Sucrose Decreases Infant Biobehavioral Pain Response to Immunizations: A Randomized Controlled Trial


  • Linda A. Hatfield

    1. Linda A. Hatfield, PhD, CRNP, Beta Sigma, Aventis Pasteur/American Nurses Foundation Scholar, Assistant Professor, School of Nursing, College of Health and Human Development, and Assistant Professor, Public Heath Sciences, College of Medicine, The Pennsylvania State University, University Park, PA. This work was supported by a grant from Children's Miracle Network. I thank my PhD dissertation committee, Judith Hupcey, EdD, Associate Professor, Nursing, Chair; Cheston Berlin, MD, Professor of Pediatrics and Pharmacology; Vernon Chinchilli, PhD, Distinguished Professor, Public Health Sciences; and Mary Beth Clark, EdD, Assistant Professor, Nursing for their expert advice and thoughtful comments. I also acknowledge the contributions of the physicians, nurses, medical office associates, and medical record assistants at the University Pediatric Associates at Penn State Children's Hospital and the parents who gave their consent for this study. Correspondence to Dr. Hatfield, The Pennsylvania State University, 307B HHD East, University Park, Pennsylvania 16802. E-mail:
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Purpose: To evaluate the effectiveness and age-related changes in analgesia of oral sucrose as a preprocedural intervention during routine immunizations in infants at 2 and 4 months of age. Design: A double-blind, randomized, placebo-controlled clinical trial of 40 healthy term infants scheduled to receive routine immunizations from a pediatric ambulatory care clinic during May 2005 to July 2005.

Methods: Infants received 24% oral sucrose solution or the control solution of sterile water 2 minutes before routine immunizations at both their 2- and 4-month, well-child visits. The University of Wisconsin Children's Hospital pain scale was used to measure serial acute behavioral pain responses at baseline, 2, and 5 minutes after administration of the solution. Repeated measures ANOVA was used to examine between-group differences and within-subject variability of the effects of treatment on overall behavioral pain scores.

Findings: Infants receiving oral sucrose (n=20) showed a significant reduction in behavioral pain response 5 minutes after administration compared to those in the placebo group (n=20). At 2 minutes following solution administration, both sucrose and sterile water showed the highest mean pain score (4.54 and 4.39 respectively) indicating a severe amount of pain. At 5 minutes, the sucrose group returned to near normal at 0.27 while the placebo group remained at 3.02 indicating a percentage difference in mean pain scores relative to sterile water pain scores of 90.9. No statistically significant age-related change in behavioral pain response was noted between 2- and 4-month-old infants at 2 minutes and 5 minutes following treatment administration.

Conclusion: Sucrose is an effective preprocedural intervention for decreasing behavioral pain response in infants after immunizations.

Clinical Relevance: Efforts to decrease the pain associated with immunizations can promote parental adherence to recommended immunizations schedules, prevent a resurgence of vaccine-preventable diseases and mitigate adverse neurologic outcomes in infants.