I remember the appointment vividly. My infant daughter waited unknowingly for the shots; my 2-year-old son, worried, began to sing her favorite song. My son and I got our faces up close and touched my daughter’s hands and belly while the doctor administered the immunizations in her thigh. Baby Audrey winced momentarily, then returned to smiling as she gazed up at us. I was amazed, and my son felt empowered.
It turns out that there’s science to support our actions. A growing body of research shows what many parents know instinctively: Music is an effective way to distract young children from painful medical procedures.
“It’s one more tool we have in our handbag to help children,” said Lisa Hartling, director of the Alberta Research Center for Health Evidence in Canada, who has studied the role of music in mitigating medical-procedure stress in kids.
Hartling co-authored a study this year that measured the effect of recorded music during the insertion of an intravenous line. Researchers monitored pain and distress in 42 children, ages 3-11, before and after the procedure. Half received standard emergency room care; the other half listened to music played via room speakers. The IV insertion was distressing to all kids, but researchers observed twice as many signs of distress in kids who weren’t exposed to music as in those who were. Pain, as reported by the kids, increased with the procedure in those who didn’t have the music, but remained low in those who did.
Not just any music will do the trick, Hartling says. The purpose is to distract rather than soothe, and booming, complicated music is most effective. One piece used in the study was “Jupiter” from the symphony “The Planets.” “It’s very energetic, with lots of sounds and themes,” Hartling says.
Other useful techniques include storytelling, guided imagery (talking to kids about a special place or event), blowing soap bubbles and tablet games. Sipping sugar water, sitting in parents’ laps and deep breathing can also help mitigate children’s pain in the doctor’s office or the emergency room.
Such distractions might require a rethinking of the doctor visit. For years the protocol in many pediatric practices has been to give out stickers or candy after kids get their shots. “Why not put something in place before the injection?” asks Denise Harrison, a nurse and researcher at the University of Ottawa.
In a 2010 study, Harrison found that in 13 of 14 clinical trials, use of a sugar solution – typically given orally two minutes before an injection – reduced babies’ crying upon getting the shot.
Harrison and William Zempsky, head of pain medicine at Connecticut Children’s Medical Center, are part of a group of physicians and researchers trying to change the way health care providers manage pain in children. They have compiled evidence for sugar solutions and other approaches such as a skin spray, Pain Ease, that produces a freezing sensation, and a patch that numbs the skin before the shot. Zempsky co-authored a clinical report for the American Academy of Pediatrics that offered pain-reducing strategies for immunizations, including the use of sugar solutions.
In the ER, sometimes kids need strong pain medications, but there’s a reluctance to give such drugs to children, especially very young ones.
“Studies show that kids under 2 years don’t get appropriate pain meds,” Zempsky says, noting that physicians and parents are fearful of giving them opiate drugs such as morphine. “But these drugs are safe and effective and appropriate to use,” he says, especially with painful injuries such as a fracture or a scald burn.
More attention to pain
Distraction techniques should be used in conjunction with these pain meds, says Stephen Teach, associate chief of the Emergency Medicine Trauma Center at Children’s National Medical Center. Teach asks parents to help. He’ll say: “Here’s what I’m going to do. Here’s what you can do.” His suggestions? Talk in your child’s ear about a vacation or a favorite stuffed animal; let him play a computer game on a tablet; have her blow soap bubbles.
“It’s been a gradual evolution, but now ER physicians are paying more attention to pain,” Zempsky says. Health researchers want pediatricians to address the specter of pain with immunizations as well.
Parents should be more direct and advocate for pain management whether at the pediatrician’s office or the emergency room, Harrison says. “Just do it,” she says. “Tell your provider, “I’ll be breast-feeding my child’ (while the injection is being done) or ‘I’ve brought my sugar water.’”