Pain Reduction During Immunization: A Review of Quantitative Study

This report provides a detailed review of a quantitative study investigating the effectiveness of oral sucrose in reducing pain responses during immunization in 16-19 month old infants. The study, involving 537 healthy infants, employed a semi-experimental design with randomized control trials to compare crying times between infants receiving oral sucrose solutions (25% and 75% concentrations) and a control group. Data was collected via video recordings, and statistical analysis was performed using SPSS to determine the differences in mean crying times. The review assesses the study's background, research design, sampling methods, data collection techniques, and data analysis, concluding that the study's methodology was appropriate and the results suggest that oral sucrose administration, particularly in higher concentrations, can effectively reduce pain and distress during immunization procedures. The findings are deemed generalizable to other immunization centers and potentially applicable in other settings involving injections for young children.

Running head: PAIN REDUCTION DURING IMMUNIZATION 1
Oral sucrose administration to reduce pain response during immunization
Name
Institutional Affiliation

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1. Background of the study
a) The main health concern in this study is the pain that results from immunisation
procedures mainly done during childhood. These painful procedures can result in various
consequences such as fear, anxiety and distress among children and their parents as well.
Needle phobia, in particular, has been found to be the commonest result of painful
immunisations (McMurty et al. 2015). This will, in turn, affect their health-seeking
behaviour in the long run. This can start merely by lack of compliance to scheduled
immunisations and in future, avoidance of medical care. Several interventions can be
employed to reduce distress to the infants. They include psychological interventions,
pharmacologic interventions (such as the use of oral sucrose) and physical interventions
by use of specific injection techniques.
b) Results from previous studies indicate very minimal analgesic properties of oral sucrose
on children. They, however, show that it has the capacity to reduce pain in the newborns.
Previous study results also conclude that non-pharmacologic interventions can be used to
ease the needle pain during immunisation (McNair, (2013).
c) Results from this study would be significant in reducing pain and anxiety associated with
vaccine injections, therefore preventing parents and their infants from skipping scheduled
immunisations. This will also improve turnout for vaccination among parents which will
play a bigger role in the prevention of preventable diseases. This is a study that, if results
turn out positive, will improve the health seeking behaviour of people right from infantry
into adulthood. Immunization being a global health strategy with virtually every infant on
the planet receiving a number of vaccines, this study becomes even more useful.

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The research design
2. Overview of the research design
a) This study aimed to find out the effect of oral sucrose solution on the crying times of 16-
19-month-olds. The crying times would be a direct indicator of distress in the
participants.
b) A semi-experimental design is employed. This type of design makes use of the scientific
method to examine an intervention experimentally.
c) A characteristic of this design is its ability to employ the use of randomisation of
subjects or sample units into control and treatment units. The outcomes from the two
groups are then compared. Field experiments as a research design are thought to have a
higher external validity compared to laboratory experiments. The design has several
strengths in that it’s more likely to reflect what happens in real life due to its natural
setting. The likelihood of various demand characteristics affecting findings with this kind
of design is also reduced. However, an undesired feature encountered is the limited
control over extraneous or external variables that may make the findings biased.
d) This design also met the aim of the study since randomising the recruited children and
infants and blinding of nurses, parents and investigators ensured any interference from
them. A randomised control trial like this facilitated comparison of the distress as a result
of injections between those participants who received the oral sucrose solution and those
who didn’t receive. This enabled the researchers to make deductions of whether the oral
sucrose solution has analgesic effects on children beyond the newborn age or not.
Reduction in the duration of cries in those participants who had received the solution

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compared to the controls would mean that the solution has a role in immunisation
procedures.
3. Sampling
a) A total of six hundred and ninety-four healthy children and infants aged 16-19 months
were recruited at the department of pediatrics in the Well-Child unit. The participants
were required to have the following characteristics:
1. The infants should have been born at term
2. Should have been born with a normal birth weight
3. Healthy with no other co-morbidities
4. Should have had at least routine well-child care
b) Those who failed to meet the above characteristics were excluded from the analysis of
their results; thus 537 infants had their results analysed. Younger infants under the age
bracket were excluded from the study since its already common knowledge that
newborns respond to analgesic properties of oral sucrose. Children with other disorders,
for example, congenital disabilities and other diseases were also included since they
could already be crying due to their disease or condition and the injection as such. They
could also exaggerate the cry and prolong it leading to erroneous results.
c) It’s important to have the sampling criteria identified before recruiting participants for
several reasons (Robinson, 2014). Having the sampling criteria beforehand helps to avoid
bias while selecting the participant. This can influence the results of the study. It also
helps to reduce participant numbers to required ones. Lastly, this improves the quality of
the research and influences the validity of results when bias is avoided while choosing the
samples.

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d) The simple random sampling technique was used in selecting the participants. Each child
at the hospital, therefore, had an equal chance of being chosen as long he/she met the
criteria. By this method, five hundred and thirty-seven infants were randomly selected.
This technique was the most appropriate to use to avoid bias during the selection of the
infants hence leading to more representative results.
e) This technique was the most appropriate. Other alternatives such as stratified sampling
and systematic were not workable in this situation. Stratifying the target population (the
infants) would not be appropriate in this case since it is time wasting and not necessary to
achieve the objectives. Convenience sampling would be more bias since infants from a
particular place may not react similarly to pain due to the different psychosocial
environments and upbringing (Robinson, 2014). Systematic sampling could have worked
too, but the technique would easily include samples from different age brackets. This left
simple random sampling as the best choice and more appropriate for this kind of study.
The sample that resulted from the recruitment was also appropriate for the study since the
participants were in the required age bracket with no comorbidities to affect the results.
The number of participants chosen was also large enough to make conclusions from it
and representative of the rest of the population in the same age bracket.
4. Data collection
a) Data was collected by videotaping the procedures as they were being done. The crying
durations were then extracted from the videos and recorded for analysis.
b) The field experiment was carried out by first mothers getting seated with their infants and
children in their arms with the nurse handling them as usual. All infants and children
were ensured to be awake during the procedure. The nurse then orally administered all

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the solutions required for the test which had been prepared earlier by a pharmacist. Oral
Polio vaccine was then first given orally then followed by intramuscular tetanus, acellular
pertussis and diphtheria, intramuscular hepatitis A and intramuscular pneumococcus were
administered in the left and right deltoid areas concurrently. Three or two injections were
given to all infants and those who had received pneumococcus vaccination at one year of
age were not vaccinated again. The whole procedure was videotaped.
c) Videotaping as a method of data collection fitted the study appropriately since the crying
times of the participants could be obtained directly by reviewing the video and measuring
the playtime of the cries. It’s also a method of data storage at the same time for future
reference. The video also gives the researchers an opportunity to find any other
extraneous causes of cries that may have come in during the procedure by re-watching
the video.
d) Video recording has various advantages and disadvantages. One of the advantages is that
they can elicit information from people who cannot be able to provide it (Albuquerque,
2014). For example, by watching activities of subjects in the natural environment, you
can obtain information from them without confronting them which could influence the
data a researcher wants. Information can also be obtained directly from a participant a
world away via video conferencing (Sullivan, 2012). Videotaping also stores information
for future reference at the same time. Some disadvantages include the costliness of the
method resulting from the purchase of the video recorders and batteries, and the expertise
required to obtain the relevant information from the records may be scarce.
e) Other alternative methods that this researcher would have chosen include voice recording
which could have still provided the cries of the infants and observation. Researchers

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could have observed the procedures and recorded the crying times. Observation could
have been more labour intensive though.
5. Data analysis and results
a) Statistical analysis was done on the data collected. Differences between the control and
the group that was given oral sucrose were investigated by an analysis of variance test.
The software application SPSS was employed to perform the statistical analysis.
Differences between the mean crying times of the three categories were produced by the
software application (SPSS). The following table shows the crying times as obtained
from the study.
group Control 25% sucrose 75% sucrose
Crying time (s) 120 +/- 34 63.3 +/- 26 43.4 +/- 17
(Table from Eur J Pediatr (2014)
Infant crying times were reduced by 64% when 75% sucrose was used according to the
data analysis.
b) The method of data analysis was appropriate for the study question since arithmetic
calculation of crying times when oral sucrose solutions were used and comparing them
with the times when it wasn't used would indicate more clearly whether there was a
reduction in crying times or not. The research design being semi-experimental and results
being quantitative; this statistical analysis method is acceptable. The use of SPSS
application to analyse the results was also called for since it is both current, convenient
and time saving considering how bulky the study was in terms of getting the results from
the videos recorded.

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c) In quantitative research, it’s vital to select applicable methods of data analysis to ensure
there is rigour. The researchers discovered that indeed oral sucrose administration slightly
reduces the duration of cries and due to the meticulous way in which the data was
collected and recorded via videotaping and analysed, they concluded that the analysis
was rigorous enough producing results that were relatively reproducible.
d) The researchers described the results as representative of other setups and valid for
implementation of the findings. Researchers concluded that the results had enough
statistical significance to be used in deciding whether to incorporate oral sucrose in
immunisation procedures. The sampling technique and the relatively acceptable sample
size used improved the statistical significance of the results. From the results, one can
also conclude that oral sucrose administration in high concentrations should be
incorporated in vaccination procedures.
e) There are several other settings into which these results can be generalised. These include
other immunisation centres in all other countries and in cancer centres where children
have to be given drugs via regular injections. In addition, the results are justified to be
generalized in as a background to other research in participants aged between sixteen and
nineteen years.
References

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Albuquerque, U. P., Ramos, M. A., de Lucena, R. F. P., & Alencar, N. L. (2014). Methods and
techniques used to collect ethnobiological data. In Methods and techniques in
Ethnobiology and Ethnoecology (pp. 15-37). Humana Press, New York, NY.
El-Magd, A. N. A., Ali, B. A. E. M., El-Kreem, H. E. A., & Mohammed, N. T. (2014). Effect of
oral Sucrose administration on reducing the infantile sensation of pain during obligatory
immunisations at Minia City
Farkas, C., Solodiuk, L., Taddio, A., Franck, L., Berberich, F. R., LoChiatto, J., & Solodiuk, J.
C. (2015). Publicly Available Online Educational Videos Regarding Pediatric Needle
Pain. The Clinical journal of pain, 31(6), 591-598.
Friedrichsdorf, S. J., Postier, A., Eull, D., Weidner, C., Foster, L., Gilbert, M., & Campbell, F.
(2015). Pain outcomes in a US children’s hospital: a prospective cross-sectional
survey. Hospital pediatrics, 5(1), 18-26.
Karlsson, K., Rydström, I., Nyström, M., Enskär, K., & Englund, A. C. D. (2016). Consequences
of needle-related medical procedures: A hermeneutic study with young children (3–7
years). Journal of Pediatric Nursing: Nursing Care of Children and Families, 31(2),
e109-e118.
McMurtry, C. M., Riddell, R. P., Taddio, A., Racine, N., Asmundson, G. J., Noel, M., ... & Shah,
V. (2015). Far from “just a poke”: common painful needle procedures and the
development of needle fear. The Clinical journal of pain, 31(Suppl 10), S3.
McNair, C., Yeo, M. C., Johnston, C., & Taddio, A. (2013). Non-pharmacological Management
of Pain During Common Needle Puncture Procedures in Infants. Clinics in
Perinatology, 40(3), 493-508.

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McCall, J. M., DeCristofaro, C., & Elliott, L. (2013). Oral sucrose for pain control in non-
neonate infants during minor painful procedures. Journal of the American Association of
Nurse Practitioners, 25(5), 244-252.
Robinson, O. C. (2014). Sampling in interview-based qualitative research: A theoretical and
practical guide. Qualitative Research in Psychology, 11(1), 25-41.
Shah, V., Taddio, A., McMurtry, C. M., Halperin, S. A., Noel, M., Riddell, R. P., & Chambers,
C. T. (2015). Pharmacological and combined interventions to reduce vaccine injection
pain in children and adults: systematic review and meta-analysis. The Clinical journal of
pain, 31(Suppl 10), S38.
Sullivan, J. R. (2012). Skype: An appropriate method of data collection for qualitative
interviews? The Hilltop Review, 6(1), 10.
Weerahandi, S. (2013). Exact statistical methods for data analysis. Springer Science & Business
Media.
Zhou, F., Shefer, A., Wenger, J., Messonnier, M., Wang, L. Y., Lopez, A., ... & Rodewald, L.
(2014). Economic evaluation of the routine childhood immunisation program in the
United States, 2009. Pediatrics, 133(4), 577-585.