Ease immunizations by giving least painful shot first

A funny thing happened during my daughter's latest immunizations: her 5-year-old brother got a marriage proposal.

With his own recent shots still fresh in his mind, he was sweetly anxious about his little sister's vaccinations, even lending her his favorite stuffed dog to hold for comfort. When the shots arrived, there were still plenty of tears—but not so much from the examination table. Sure, my daughter cried, but my son outright bawled, leading the nurse to say she'd marry such a sensitive guy in a heartbeat if only he were 35 years older. (Of course, within the hour he was back to tormenting his sister in typical big-brother fashion, but it was a touching moment.)

There's no getting around it: shots aren't fun for anyone—not the child, the parent and, in our case, the anxious sibling. Although the injections are over quickly, those few moments of sharp pain can be upsetting for all. But, according to a new study, there may be a simple way to reduce a child's distress when getting multiple shots: give the least painful one first.

The study included 120 healthy babies age 2 to 6 months who were getting two shots: the pneumococcal conjugate vaccine (PCV) and the combination vaccine for diphtheria, polio, tetanus, pertussis and Haemophilus influenzae type b (DPTaP-Hib). The PCV vaccine is the more painful of the two, which experts attribute to its lower pH (this means it's more acidic).

The babies were randomly assigned to get either the PCV or DPTaP-Hib vaccine first. Neither the parents nor the doctors knew which shots were being injected when, as the syringes were labeled only with the order they were to be given. The babies were videotaped during the injections, with a researcher scoring their pain based on facial expressions, crying and body movements. Parents were also asked to rate their child's pain on a scale of zero to 10.

Babies who were given the less painful DPTaP-Hib shot first showed less pain overall than those who had the PCV vaccine first. Parents also rated their babies' pain as lower when the DPTaP-Hib shot was given first.

The difference in pain scores wasn't huge, but it was big enough for the researchers to recommend that babies routinely be given the less painful shot first. When children have the more painful shot at the start, it may focus their attention on the procedure and activate pain-processing centers in the brain. This may mean a more intense pain response to any shots that come after.

What you need to know. Having the less painful shot first won't stop a baby from feeling the discomfort of immunizations, but it could ease it slightly. The study didn't explore whether the same holds true for older children, but it certainly wouldn't hurt to try. I've made a mental note to ask my doctor about this when our next immunizations roll around.

—Sophie Ramsey, patient editor

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