Reducing The Pain Caused By Children Vaccinations

Injections for vaccinations are the most common source of pain in children. The pain associated with such injections is a source of distress for children and their parents. International Association for the Study of Pain (IASP) developed the standard definition of pain more than 20 years ago: Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage. It states further that pain always is subjective and learned through experiences related to injury early in life. Alternatively, McCaffrey proposes that pain is whatever the patient says it is and that it exists whenever he or she says it does. Untreated pain can have long-term consequences including preprosedural anxiety, hyperalgesia, needle fears, and health care avoidance behaviours. According to an atraumatic nursing care lesson, reducing pain during children vaccination is important. Minimizing pain during vaccination can help children to prevent distress, development of needle fears, and subsequent health care avoidance behaviours. More positive experiences during vaccine injections also maintain and promote trust in health care providers (Taddio, 2010). There are some managements of delayed onset of pain based on systematic reviews of the literature. The scope was limited to acute pain and distress at the time of vaccine injection in children. This paper will give informations about 5 managements to reduce pain according to Grade A and B recommendation of ENAs classification guide line for practice. They are giving distraction, providing tactice stimulations, holding, giving praise and reward, and numbing medicine (topical anesthetic). The first management is giving distraction. Distraction is the best way to calm the children. Distraction is defined as the use of strategies to take an individuals attention away from the procedure (Cohen, 2006). Attention capacity during painful episodes may be diverted away from pain and occupied by focusing on information irrelevant to the noxious stimuli. Alternatively, attention can be focused away from noxious stimulation by suppressing awareness of it. Children will give more attention to distraction than vaccination procedures, so it help them to reduce pain caused by injection. A number of studies have examined distraction during painful procedures with good results. There are some examples of distraction, such as watching cartoon, listening to music, reading, blowing bubbles, talking (not about the hospital), or counting. The second management is providing tactile stimulations, such as rubbing the skin near or opposite the injections site before and during the procedure. Providing tactile stimulation is a cost-neutral intervention that may reduce the sensation of pain. The proposed
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mechanism of action involves the gate control theory of pain and the notion that the sensation of touch competes with the sensation of pain for transmission to the brain, thereby resulting in less pain. Providing tactile stimulation before and during injection results in less pain (Taddio, 2009). The third management is holding the children. Many children like their parents to hold them during the procedure. Younger children like to sit on their parents lap, and older children may prefer their parent to hold their hand or rub their back. This intervention will make children feel comfort. Feeling comfort can reduce anxiety which increase painful stimuli. Parents and caregivers play an important role during an office visit when children receive vaccines. They can comfort their children, making them feel safe and secure. Parents also can help with the safe delivery of vaccines by securely holding children when shots are given (Natalia, Kurumaningrum & Nuryanto, 2011). A parents embrace during vaccination offers several benefits, such as safely prevents children from moving their arms and legs during injections, avoids frightening children by embracing them rather than overpowering them, encourages parents to nurture and comfort their child, allows the health care professional steady control of the limb and the injection site, and produces endorphin hormone to provide feeling comfort. So, painful stimuli are decreased from limbic system. The fourth management is giving praise and reward. Praising the children right after the procedure is very important. If children feel good about how it went, they are more likely to do well with other medical tests that they may have. Give rewards like stickers or a special threat after the procedure also important. Let the children know that they have done a good job. The benefit of this management are increasing self esteem and omitting needle fears on children. Painful stimuli will increase when children get their injection fearfully (Wong, 2008). The fifth management is numbing medicines. There are topical anesthetics or numbing medicines, which may take the poke hurt less. Some anasthetics work quickly but others take a half hour until an hour to work. Make sure the children know what they will feel some pressure during the procedure, even with the medicine. Topical anesthetics are effective for reducing vaccination pain. They block afferent nerve which delivered pain stimuli to brain (limbic system). Topical anesthetics are available without a prescription, suh as lidocaine prilocaine 5% cream (EMLA), amethocaine 4% gel (Ametop) and liposomal lidocaine 4% cream (Maxilene, RGR Pharma). Education of parents (written, electronic or in person) is required, including specifying the exact site or sites of administration. Topical anesthetics must be
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applied ahead of time, 2060 minutes before the injection, depending on the commercial product being applied. If multiple vaccines are being injected during the same visit, the topical anesthetic can be applied at two separate sites (e.g., right and left legs). The vaccine or vaccines must be injected where the anesthetic has been applied. Health care providers can use a nontoxic marker to outline the area of application (Lander, 2006). The informations contained in this paper are generalizable to healthy children undergoing injection of vaccines worldwide. Organizations and health care providers involved in immunization are encouraged to adopt pain management as an integral component of the vaccination process. Supports should be put in place to facilitate the implementation of these recommendations by health care providers. Some costs may be incurred by the incorporation of these recommendations into practice, because of required training of staff, required time to practise pain management and expenditures to acquire aids (e.g., bubbles, toy, doll) and resources (e.g., pamphlets for parents and children). For the most part, these costs are relatively modest and may be offset by shorter duration of the procedure (because the childs distress and struggling are lessened) and faster recovery time. Reducing pain caused by children vaccination is recommended for health care providers and parents. In selecting specific pain-relieving strategies for use in a particular situation, clinicians and parents are advised to consider the analgesic effectiveness of individual modalities, the goals for the child, and the preferences of the child, the parents and the clinician. Health care providers should offer pain-relieving options to parents and children (as appropriate) when they are counseling about other aspects of immunization and child care, as parents and children are largely unaware of effective pain-relieving strategies. Clinicians are advised to combine different pain-relieving strategies, as such combinations improve pain relief.

REFERENCES Cohen L.L., MacLaren J.E., Fortson B.L., et al. Randomized clinical trial of distraction for infant immunization pain. Pain 2006;125:165-71. Lander J.A., Weltman B.J., So S.S. EMLA and amethocaine for reduction of childrens pain associated with needle insertion. Cochrane Database Syst Rev 2006;(3):CD004236. Natalia, R., Kusumaningrum, A., &. Nuryanto. (2011). Pengaruh pelukan ibu terhadap tingkat nyeri bayi saat injeksi imunisasi di wilayah kerja puskesmas indralaya ogan ilir tahun 2011.Skripsi.UniversitasSriwijaya:Program Kedokteran. (tidak dipublikasikan).
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Taddio A., Chambers C.T., Halperin S.A, et al. Inadequate pain management during childhood immunizations: the nerve of it. Clin Ther 2009;31(Suppl 2):S152-67. Taddio, A., et al. (2010). Reducing the pain of childhood vaccination: an evidence-based clinical practice guideline.Canadian medical association jurnal, 182(18), E843E855. Wong, D.L., Hockenberry-Eaton, M., Wilson, D., Winkelstein, M.L., Schwartz, P. (2001). Wongs essensial of pediatric nursing (6th Ed.).Diterjemahkan Oleh Hartono, A., Kurnianingsih, S., & Setiawan. Edt. Yudha, E.K., Wahyuningsih, E., Yulianti, D., Subekti, N.B. (2008). Buku ajar keperawatan pediatrik (edisi 6, volume 2). Jakarta: EGC.