A ‘spoonful of sugar’helps the needle go in

September 2011

Do sweet solutions help relieve pain for children having immunisations?

CLINICAL BOTTOM LINE:

Giving sweet solutions orally prior to immunisation injections results in fewer children crying and shorter periods of crying duration in infants. It is not known whether sweet solutions have similar efficacy to other modes of pain relief (topical or oral).

CLINICAL SCENARIO:

You have read that paracetamol use is possibly associated with asthma incidence. Paracetamol is used to reduce pain after immunisations in your family practice. Your colleagues have started discussing alternatives and one raises the question of whether using sugar in any form is effective for managing children’s pain. You undertake to review the evidence.

QUESTION:

Among young children having immunisations, is sugar effective for reducing pain?

EARCH STRATEGY:

PubMed clinical queries: sugar AND immunisation.

CITATION:

Harrison D, et al. Efficacy of sweet solutions for analgesia in infants between 1 and 12 months of age: a systematic review. Arch Dis Child 2010; 95:406-13.

STUDY SUMMARY:

Systematic review of oral sweet solutions compared to water or no treatment. Inclusion criteria were (1) Type of study was randomised controlled trials; (2) Patients were infants aged up to 12 months; (3) Interventions were sucrose, glucose or other sweet solution administered during any painful procedures; (4) Outcomes were cry behaviours, validated pain scales, or physiological indicators of pain. 695 titles were screened, 37 were retrieved for further review trials and 14 trials were included.

VALIDITY:

Search strategy – electronic searches of MEDLINE, Embase, CINAHL, PsycINFO and all EBM Reviews. Recent major paediatric and paediatric pain conference proceedings were handsearched and reference lists from retrieved articles. There were no language limitations. Risk of bias – it was not reported how studies were screened or selected, but two reviewers independently extracted data from included studies; authors were contacted for additional information if data was not described. Only where clinical heterogeneity was sufficiently low were studies combined in meta-analysis.

Quality assessment – methodological quality in each study was independently assessed by two reviewers and disagreements resolved by consensus. Elements assessed were randomisation generation, allocation concealment, blinding of intervention, incomplete outcome data reported, selective outcome reporting and other sources of bias. Overall – a high quality review of variable quality studies.

RESULTS:

Fourteen trials involving 1674 injections on 1676 patients were identified. One trial compared sweet solutions to water and no treatment groups, one trial compared sweet solution to no treatment and the remaining trials compared sweet solutions to water. Ten trials used sucrose solutions (concentration 30–75%), two trials used 30% glucose and one trial compared 25% or 50% sucrose or 40% glucose to water. Generally all trials were good quality but five trials did not report randomisation sequence; two trials did not report allocation concealment; two studies were not blinded; and one study had incomplete outcome data. Using sweet solutions resulted in reduced incidence and duration of crying. It was not possible to combine studies to examine the effect of different concentrations or different solutions.

 

 

Table. Results with 95% confidence intervals

 

 

Intervention effects

Sweet solution

(n/N)

Control

(n/N)

RR

(95%CI)

WMD

(95%CI)

Crying incidence

76/119

 

100/124

 

0.80

(0.69 to 0.93)

Crying duration

(seconds)

280

289

-11.8

(-22.8 to -0.9)

 

 

COMMENTS:

One trial compared sweet solution to topical analgesia in addition to a no treatment control, with no differences between sweet solution or topical analgesia.

Sweet solutions are readily available, easy to administer and have a very short onset time to analgesia.

Reviewer: Dr Andrew Jull, RN PhD, associate professor (School of Nursing, University of Auckland), nurse advisor – quality, Auckland District Health Board.