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A Systematic Review and Meta-Analysis of the Effectiveness of Physical Interventions Administered Orally for Infants
Vibhuti Shah1,2, Kaytlin Constantin3, Anna Taddio4,5,6
1Professor, Department of Psychology, University of Guelph, Guelph, ON.
Insights
Breastfeeding and sweet-tasting solutions effectively reduce infant distress during vaccine injections. These oral interventions offer significant comfort, making vaccinations a less stressful experience for babies.
Area of Science:
- Pediatrics
- Pain Management
- Evidence-Based Medicine
Background:
- Infants frequently experience distress during routine vaccinations in their first year.
- Repeated needle-stick pain can negatively impact infant well-being.
- Effective, safe interventions are needed to mitigate vaccine-related distress.
Purpose of the Study:
- To systematically review oral interventions for reducing infant distress during vaccinations.
- To evaluate the efficacy of nutritive and non-nutritive oral methods.
- To synthesize evidence on breastfeeding, sweet solutions, and non-nutritive sucking.
Main Methods:
- Systematic review using Cochrane methodology and GRADE.
- Searched multiple databases for randomized and quasi-randomized controlled trials.
- Analyzed distress as the critical outcome, prioritizing placebo-controlled trials.
Main Results:
- Fifty-nine studies were included, with evidence certainty ranging from moderate to very low.
- Breastfeeding during vaccination significantly reduces distress (SMD=-2.38, moderate certainty).
- Sweet-tasting solutions like sucrose and glucose also effectively reduce infant distress.
Conclusions:
- Breastfeeding and sweet-tasting oral solutions are recommended for reducing infant vaccine distress.
- These interventions provide a preferred, evidence-based approach to pain management.
- Further research may clarify the effectiveness of non-nutritive sucking.
Background:
Infants experience distress from repeated vaccine injections in the first year of life. This systematic review evaluated oral nutritive and non-nutritive interventions to reduce distress including: breastfeeding (pre-injection and during), bottle-feeding, sucrose solution, glucose/dextrose solutions, other sweet-tasting oral liquids, and non-nutritive sucking.
Design/Methods:
Cochrane methodology and GRADE were used. Searches were conducted in MEDLINE, EMBASE, APA PsycINFO, CINAHL, and ProQuest Dissertations to identify relevant randomized and quasi-randomized controlled trials. Distress was the critical outcome. Placebo-controlled trials were prioritized when possible. Eligible studies were reviewed and data extracted by at least 2 reviewers. A random-effects model was used to pool the data; results are presented as standardized mean differences (SMDs) with 95% CIs. The certainty of evidence (graded from high, moderate, low, to very low) and the magnitude of effect were used to develop summary statements.
Results:
Fifty-nine distinctive studies were included, with certainty of evidence ranging from moderate to very low. The magnitude of effect exceeded the minimum threshold (SMD ≥0.2) for all interventions. Breastfeeding during vaccinations likely results in a large reduction in distress (SMD=-2.38, moderate certainty). Breastfeeding pre-injection (SMD=-1.19, low certainty) and bottle-feeding (SMD=-1.65, low certainty) may both result in a large reduction in distress. Evidence from placebo-controlled trials shows that sucrose solution likely results in a large decrease in distress (SMD=-1.02, moderate certainty) and glucose/dextrose solutions likely reduce distress (SMD=-0.78, moderate certainty). Other sweet-tasting oral liquids likely result in a large decrease in distress (SMD=-1.47, moderate certainty). Non-nutritive sucking may reduce distress, but the evidence is very uncertain (SMD=-1.98, very low certainty).
Conclusions:
In infants, breastfeeding, sweet-tasting solutions, and other oral sweet-tasting liquids are preferred oral interventions to reduce vaccine injection-related distress.
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