Reducing the pain of childhood vaccination: an evidence-based clinical practice guideline (summary)

Our objective was to develop a clinical practice guideline, based on systematic reviews of the literature, as interpreted by experts, to assist clinicians in managing procedure-related pain and distress among children undergoing vaccine injections. The scope was limited to acute (immediate) pain and distress at the time of vaccine injection in children 0 to 18 years of age. We did not consider the management of delayed-onset pain occurring in the hours or days after the injection. The term "distress" is often used to refer to the combination of pain and anxiety or fear experienced by children before and during painful medical procedures. For the purposes of this guideline, we considered distress and pain together, referring to the combination as "pain." We developed a knowledge translation plan to facilitate dissemination and implementation of the guideline. This plan incorporates several educational tools, including a guide to pain management for parents and caregivers (Appendix 1, available at www.cmaj.ca/cgi /content/full /cmaj .092048 /DC1), a guide to pain management for health care providers (Appendix 2, available at www.cmaj.ca/cgi /content/full /cmaj .092048/DC1), a tool that health care providers can use to assess and document pain (Appendix 3, available at www.cmaj.ca /cgi/content /full /cmaj.092048/DC1) and a website and educational video for parents and health care providers (available online and freely accessible at www.sickkids .ca/Learning/SpotlightOnLearning /profiles-in-learning/help-eliminate-pain-in-kids/index.html). In addition, several professional organizations (listed at the end of the article) have endorsed or supported this guideline and will assist in its dissemination. This assistance includes online links to the guideline and associated tools and incorporation of recommendations in immunization resources. Educational workshops are being offered to various stakeholder groups. Faculty of Pharmacy ([Anna Taddio BScPhm PhD]) and Departments of Paediatrics (Ipp), of Family and Community Medicine (Midmer) and of Health Policy, Management and Evaluation ([Valerie Palda MD MSc], [Vibhuti Shah]), Faculty of Medicine, University of Toronto, Toronto, Ont.; Research Institute (Taddio, Ipp, [Rebecca Pillai Riddell PhD]) and Department of Psych - iatry (Pillai Riddell), The Hospital for Sick Children, Toronto, Ont.; Canadian Center for Vaccinology ([Mary Appleton BA], Halperin, [Noni MacDonald], Scott), Halifax, NS; Departments of Pediatrics