Children’s Pain and Distress at a Public Influenza Vaccination Clinic: A Parent Survey and Public Observation Study

  • Imane Ouach
  • Jessica Reszel
  • Yesha Patel
  • JoAnne Tibbles
  • Nora Ullyot
  • Jodi Wilding
  • Denise HarrisonEmail author
Original Paper


Immunizations are a necessary but distressing and painful procedure that most infants and children regularly undergo. Each year, a tertiary pediatric hospital in Canada holds an influenza vaccination clinic for all staff and their families. Evidence-based interventions to reduce pain and distress in babies and children are used. Despite this, infants and children continue to be distressed throughout the vaccination procedure. The objectives of this study were to: (1) measure the prevalence of distress among infants and children before, during, and after vaccine administration at the clinic, and (2) evaluate parents’ perception of their child(ren)’s distress before, during, and after vaccine administration and the effectiveness of pain management interventions used during the clinic. A cross-sectional design of naturalistic observation and parent surveys was used and data was analyzed using descriptive statistics. A total of 283 children between 6 months and 18 years were vaccinated at the clinic, with 52% observed to be distressed before, during, or after the procedure. There were 115 parents of 206 children that completed the survey; 47% of these parents perceived that their children were distressed before, during, or after vaccination, and 42% perceived that the pain treatments used for their child(ren) were very effective. The results of this study will continue to inform interventions for needle-related pain and distress management, as well as improvements for future public vaccination clinics.


Fear Pain management Pediatrics Immunization Influenza 



This study was partially funded by the University of Ottawa Undergraduate Research Opportunity Program (UROP). Thank you to the Be Sweet to Babies team of volunteer research assistants for their time, as well as the CHEO Occupational Health and Wellness Team and the Child Life Team for their support.


This study was funded by the University of Ottawa (Grant No. 722240102245).

Compliance with Ethical Standards

Conflict of interest

The authors declare they have no actual or potential conflict of interest. The authors alone are responsible for the content and writing of the paper.

Ethical Approval

The Children’s Hospital of Eastern Ontario Research Ethics Board approved this study (#17/152X). All procedures involving human participants were performed in accordance with ethical standards of the institutional research committee.


  1. 1.
    Taddio, A., Chambers, C. T., Halperin, S. A., et al. (2009). Inadequate pain management during routine childhood immunizations: The nerve of it. Clinical Therapeutics, 31, 152–167.CrossRefGoogle Scholar
  2. 2.
    Government of Canada. (2015). Prevention of flu (influenza). Retrieved from
  3. 3.
    World Health Organization. (2012). Vaccines against influenza: WHO position paper. Weekly epidemiological record, 87(47), 461–476.Google Scholar
  4. 4.
    Taddio, A., Ipp, M., Thivakaran, S., et al. (2012). Survey of the prevalence of immunization non-compliance due to needle fears in children and adults. Vaccine, 30(32), 4807–4812.CrossRefGoogle Scholar
  5. 5.
    Brady, K., Avner, J. R., & Khine, H. (2011). Perception and attitude of providers toward pain and anxiety associated with pediatric vaccine injection. Clinical Pediatrics, 50(2), 140–143.CrossRefGoogle Scholar
  6. 6.
    Schechter, N. L., Zempsky, W. T., Cohen, L. L., McGrath, P. J., McMurtry, M., & Bright, N. S. (2007). Pain reduction during pediatric immunizations: Evidence-based review and recommendations. Pediatrics, 119(5), 1184–1198.CrossRefGoogle Scholar
  7. 7.
    Kikuta, A., Gardezi, F., Dubey, V., & Taddio, A. (2011). Practices and perceptions regarding pain and management during routine childhood immunizations: Findings from a focus-group study with nurses working at Toronto Public Health, Ontario. Canadian Journal of Infectious Diseases and Medical Microbiology, 22(2), 43–48.CrossRefGoogle Scholar
  8. 8.
    Harrison, D., Reszel, J., Beuno, M., et al. (2016). Breastfeeding for procedural pain in infants beyond the neonatal period. Cochrane Database of Systematic Reviews. Scholar
  9. 9.
    Pillai Riddell, R. R., Racine, N. M., Gennis, H. G., et al. (2015). Non-pharmacological management of infant and young child procedural pain. Cochrane Database of Systematic Reviews. Scholar
  10. 10.
    Uman, L. S., Birnie, K. A., Noel, M., et al. (2013). Psychological interventions for needle-related procedural pain and distress in children and adolescents. Cochrane Database of Systematic Reviews. Scholar
  11. 11.
    Harrison, D., Stevens, B., Bueno, M., et al. (2010). Efficacy of sweet solutions for analgesia in infants between 1 and 12 months of age: A systematic review. Archives of Disease in Childhood, 95(6), 406–413.CrossRefGoogle Scholar
  12. 12.
    Taddio, A., McMurtry, M., Vibhuti, S., et al. (2015). Reducing pain during vaccine injections: Clinical practice guideline. Canadian Medical Association Journal, 187(13), 975–982.CrossRefGoogle Scholar
  13. 13.
    World Health Organization. (2015). Reducing pain at the time of vaccination: WHO position paper. Weekly Epidemiological Record, 39(90), 505–516.Google Scholar
  14. 14.
    Harrison, D., Elia, S., Royle, J., & Manias, E. (2013). Pain management strategies used during early childhood immunisation in Victoria. Journal of Paediatrics and Child Health, 49, 313–318.CrossRefGoogle Scholar
  15. 15.
    Russell, K., & Harrison, D. (2015). Managing pain in early childhood immunisation. Nursing New Zealand, 21(2), 22–24.PubMedGoogle Scholar
  16. 16.
    Lisi, D., Campbell, L., Pillai Ridell, R., Garfield, H., & Greenberg, S. (2013). Naturalistic parental pain management during immunizations during the first year of life: Observational norms from the OUCH cohort. Pain, 154(8), 1245–1253.CrossRefGoogle Scholar
  17. 17.
    Patel, Y. (2018). Prevalence and management of fear, distress, and pain in children at the CHEO family flu clinic 2017 (Unpublished thesis). University of Ottawa, Canada.Google Scholar
  18. 18.
    Taddio, A., Appleton, M., Bortolussi, R., et al. (2010). Reducing the pain of childhood vaccination: An evidence-based clinical practice guideline (summary). Canadian Medical Association Journal, 182(18), 1989–1995.CrossRefGoogle Scholar
  19. 19.
    Harrison, D., & Chouiery, J. (2017). CHEO Family Flu Clinic 2016 (Unpublished report). Canada: Children’s Hospital of Eastern Ontario.Google Scholar
  20. 20.
    Harris, P. A., Taylor, R., Thielke, R., Payne, J., Gonzalez, N., & Conde, J. G. (2009). Research electronic data capture (REDCap)—A metadata-driven methodology and workflow process for providing translational research informatics support. Journal of Biomedical Informatics, 42(2), 377–381.CrossRefGoogle Scholar
  21. 21.
    Jacobson, R. M., Swan, A., Adegbenro, A., et al. (2001). Making vaccines more acceptable—Methods to prevent and minimize pain and other common adverse events associated with vaccines. Vaccine, 19(17), 2418–2427.CrossRefGoogle Scholar
  22. 22.
    Heden, L., von Essen, L., & Ljungman, G. (2016). The relationship between fear and pain levels during needle procedures in children from the parents’ perspective. European Journal of Pain, 20(2), 223–230.CrossRefGoogle Scholar
  23. 23.
    Wright, S., Yelland, M., Heathcote, K., & Ng, S. K. (2014). Fear of needles: Nature and prevalence in general practice. Australian Family Physician, 38(3), 172–176.Google Scholar
  24. 24.
    Taddio, A., Illersich, A. F., Illersich, A. N., & Wells, J. (2009). From the mouth of babes: Getting vaccinated doesn’t have to hurt. Canadian Journal of Infectious Diseases and Medical Microbiology, 25(4), 196–200.CrossRefGoogle Scholar
  25. 25.
    Harrison, D., Joly, C., Chretien, C., et al. (2014). Pain prevalence in a pediatric hospital: Raising awareness during Pain Awareness Week. Pain Research and Management, 19(1), 24–30.CrossRefGoogle Scholar
  26. 26.
    Taddio, A., Manley, J., Potash, L., Ipp, M., Sgro, M., & Shah, V. (2007). Routine immunization practices: Use of topical anesthetics and oral analgesics. Pediatrics, 120(3), 637–643.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Children’s Hospital of Eastern Ontario (CHEO) Research InstituteOttawaCanada
  2. 2.University of OttawaOttawaCanada
  3. 3.Children’s Hospital of Eastern Ontario (CHEO)OttawaCanada

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