Schechter Neil L, Zempsky William T, Cohen Lindsey L, McGrath Patrick J, McMurtry C Meghan, Bright Nancy S
Pain Relief Program, Connecticut Children's Medical Center, Hartford, Connecticut 06106, USA.
Pediatrics. 2007 May;119(5):e1184-98. doi: 10.1542/peds.2006-1107.
The pain associated with immunizations is a source of anxiety and distress for the children receiving the immunizations, their parents, and the providers who must administer them. Preparation of the child before the procedure seems to reduce anxiety and subsequent pain. The limited available data suggest that intramuscular administration of immunizations should occur in the vastus lateralis (anterolateral thigh) for children <18 months of age and in the deltoid (upper arm) for those >36 months of age. Controversy exists in site selection for 18- to 36-month-old children. A number of studies suggest that the ventrogluteal area is the most appropriate for all age groups. Longer needles are usually associated with less pain and less local reaction. During the injection, parental demeanor clearly affects the child's pain behaviors. Excessive parental reassurance, criticism, or apology seems to increase distress, whereas humor and distraction tend to decrease distress. Distraction techniques vary with the age, temperament, and interests of the child, but their efficacy is well supported in the literature. Sucrose solution instilled directly into the mouth or administered on a pacifier reduces evidence of distress reliably in children <6 months of age and should be used routinely. Although there is no perfect topical anesthetic available at this time, selective use for children who are particularly fearful or who have had negative experiences in the past is highly endorsed. Pressure at the site, applied with either a device or a finger, clearly reduces pain. Finally, in the era of multiple injections, it seems that parents prefer that multiple injections be given simultaneously, rather than sequentially, if there are enough personnel available. Immunizations are stressful for many children; until new approaches are developed, systematic use of available techniques can significantly reduce the burden of distress associated with these procedures.
与免疫接种相关的疼痛是接受免疫接种的儿童、他们的父母以及必须实施接种的医护人员焦虑和痛苦的来源。在操作前对儿童进行准备似乎可以减轻焦虑和随后的疼痛。有限的现有数据表明，对于18个月以下的儿童，免疫接种应在外侧股肌（大腿前外侧）进行，对于36个月以上的儿童，应在三角肌（上臂）进行。对于18至36个月大的儿童，接种部位的选择存在争议。一些研究表明，臀中肌区域适用于所有年龄组。较长的针头通常与较少的疼痛和较少的局部反应相关。在注射过程中，父母的态度明显影响孩子的疼痛行为。父母过度的安慰、批评或道歉似乎会增加痛苦，而幽默和分散注意力则往往会减轻痛苦。分散注意力的技巧因孩子的年龄、气质和兴趣而异，但它们的效果在文献中得到了充分支持。直接滴入口腔或通过安抚奶嘴给予蔗糖溶液能可靠地减轻6个月以下儿童的痛苦迹象，应常规使用。尽管目前没有完美的局部麻醉剂，但强烈建议对特别害怕或过去有过负面经历的儿童选择性使用。使用器械或手指在注射部位施压显然可以减轻疼痛。最后，在多次注射的时代，如果有足够的人员，父母似乎更倾向于同时进行多次注射，而不是依次进行。免疫接种对许多儿童来说是有压力的；在开发出新方法之前，系统地使用现有技术可以显著减轻与这些操作相关的痛苦负担。
