388
116. Halperin SA, McGrath P, Smith B, Houston T. Lidocaine-prilocaine patch decreases the pain associated with the subcutaneous administration of measles-mumps-rubella vaccine but does not adversely affect the antibody response. J Pediatr. 2000;136:789-794
117. Casssidy KL, Reid GJ, Mcgrath PJ, et al. A randomized double-blind, placebo-controlled trial of the EMLA patch for the reduction of pain associated with intramuscular injection in four to six-year-old children. Acta Paediatr. 2001;90:1329-1336
118. Taddio A, Nulman I, Goldbach M, Ipp M, Koren G. Use of lidocaine-prilocaine cream for vaccination pain in infants. J Pediatr. 1994;124:643-648
119. Uhari M. A eutectic mixture of lidocaine and prilocaine for alleviating vaccination pain in infants. Pediatrics. 1993;92:719-721
120. Halperin BA, Halperin SA, McGrath P, Smith B, Houston T. Use of lidocaine-prilocaine patch to decrease intramuscular injection pain does not adversely affect the antibody response to diphtheria-tetanus-acellular pertussis-inactivated poliovirus-Haemophilus influenzae type b conjugate and hepatitis B vaccines in infants from birth to six months of age. Pediatr Infect Dis J. 2002;21:399-405
121. de Waard-Van Der Spek FB, Oranje A, Mulder PG, Bernsen JC, van der Kleij-Troost BW, van den Berg J. EMLA cream as a local anaesthetic in MMR vaccination. Int J Clin Pract. 1998;52:136
122. Obrien L, Taddio A, Ipp M, Goldbach M, Koren G. Topical 4% amethocaine gel reduces the pain of subcutaneous measles-mumps-rubella vaccination. Pediatrics. 2004;114(6). Available at: www.pediatrics.org/cgi/content/ full/114/6/e720
123. Taddio A, Gurguis MG, Koren G. Lidocaine-prilocaine cream versus tetracaine gel for procedural pain in children. Ann Pharmacother. 2002;36:687-692
124. Reis EC, Holubkov R. Vapocoolant spray is equally effective as EMLA cream in reducing immunization pain in school aged children. Pediatrics. 1997;100(6). Available at: www.pediatrics.org/cgi/content/full/100/6/e5
125. Abbott K, Fowler-Kerry S. The use of topical refrigerant anesthetic to reduce injection pain in children. J Pain Symptom Manage. 1995;10:584-590
126. Maikler VE. Effects of a skin refrigerant/anesthetic and age on the pain responses of infants receiving immunizations. Res Nurs Health. 1991;14:397-403
127. Reis EC, Roth EK, Syphan JL, et al. Effective pain reduction for multiple injections in young children. Arch Pediatr Adolesc Med. 2003;157:115-120
128. Eichenfeld LF, Funk A, Fallon-Friedlander S, Cunnigham BB. A clinical study to evaluate the efficacy of ELA-Max (4% liposomal lidocaine) as compared with eutectic mixture of local anesthetics for pain reduction of venipuncture in children. Pediatrics. 2002;109:1093-1099
129. Kleiber C, Sorenson M, Whiteside K, Gronstal BA, Tannous R. Topical anesthetics for intravenous insertion in children: a randomized equivalency study. Pediatrics. 2002;110:758-761
130. Zempsky WT, Anand KS, Sullivan KM, Fraser D, Cucina K. Lidocaine iontophoresis for topical anesthesia prior to intravenous line placement in children. J Pediatr. 1998;132:1061-1063
131. Zempsky WT, Sullivan J, Paulson MD, Hoath SB. Evaluation of a low-dose iontophoresis system for topical anesthesia in adults and children: a randomized controlled trial. Clin Ther. 2004;26:1110-1119
132. Maloney JM, Bezzant JL, Stephen RL, Petelenz TJ. Iontophoretic administration of lidocaine anesthesia in office practice: an appraisal. J Dermatol Surg Oncol. 1992;18:937-940
133. Katz NP, Shapiro DE, Herrmann TE, Kost J, Custer LM. Rapid onset of cutaneous anesthesia with EMLA cream after pretreatment with a new ultrasound-emitting device. Anesth Analg. 2004;98:371-376
134. Zempsky WT, Robbins B, Benson L, et al. Randomized, double-blind, placebo-controlled study of ALGRX 3268: a topical lidocaine delivery system for topical anesthesia prior to venipuncture in children. J Pain. 2005;6(suppl 1):S50
135. Midgal M, Chudzynnska-Pomianowska E, Vause E, Henry E, Lazar J. Rapid, needle-free delivery of lidocaine for reducing pain of venipuncture among pediatric subjects. Pediatrics. 2005;115(4). Available at: www.pediatrics.org/cgi/content/full/115/4/e393
136. Baron ED, Harris L, Redpath WS, et al. Laser-assisted penetration of topical anesthetic in adults. Arch Dermatol. 2003;139:1288-1290
137. Shapiro H, Harris L, Hetzel FW, Bar-Or D. Laser assisted delivery of topical anesthesia for intramuscular needle insertion in adults. Lasers Surg Med. 2002;31:252-256
138. Keen MF. Comparison of intramuscular injection techniques to reduce site discomfort and lesions. Nurs Res. 1986;35:207-210
139. Barnhill BJ, Holbert MD, Jackson NM, Erickson RS. Using pressure to decrease the pain of intramuscular injections. J Pain Symptom Manage. 1996;12:52-58
140. Chung JWY, Ng WMY, Wong TKS. An experimental study on the use of manual pressure to reduce pain in intramuscular injections. J Clin Nurs. 2002;11:457-461
141. Foster R, Eberhart T, Zuk J, et al. Is the ShotBlocker effective in reducing immunization pain? Presented at: International Symposium on Pediatric Pain; June 25-29, 2006; Vancouver, British Columbia, Canada
142. Bogin FJ, Bernstein BA, Payton JS, Schechter NL, Ristau B. A comparison of the pain associated with simultaneous (SIM) vs. sequential (SEQ) immunization injection given at the 9 and 12 month well child visits. Pediatr Res 2004;55:210A
143. Horn MI, McCarthy AM. Children's responses to sequential versus simultaneous immunization injections. J Pediatr Health Care. 1999;13:18-23
144. Agency for Healthcare Research and Quality. US Preventative Services Task Force Guide to Clinical Preventative Services, 2006. AHRQ publication 06-0588. Available at: www.ahrq.gov/clinic/pocketgd.pdf. Accessed March 8, 2007