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‘Five S’s’ can keep babies calm during shots

Researchers say infants exposed shortly after vaccination to the “Five S’s” of physical intervention — swaddling tightly in a blanket, being laid sideways or on the stomach while awake, shushing, swinging back and forth, and being allowed to suck on something, often a pacifier — scored lower on a pain measurement scale and stopped crying more rapidly than babies given a concentrated sugar solution, one of the most common pain relief treatments for infants getting shots and other medical procedures.

“Some parents might be a little skittish giving their babies vaccines knowing it’s not painless,” says pediatrician John Harrington of Children’s Hospital of The King’s Daughters in Norfolk, Va., who led the study, published today in the journal Pediatrics.

But that should not prevent parents from getting these important shots. “They can do something to reduce the pain and soothe their child,” he says.

Tips for parents:

Whether your child is 2 months or 12 years old, getting an immunization can be a stressful, frightening experience. But parents who stay calm and confident before, during and after the procedure, are best able to help their child, says Laura Freed, who helps support children and their families as a child life specialist at Helen DeVos Children’s Hospital in Grand Rapids, Mich. The Child Life staff at DeVos Children’s offers these tips for helping parents help their kids when getting shots:

Preparation. A child who needs a lot of processing time can be told a few days before the scheduled immunization. A very anxious child may cope best if told just moments before the immunization is administered.

Choices. Let them bring a favorite blanket, stuffed animal, listen to music, read a book or use an hand-held game. Something they haven’t played or used in a while may seem more enticing. Be sure the start using it before the nurse enters the room so they are really engaged.

Positioning. Parents can help securely hold their child and reduce stress and anxiety using “positions of comfort.”

Positive feedback. Be specific in your praise of how they handled the procedure. For example, “I really love how you held so still for your poke or “You were very brave.”

The “Five S’s” concept was developed a decade ago by Harvey Karp, an assistant professor of pediatrics at the USC School of Medicine, and author of the book and DVD, The Happiest Baby on the Block. He says the technique eases babies by imitating the “symphony of sensations, noise, jiggly movements and touching” in the womb.

“There’s been 30 to 40 years of research showing the individual S’s work, but what was missing was the recognition that babies are born with a reflexive-off switch for crying and an on-switch for sleeping,” says Karp.

Breastfeeding has long been used to comfort babies during and after infant immunizations, “but if you’re not breastfeeding, the Five S’s approach is a nice alternative,” says Harrington.

In the study, immediately after being vaccinated at their 2- and 4-month well-child visits, 230 infants were given either water or oral sucrose and then either standard-of-care comfort measures (such as pacifiers and distraction) by their parents, or the Five S’s intervention by medical residents.

A modified infant pain-scoring tool was used to assess babies’ pain levels at 15-second intervals for two minutes. Length of crying time was also measured. Results showed that babies getting the Five S’s, both with and without sugar, had significantly lower pain scores and shorter crying times than babies getting other comfort measures.

That the physical interventions worked just as well with or without sugar may be particularly good news in an era of rapidly increasing childhood obesity, says Harrington.



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