Sucrose for the relief of pain associated with immunization injections in infants: Addressing injection pain as a barrier to immunization in India

Background: Parents often report withholding follow-up immunization from their infants due to the distress associated with injections. With the introduction of immunization schedules that require multiple injections per visit across the developing world, it is imperative to address injection pain, a known barrier to immunization compliance. Objective: A double-blind randomized controlled trial was done to evaluate the efficacy of sucrose for the relief of pain associated with immunization injections in infants. Methods: 50 healthy infants (mean age 3.3 ± 1.7 months) brought to the pediatric ambulatory clinic of a tertiary hospital in Pune, India for their routine 6, 10 and 14 weeks oral Polio and DPT intramuscular immunization were randomized to receive by mouth 2 ml of sucrose solution (75% w/v) or distilled water (placebo) before the injection. A blinded observer analyzed video recordings of each injection procedure to measure the duration of crying and to score the Modified Behavioral Pain Scale (MBPS), an infant pain assessment tool. Results: There was a significant reduction in crying times and pain scores in the group receiving sucrose as against the controls. The mean (SD) crying time in seconds for the sucrose group (n=25) was 28.28 (9.82) vs. 44.60 (11.64) for the control group (n=25; p<0.0001 using t test). The mean (SD) MBPS score after injection for sucrose was 6.80 (0.71) vs. 7.24 (0.66) for controls (p=0.0344 by the Mann-Whitney test). Conclusion: Sucrose is a safe, convenient and inexpensive non-pharmacologic analgesic that can be adopted by infant immunization programs for injection pain control.