Implementing a clinical protocol using breastfeeding to mitigate vaccination pain in infants

Although an effective public health intervention and a routine pediatric practice, vaccines are a common source of iatrogenic pain in childhood. Techniques, such as exam table restraint may cause infants to struggle and heighten distress, but studies demonstrate that breastfeeding and lap holding are effective strategies to reduce injection pain during vaccination.

Adoption of pain-relieving techniques into clinical practice is often underutilized. In a pediatric clinical practice in southern Connecticut, there were no guidelines for providing pain mitigation strategies, including breastfeeding, during infant vaccination.

The Plan-Do-Study-Act (PDSA) cycle was used for the improvement process. A clinical protocol introduced breastfeeding as a pain-relieving strategy during vaccination; lap holding was a second option. All clinical staff were educated on the infant pain experience, and nurses were further trained on vaccine administration techniques during breastfeeding.

A total number of 354 infants were seen for vaccination during the 12-week project: 168 were breastfed infants, of which 53% were breastfed during vaccination; 234 were placed on the parent/caregiver's lap during vaccination; and only 13 infants were restrained on the exam table. There was no documentation of position for 18 infants.

A clinical protocol was an effective tool to guide nurses on pain-relieving options, such as breastfeeding and lap holding, during vaccine administration. Positive experiences during vaccination administration have the potential for short-term and long-term benefits including, compliance with routine care and adherence to vaccination schedules.