Topical Lidocaine Could Help Make Infant Vaccines Less Painful — Physician’s First Watch

Medical News |
December 13, 2016

Topical Lidocaine Could Help Make Infant Vaccines Less Painful

By Kelly Young

Edited by David G. Fairchild, MD, MPH, and Jaye Elizabeth Hefner, MD

Topically applied lidocaine may help ease vaccination pain in infants, according to a study in the Canadian Medical Association Journal.

Roughly 350 infants who were undergoing vaccinations in their first year of life were randomized to one of four groups:

  • Placebo

  • Educational video for parents about how to soothe their infants

  • Oral sucrose plus video

  • Lidocaine applied topically to injection site prior to injection plus sucrose and video

Families who didn't receive an active intervention received a corresponding dummy intervention instead (e.g., placebo video, placebo oral solution).

The lidocaine-sucrose-video group had the lowest infant pain scores, based on facial grimacing, crying, and body movements. Scores in the video group and sucrose-video group did not differ from the placebo group.

The authors conclude: "Given that vaccination pain is iatrogenic and most infants were distressed despite the use of cointerventions, consideration should be given to adding lidocaine to reduce the burden of pain."

Reader Comments (5)

Bala P. Naidoo FRCPC Physician, Pediatrics/Adolescent Medicine, Office Canada

Agree totally with this comment. I have administered my own immunization for > 40 yrs and my experience is exactly the same. One vaccine that always elicits crying is the PREVNAR 13-spontaneous and brief.

JUDITH SPANGENBERG Other, Access Services.`

This works if it is crean that is left on for at keast 1.2 hour, not a quick spray or smudge. The deeper assistant, which is really better for blood draws, etc, is the Synera patch, using Tetracaine, which works to a deeper level (7 ml vs. 5ml) than EMLA and substitutes. But Pharmaceutical coverage companies (e.g. Humana) refuse to delve into the future data which is already proven.


Many babies do not even cry with a vaccination and most that do are happy again in a couple of minutes. Most older children with whom my nurses or I had given previous injections had no reaction to the vaccination. Though there were a few that always did react with reluctance or a grimace. But to expose every child to an additional chemical and the added cost and time of a lidocaine patch does not seem right.

Jjean Rinaldo MD Physician, Internal Medicine

No surprise., needles hurt. Why not adopt this also as standard of care for all ages for phlebotomy, IVs , ABGs etc? This pain is not trivial especially for elderly sick patients. Long practice of "takes too much of my time, just, suck it up" should come to an end for all patients for iatrogenic easily preventable pain inflicted by health care providers.

Linda Carter, RDH, MS Other Healthcare Professional, retired

Good idea, except for the use of routine sucrose. Babies, like me, born with Hereditary Fructose Intolerance [or others with Congenital Sucrose-Isomaltose Intolerance] this very much NOT OK for us --even minute amounts can make us ill.
A dextrose treat would be safe for everyone.

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