Giving infants small amounts of sugar solution may reduce the pain they feel during injections, show results from a Cochrane systematic review.
While the data are not conclusive, they show that babies undergoing needle-related procedures did not cry for as long if they were given a sweet-tasting solution at the time of injection, supporting the efficacy of the approach.
"Further well-controlled randomized controlled trials are warranted in this population to determine the optimal concentration, volume, method of administration, and possible adverse effects," write Manal Kassab (Jordan University of Science and Technology, Irbid) and co-authors in the Cochrane Database of Systematic Reviews.
Orally administered sweet-tasting solutions have an established pain-reducing effect, but their mechanism of action is unclear. In this study, Kassab's team evaluated the effectiveness of sweet-tasting solutions in reducing needle-related pain in infants aged between 1 month and 1 year.
A literature search for relevant research identified 14 randomized controlled trials (RCTs) involving 1551 infants. The procedures used in these trials included subcutaneous and intramuscular injections, venepuncture, and heel lance; the active intervention was typically a sucrose solution given 2 minutes before immunization; and control interventions included no treatment, water, another sweet-tasting solution, and other pharmacologic and non-pharmacologic methods of pain relief.
The quality of these trials was reasonable, Kassab et al remark, but they used a variety of pain measures, making it difficult to pool the data. Nevertheless, the results demonstrate a reduction in duration of crying time in infants administered a sweet-tasting solution, the authors report.
Secondary analyses found no significant difference between sucrose and a local analgesic cream with regard to pain and the duration of infant crying. The researchers were unable to identify the optimal concentration, volume, or method of administration, or possible long-term effects, however, and they say their review highlights the paucity of RCTs in the field.
They conclude with a list of recommendations for further studies, which include more rigorous randomization and blinding, evaluation of different sucrose concentrations given before and during injection, assessment of long-term outcomes such as tooth decay and obesity, and use of a validated pain outcome measure.
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