Swaddling, Shushing, Swinging, Sucking and Stomach

Vaccine pain for babies lessened with five S plan

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) Watching your child whimper in pain can break your heart, so pediatric visits for immunizations can stress out the whole family. But there are ways to reduce the pain without meds.

A new study finds that a classic non-medical way to soothe a crying baby for any reason also works for reducing infants' pain from shots.

The five Ss are familiar to many parents: swaddling, shushing, swinging, sucking and side/stomach position. And those same 5 Ss can reduce pain from injections too.

"Ask your pediatrician how to reduce your baby's immunization pain."

John Harrington, MD, in the Department of Pediatrics at Eastern Virginia Medical School, and colleagues conducted a study to find out whether either of two different methods could reduce babies' pain following vaccine shots.

They studied 230 babies, ages 2 months and 4 months. Most of those in the study were African-American babies who lived in the city and were enrolled in Medicaid.

Children born early or late, or children who had been given a pain killer within four hours before vaccination, were excluded from the study.

Half of the children received 2 mL of water and half received 2 mL of sugar water at two minutes before they received their shots.

Each of these two groups was then split in half: one group received standard comfort as any child would from his or her parent while the other group received care from their parents using the 5 Ss method immediately after the shots.

The researchers then used a pain score measurement to assess each baby's pain every 15 seconds for two minutes and then every 30 seconds for an additional three minutes. They also measured how long each baby cried.

The two groups who were comforted using the 5 Ss, whether they received plain water or sugar water, had lower average pain scores as time went by after the shots.

The group receiving sugar water but not soothing with the 5 Ss had the next lower average pain scores.

The length of time each baby cried showed a similar pattern: the crying decreased more quickly in the 5 Ss groups. The researchers found that there was not a significant difference between the 5 Ss group with the plain water compared to the 5 Ss group given sugar water.

To use the 5 Ss, three doctors viewed training videos first. Then, one of them swaddled the infants within 15 seconds after the baby received the vaccinations.

The babies then were immediately put into a position on their side or on their stomach while the doctor swayed or swung them back and forth while making the "shushing" sound.

The baby was given a pacifier to suck on 30 seconds after the shots at the recommendation of Dr. Harvey Karp, the physician who came up with the 5 Ss method in his book "The Happiest Baby on the Block."

Although pain decreased as time went by for all four groups of infants, it decreased fastest for the two 5 Ss groups. For example, at one minute after the shots, the group receiving only the 5 Ss had a pain score of 1.5 and the 5 Ss group with sugar water had a 2 on a scale of 1 to 8.

The group with only sugar water had a score of almost 3 after one minutes and the group with plain water and no 5 Ss had a pain score of almost 4.

By three minutes after the shots, all four groups had a measurement under 2 on the scale of 1 to 8.

The researchers concluded that using the 5 Ss after a 2-month or 4-month-old baby was vaccinated appears to reduce the child's pain and crying faster than not using this method.

The success of the method, however, depends on parents providing the 5 Ss effectively. The child should be properly swaddled right away and held so that he or she is on his or her side or stomach in the parent's arms.

Then, the parent should begin loudly "shushing" while swaying dramatically (not softly) from side to side. The pacifier may or may not be helpful depending on whether a child is used to it and whether the child has already begun calming down.

The study was published online April 16 in the journal Pediatrics. The research was funded internally at the Eastern Virginia Medical School and Children's Hospital of The King's Daughters in Norfolk. The authors declared no conflicts of interest.

Reviewed by: 
Review Date: 
April 24, 2012
Last Updated:
April 24, 2012