Optimising immunisations for children with needle phobia and/or developmental disorders: a retrospective audit to...

Need for immunisation under sedation services in hospitals for children with needle phobia and/or developmental and behavioural disorders has escalated over the last decade. We aimed to evaluate Australia's largest and longest running immunisation under sedation service over a 6-year period to inform policy and practice.

A retrospective medical record audit was conducted between January 2017 and December 2022 for all patients accessing the immunisation under sedation at the Royal Children's Hospital (RCH). Data on patient demographics, diagnosis, vaccine type, pre-hospital sedation, distraction and sedation techniques and outcomes were extracted from the Electronic Medical Record (EMR).

Over six years, 518 patients accessed the service, with a total of 922 encounters for immunisation. Most children had a primary diagnosis of needle phobia (54%) or autism spectrum disorder (ASD) (31%). Immunisations were successfully delivered in 91% of encounters. Most encounters for children with needle phobia (69%; 337/486), anxiety (61%; 33/54) and behavioural disorders (62%; 30/48) received nitrous oxide alone, whereas nearly half the encounters for children with ASD (46%, 126/275) and intellectual disability (ID) (47%, 17/36) received both nitrous oxide and midazolam. Failed immunisation was seen more with no sedation (68%; 30/44), midazolam alone (12%; 7/54) and in children with ASD 18% (28/158).

The tertiary immunisation under sedation service at RCH in Australia has grown rapidly over the last decade, with increasing demand for children with needle phobia and/or developmental and behavioural disorders. This study provides key practice points to optimise immunisation success and ensure a more positive experience for children and their families.