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The '5 S's': Easing baby pain after vaccine shots
The "5S's" include swaddling (tightly wrapping a baby in a blanket almost like a burrito) and a side/stomach position such as this.
April 16th, 2012
12:01 AM ET

The '5 S's': Easing baby pain after vaccine shots

For most parents -  even the strongest believers in the benefits of vaccines - anticipating how their newborns' facial expressions will turn from curious to shock before they burst into tears from the needle stick, can make the next well-baby check-up something they would love to skip.

But doctors at Children's Hospital of the King's Daughters in Norfolk, Virginia, have found an easy way - actually five easy ways - to help calm a baby's pain (and anxiety), without any medication.

It's called the "5 S's":  swaddling (tightly wrapping a baby in a blanket almost like a burrito), side/stomach position, shushing sounds, swinging and sucking.

If babies were doing four out of five of these "S's," they would usually stop crying within 45 seconds after the shot, according to a new study published in the journal Pediatrics.

Parents aren't the only ones who are concerned about the pain babies feel when they get vaccine shots. Doctors and nurses - the ones sticking the needles into the little babies - are too.

In the past, doctors would recommend giving an infant some baby Tylenol or Advil, to prevent any possible fever from developing and also to provide pain relief.  But that changed a few years ago when a study, published in the medical journal The Lancet,  found  that giving acetaminophen (the main ingredient in Tylenol) before or after vaccination actually made the vaccine less effective because fewer antibodies were produced.

Watch more about easing vaccine pain for babies

Breastfeeding can help reduce pain and calm a child because it gives the infant comforting skin-to-skin contact and  distracts the child. Also, mother's milk contains sugar which is known to have pain-relieving effects.  However, if a mother is no longer breastfeeding or uncomfortable doing so in a pediatrician's exam room, that's not really an option.

So the standard of care for helping reduce pain stemming from vaccinations or circumcision or drawing blood has been sugar.

"A lot of neonatologists use sugar for a painful procedure," says lead study author Dr. John Harrington. "It's poor medicine not to give sugar before medical procedures because it does work."

On the other hand Harrington, who is a pediatrician at Children's Hospital of the King's Daughters, says if children keep getting sugar to help relieve pain, that doesn't help alleviate the obesity problem we have today.

So Harrington was searching for something that would provide a pain-relief alternative.  A guest lecture given by Dr. Harvey Karp, creator of the DVD and book "The Happiest Baby on the Block" gave him the idea for his study.

Karp had found that when parents use the "5 S's" it triggers a calming reflex in the baby.  Harrington knew many parents found this method to be helpful with colicky babies, so he decided to see how it would work when giving vaccinations in his clinic.

He devised a trial with 230 healthy infants who came to his clinic for regular check-ups at 2- and 4-months of age.  They were divided into four groups:  One group was given 2 millilitres of water  2 minutes before getting the vaccine.

The second group was given 2 millilitres of sugar-water.

The third group was only given the "5 S's" after the shot.

And the last group was given 2 millilitres of sugar-water before the shot and the "5 S's" after the vaccination.

At least four of the "5 S's" had to be completed (babies were not always able to suck on a pacifier because they were either crying too hard, already calming down or unfamiliar with a pacifier.

Harrington and his team thought the sugar solution plus the physical intervention using the "5 S's" would be most effective.  The study authors reported that "the pain scores and crying time in the group of physical intervention alone were essentially identical and sometimes even lower than the physical intervention with sucrose group."

Harrington says the babies who only received the sugar solution were still crying 2 minutes after getting the shot.  But most of the babies who got the physical intervention stopped crying by 45 seconds.

"By a minute [following the shot], nobody was crying or making any sort of fuss at all," he says.

Dr. Karp wasn't involved in the study but he says this research shows the that the "5 S's" are twice as effective as sugar, which has been the gold standard up until now.  But he believes Harrington's study actually underestimates the effectiveness of the "5 S's" because the sugar-water is given 2 minutes before the shot and the swaddling and swinging etc. didn't begin until 15 to 30 seconds after the shot.

Karp recommends doctors swaddle the baby before the procedure and just leave the legs exposed (that's where the injections in young babies are made), thus triggering the calming reflex before the procedure.  He also recommends doctors have a white-noise CD on before the shot is given.  "That will give a much faster [calming] response," says Karp.  He says white noise is as important as swaddling when it comes to triggering an infants calming reflex and should be used until the baby's first birthday.

This is the second study that shows how the "5 S's" help babies, says Karp. "A 2011 Penn State report found the '5 S’s' helped increase infant sleep and reduce infant obesity."

The study authors acknowledge they tested their hypothesis on more 2-month olds than 4-month olds.  They attribute that to parents being so amazed by the calming effects of swaddling etc. when they came in for the 2-month check-up, they then asked to learn how to do it themselves.  Therefore the number of parents in the test group who didn't use the "5 S's" to calm their babies at the next (4-month) visit was very small.  Harrington acknowledges that more research needs to be done to validate his study, but the results show you don't need a spoon full of sugar to get a vaccination because using the "5 S's" is more effective.

The real benefit, he says, is that "the parents had learned that they could soothe their child without giving their child sugar or giving medicine."

If this leads to less stress and anxiety at doctors visits, that doesn't hurt either.


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