Is pain relief for babies before immunizations helpful?

Do you need to anesthetize your child for their routine immunizations? A very well done study published last month in the Canadian Medical Association Journal found that applying topical lidocaine along with other methods helps reduce the pain—but not by a lot.

They used three previously recommended methods of pain relief on 352 children at 2, 4, 6, and 12 months. Using nothing, video instruction on how to soothe their baby, or video instruction plus oral concentrated sugar solution gave an immediate pain score of 6.7 where zero is no distress and 10 is very bad pain. The pain score went down to 6.3 if they put on topical lidocaine plus the other interventions.

"We found that, when used consistently during vaccine injections in the first year of life, only liposomal lidocaine combined with parental video instruction and orally administered sucrose showed a benefit on acute pain when compared with placebo, video alone, and video and sucrose together," wrote the authors.

So why don't we run out and use topical lidocaine on all babies before shots? There are some issues and potential problems not mentioned in the study's main findings:

1.  The reduction in pain is less than 5 percent.

2.  Topical lidocaine varies greatly in price, but even at wholesale costs at least $5 per dose, and retail without insurance can cost $40 per dose and the child will need at least two doses each visit.

3. The topical lidocaine needs at least 5 minutes to work, which could make for a longer visit.

4. Many people get an allergic reaction to topical lidocaine with repeated use.

5. Athough many people hate the idea of getting shots, the pain of infant shots is not the initial pain of the needle, but the deep pain that occurs with primarily the Tetanus immunization about four hours later.

While I see nothing seriously wrong with using the lidocaine on the skin on babies before shots (although I worry about inducing allergy), I believe giving a single dose of acetaminophen such as Tylenol if the baby is in discomfort later makes more sense.

Have a question for the Healthy Kids panel? Ask it here. Read more from the Healthy Kids blog »