Podcast: Does breastfeeding reduce vaccination pain in babies aged 1 to 12 months?

In their first year of life, babies are likely to receive many vaccinations, which are vital for public health. However, the experience can be painful and distressing for the babies and their parents. In a new Cochrane Review from October 2016, Denise Harrison from the University of Ottawa in Canada and colleagues examined the research into whether breastfeeding might reduce this pain. She tells us what they found in this podcast.

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John: Hello, I'm John Hilton, editor of the Cochrane Editorial unit. In their first year of life, babies are likely to receive many vaccinations, which are vital for public health. However, the experience can be painful and distressing for the babies and their parents. In a new Cochrane Review from October 2016, Denise Harrison from the University of Ottawa in Canada and colleagues examined the research into whether breastfeeding might reduce this pain. She tells us what they found in this podcast.

Denise: When we embarked on this Cochrane Review we already knew from an earlier review that breastfeeding newborn babies reduces pain during injections or blood work, but we didn’t know if this was true for older babies, up to one year old. If breastfeeding is effective at reducing pain during painful injections and other procedures for these babies, this might make it easier to achieve the public health gains from vaccination and so we aimed to review the evidence on whether breastfeeding reduced pain in babies aged from 1 to 12 months.
We found 10 trials which included nearly 1100 babies. Eight of the trials were randomised, and two were quasi-randomised. There were three trials each from India and Iran, two from Turkey and one each from Canada and Jordan. All trials investigated breastfeeding during vaccination.
The main ways pain was measured was the time babies spent crying and pain scores. We found that breastfeeding, compared to holding, or laying the baby on the examination table led to less crying time and lower pain scores. This is clinically important because it shows that we have a way to reduce pain and stress for babies who are breastfeeding, during injections. However, none of the studies reported on adverse effects, such as coughing or choking while breastfeeding and no studies reported if babies refused to breastfeed. 
We assessed the quality of the evidence for pain reducing effects of breastfeeding during vaccination as moderate for reducing pain scores and crying time, especially in infants up to six months of age. These findings support The World Health Organization (WHO) position statement which recommends breastfeeding babies during vaccination where culturally acceptable and feasible. But we’re less sure about the effects for babies aged 6 to 12 months because there was much less evidence for these older babies.
In conclusion, if mothers are breastfeeding their babies, this can be done during injections to reduce pain for the baby. If mothers are not breastfeeding, or prefer not to breastfeed during the injection, other systematic reviews can still help as these have shown that small amounts of sugar water reduce babies’ pain.

John: If you would like to read more about the evidence for breastfeeding during painful procedures, and to find the other reviews that Denise mentioned, all you need to do is go online to Cochrane Library dot com and search ‘procedural pain in infants’.

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