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Be Sweet to Hospitalized Toddlers During Venipuncture: A Randomized Controlled Trial of Sucrose Compared With Water
Shokoufeh Modanloo1,2, Nick Barrowman3, Brenda Martelli2
1University of Ottawa-School of Nursing, Faculty of Health Sciences.
Insights
Oral sucrose did not significantly reduce pain in hospitalized toddlers during venipuncture. However, younger toddlers (under 24 months) showed some reduction in crying time and pain scores with sucrose administration.
Area of Science:
- Pediatric Pain Management
- Clinical Pharmacology
Background:
- Sweet-tasting solutions like sucrose are effective analgesics for infants during painful procedures.
- Evidence for sucrose efficacy in children over 12 months of age is less conclusive.
Purpose of the Study:
- To evaluate the effectiveness of oral sucrose compared to a placebo (water) for pain relief in hospitalized toddlers aged 12 to 36 months undergoing venipuncture.
- To assess pain using cry duration and FLACC scores.
Main Methods:
- A blinded, two-arm randomized controlled trial was conducted with 95 hospitalized toddlers (12-36 months).
- Participants were randomized to receive either 25% sucrose or water before venipuncture, with topical anesthetics as standard care.
- Pain was measured by cry duration and Face, Legs, Activity, Cry, Consolability (FLACC) scores.
Main Results:
- No significant difference in crying time or FLACC scores was observed between the sucrose and water groups (P>0.05).
- Younger toddlers (12-24 months) showed a trend towards reduced crying time (10%) and lower FLACC scores (1.2 points) with sucrose compared to older toddlers.
- Overall, toddlers experienced significant distress during venipuncture despite standard care.
Conclusions:
- Oral sucrose is not an effective analgesic for hospitalized toddlers aged 12 to 36 months during venipuncture.
- The findings suggest that sucrose may offer limited benefit for pain reduction in younger toddlers within this age range.
- Further research may be needed to explore alternative or adjunctive pain management strategies for this population.
Objectives:
High-quality evidence demonstrates analgesic effects of sweet-tasting solutions for infants during painful procedures. However, evidence of the analgesic effects of sucrose beyond 12 months of age is less certain. The aim of this study was to ascertain the efficacy of oral sucrose in hospitalized toddlers (ages 12 to 36 mo) compared with placebo (water) during venipuncture.
Materials And Methods:
Blinded, 2-armed randomized controlled trial including hospitalized toddlers aged 12 to 36 months. Toddlers were randomized to either 25% sucrose or water before venipuncture, stratified by age (12 to 24 mo and more than 24 to 36 mo). Standard of care included topical anesthetics for both groups. Pain assessment included cry duration and FLACC (Face, Legs, Activity, Cry, Consolability) scores. Descriptive statistics and linear models were used to report the percentage of time crying and mean differences in FLACC scores. Data analysis was performed using R, version 3.6.3.
Results:
A total of 95 toddlers were randomized and 85 subsequently studied. The median percentage of time spent crying between insertion of the first needle and 30 seconds after the end of procedure in both groups was 81% (interquartile range=66%). There was no significant difference in crying time and FLACC scores between groups (P>0.05). When examining effects of sucrose for the younger toddlers (less than 24 mo of age) there was a reduction in crying time of 10% and a 1.2-point reduction in mean FLACC scores compared with the toddlers older than 24 months.
Discussion:
Findings highlight that toddlers become highly distressed during venipuncture, despite the standard care of topical anesthetics. In addition, sucrose does not effectively reduce distress especially in the older group of toddlers.
