Managing pain-and-distress during infant vaccination: An integrative literature review

Background Vaccination during infancy is pivotal for reducing childhood morbidity and mortality; however, it is also the most common cause of severe pain-and-distress in infants. Evidence-based interventions to manage pain-and-distress include breastfeeding, local anaesthesia, and sensory stimulation. Despite globally available evidence, the management of pain-and-distress during infant vaccination remains inconsistent, contributing to lower vaccination coverage and increased vaccination fear. This review aimed to identify the best available evidence for optimally managing pain-and-distress during infant vaccination. Methods An integrative literature review was conducted using academic databases, with additional sources identified through reference lists from the primary search, the author’s EndNote library, and grey literature from professional association websites. The search was limited to English documents published between 2013 and 2023. Two independent reviewers screened documents for relevance. Critical appraisal tools were used to determine the strength of the evidence, and a data extraction table was used for thematic analysis and synthesis. Results Twenty-three articles from lower-middle-, upper-middle- and high-income countries were included, with 87% comprising randomised controlled trials and 13% cohort studies. Thematic analysis identified three themes: non-pharmacological, pharmacological, and combined/combination interventions, under which eight categories were constructed from 22 types of interventions. Each intervention was described according to its general evidence of benefit for reducing pain-and-distress during vaccination of infants Conclusion There are interventions with high evidence of benefit that overlap a large age group from ≥ 1 – ≤12 months, including breastfeeding, formula feeding and pharmacological options like EMLA. Although these may not always be feasible for HCPs and parents in all settings. Milestones progressively shift in the first year of life and it may be worthwhile to investigate these interventions in smaller age variation such as ≥ 1 to ≤ 3 months, ≥ 3 to ≤ 7 months, and > 7 to ≤ 12 months of age. Evidence in this review scarce for infants between 6–12 months. Addressing these gaps may improve the benefits and consistency of pain-and-distress management strategies for infant vaccinations, which may contribute to higher vaccination coverage. PROSPERO ID: CRD42023431021 Trial registration: Not applicable