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Guidelines

Reducing pain during vaccine injections: clinical practice guideline

Anna Taddio, C. Meghan McMurtry, Vibhuti Shah, Rebecca Pillai Riddell, Christine T. Chambers, Melanie Noel, Noni E. MacDonald, Jess Rogers, Lucie M. Bucci, Patricia Mousmanis, Eddy Lang, Scott A. Halperin, Susan Bowles, Christine Halpert, Moshe Ipp, Gordon J.G. Asmundson, Michael J. Rieder, Kate Robson, Elizabeth Uleryk, Martin M. Antony, Vinita Dubey, Anita Hanrahan, Donna Lockett, Jeffrey Scott, Elizabeth Votta Bleeker and HELPinKids&Adults
CMAJ September 22, 2015 187 (13) 975-982; DOI: https://doi.org/10.1503/cmaj.150391
Anna Taddio
Leslie Dan Faculty of Pharmacy (Taddio), University of Toronto, and The Hospital for Sick Children, Toronto, Ont.; Department of Psychology (McMurtry), University of Guelph, Children’s Health Research Institute, and Department of Paediatrics, Western University, London, Ont.; Mount Sinai Hospital (Shah), and Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Pillai Riddell), York University, Toronto, Ont.; Departments of Pediatrics (Chambers), and Psychology and Neuroscience, Dalhousie University, and Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS; Center for Child Health, Behavior and Development (Noel), Seattle Children’s Research Institute, Seattle, Wash.; Department of Pediatrics (MacDonald), Dalhousie University, IWK Health Centre and Canadian Center for Vaccinology, Halifax, NS; Centre for Effective Practice (Rogers), and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont.; Immunize Canada (Bucci), Canadian Public Health Association, Ottawa, Ont.; Child and Adolescent Health Program Committee (Mousmanis), The College of Family Physicians of Canada, Mississauga, Ont.; Alberta Health Services (Lang), and Cumming School of Medicine, University of Calgary, Calgary, Alta.; Departments of Pediatrics (Halperin), and Microbiology and Immunology, and Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, Halifax, NS; College of Pharmacy (Bowles), Dalhousie University, Halifax, NS; Immunization Programs and Vaccine Preventable Diseases Service (Halpert), BC Centre for Disease Control, Vancouver, BC; Department of Paediatrics (Ipp), The Hospital for Sick Children, and Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Asmundson), Faculty of Arts, University of Regina, Regina, Sask.; Departments of Paediatrics (Rieder), Physiology and Pharmacology, and Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ont.; Canadian Family Advisory Network (Robson), Toronto, Ont.; E.M. Uleryk Consulting (Uleryk), Mississauga, Ont.; Department of Psychology (Antony), Ryerson University, Toronto, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Communicable Disease Control (Hanrahan), Alberta Health Services, Edmonton, Alta.; Bodhi Seed Center for Healing and Conscious Living (Lockett), Milton, Ont.; Department of Emergency Medicine (Scott), IWK Health Centre, Halifax, NS; Science Directorate (Votta Bleeker), Canadian Psychological Association, Ottawa, Ont.
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  • For correspondence: anna.taddio@utoronto.ca
C. Meghan McMurtry
Leslie Dan Faculty of Pharmacy (Taddio), University of Toronto, and The Hospital for Sick Children, Toronto, Ont.; Department of Psychology (McMurtry), University of Guelph, Children’s Health Research Institute, and Department of Paediatrics, Western University, London, Ont.; Mount Sinai Hospital (Shah), and Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Pillai Riddell), York University, Toronto, Ont.; Departments of Pediatrics (Chambers), and Psychology and Neuroscience, Dalhousie University, and Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS; Center for Child Health, Behavior and Development (Noel), Seattle Children’s Research Institute, Seattle, Wash.; Department of Pediatrics (MacDonald), Dalhousie University, IWK Health Centre and Canadian Center for Vaccinology, Halifax, NS; Centre for Effective Practice (Rogers), and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont.; Immunize Canada (Bucci), Canadian Public Health Association, Ottawa, Ont.; Child and Adolescent Health Program Committee (Mousmanis), The College of Family Physicians of Canada, Mississauga, Ont.; Alberta Health Services (Lang), and Cumming School of Medicine, University of Calgary, Calgary, Alta.; Departments of Pediatrics (Halperin), and Microbiology and Immunology, and Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, Halifax, NS; College of Pharmacy (Bowles), Dalhousie University, Halifax, NS; Immunization Programs and Vaccine Preventable Diseases Service (Halpert), BC Centre for Disease Control, Vancouver, BC; Department of Paediatrics (Ipp), The Hospital for Sick Children, and Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Asmundson), Faculty of Arts, University of Regina, Regina, Sask.; Departments of Paediatrics (Rieder), Physiology and Pharmacology, and Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ont.; Canadian Family Advisory Network (Robson), Toronto, Ont.; E.M. Uleryk Consulting (Uleryk), Mississauga, Ont.; Department of Psychology (Antony), Ryerson University, Toronto, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Communicable Disease Control (Hanrahan), Alberta Health Services, Edmonton, Alta.; Bodhi Seed Center for Healing and Conscious Living (Lockett), Milton, Ont.; Department of Emergency Medicine (Scott), IWK Health Centre, Halifax, NS; Science Directorate (Votta Bleeker), Canadian Psychological Association, Ottawa, Ont.
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Vibhuti Shah
Leslie Dan Faculty of Pharmacy (Taddio), University of Toronto, and The Hospital for Sick Children, Toronto, Ont.; Department of Psychology (McMurtry), University of Guelph, Children’s Health Research Institute, and Department of Paediatrics, Western University, London, Ont.; Mount Sinai Hospital (Shah), and Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Pillai Riddell), York University, Toronto, Ont.; Departments of Pediatrics (Chambers), and Psychology and Neuroscience, Dalhousie University, and Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS; Center for Child Health, Behavior and Development (Noel), Seattle Children’s Research Institute, Seattle, Wash.; Department of Pediatrics (MacDonald), Dalhousie University, IWK Health Centre and Canadian Center for Vaccinology, Halifax, NS; Centre for Effective Practice (Rogers), and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont.; Immunize Canada (Bucci), Canadian Public Health Association, Ottawa, Ont.; Child and Adolescent Health Program Committee (Mousmanis), The College of Family Physicians of Canada, Mississauga, Ont.; Alberta Health Services (Lang), and Cumming School of Medicine, University of Calgary, Calgary, Alta.; Departments of Pediatrics (Halperin), and Microbiology and Immunology, and Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, Halifax, NS; College of Pharmacy (Bowles), Dalhousie University, Halifax, NS; Immunization Programs and Vaccine Preventable Diseases Service (Halpert), BC Centre for Disease Control, Vancouver, BC; Department of Paediatrics (Ipp), The Hospital for Sick Children, and Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Asmundson), Faculty of Arts, University of Regina, Regina, Sask.; Departments of Paediatrics (Rieder), Physiology and Pharmacology, and Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ont.; Canadian Family Advisory Network (Robson), Toronto, Ont.; E.M. Uleryk Consulting (Uleryk), Mississauga, Ont.; Department of Psychology (Antony), Ryerson University, Toronto, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Communicable Disease Control (Hanrahan), Alberta Health Services, Edmonton, Alta.; Bodhi Seed Center for Healing and Conscious Living (Lockett), Milton, Ont.; Department of Emergency Medicine (Scott), IWK Health Centre, Halifax, NS; Science Directorate (Votta Bleeker), Canadian Psychological Association, Ottawa, Ont.
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Rebecca Pillai Riddell
Leslie Dan Faculty of Pharmacy (Taddio), University of Toronto, and The Hospital for Sick Children, Toronto, Ont.; Department of Psychology (McMurtry), University of Guelph, Children’s Health Research Institute, and Department of Paediatrics, Western University, London, Ont.; Mount Sinai Hospital (Shah), and Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Pillai Riddell), York University, Toronto, Ont.; Departments of Pediatrics (Chambers), and Psychology and Neuroscience, Dalhousie University, and Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS; Center for Child Health, Behavior and Development (Noel), Seattle Children’s Research Institute, Seattle, Wash.; Department of Pediatrics (MacDonald), Dalhousie University, IWK Health Centre and Canadian Center for Vaccinology, Halifax, NS; Centre for Effective Practice (Rogers), and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont.; Immunize Canada (Bucci), Canadian Public Health Association, Ottawa, Ont.; Child and Adolescent Health Program Committee (Mousmanis), The College of Family Physicians of Canada, Mississauga, Ont.; Alberta Health Services (Lang), and Cumming School of Medicine, University of Calgary, Calgary, Alta.; Departments of Pediatrics (Halperin), and Microbiology and Immunology, and Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, Halifax, NS; College of Pharmacy (Bowles), Dalhousie University, Halifax, NS; Immunization Programs and Vaccine Preventable Diseases Service (Halpert), BC Centre for Disease Control, Vancouver, BC; Department of Paediatrics (Ipp), The Hospital for Sick Children, and Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Asmundson), Faculty of Arts, University of Regina, Regina, Sask.; Departments of Paediatrics (Rieder), Physiology and Pharmacology, and Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ont.; Canadian Family Advisory Network (Robson), Toronto, Ont.; E.M. Uleryk Consulting (Uleryk), Mississauga, Ont.; Department of Psychology (Antony), Ryerson University, Toronto, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Communicable Disease Control (Hanrahan), Alberta Health Services, Edmonton, Alta.; Bodhi Seed Center for Healing and Conscious Living (Lockett), Milton, Ont.; Department of Emergency Medicine (Scott), IWK Health Centre, Halifax, NS; Science Directorate (Votta Bleeker), Canadian Psychological Association, Ottawa, Ont.
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Christine T. Chambers
Leslie Dan Faculty of Pharmacy (Taddio), University of Toronto, and The Hospital for Sick Children, Toronto, Ont.; Department of Psychology (McMurtry), University of Guelph, Children’s Health Research Institute, and Department of Paediatrics, Western University, London, Ont.; Mount Sinai Hospital (Shah), and Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Pillai Riddell), York University, Toronto, Ont.; Departments of Pediatrics (Chambers), and Psychology and Neuroscience, Dalhousie University, and Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS; Center for Child Health, Behavior and Development (Noel), Seattle Children’s Research Institute, Seattle, Wash.; Department of Pediatrics (MacDonald), Dalhousie University, IWK Health Centre and Canadian Center for Vaccinology, Halifax, NS; Centre for Effective Practice (Rogers), and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont.; Immunize Canada (Bucci), Canadian Public Health Association, Ottawa, Ont.; Child and Adolescent Health Program Committee (Mousmanis), The College of Family Physicians of Canada, Mississauga, Ont.; Alberta Health Services (Lang), and Cumming School of Medicine, University of Calgary, Calgary, Alta.; Departments of Pediatrics (Halperin), and Microbiology and Immunology, and Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, Halifax, NS; College of Pharmacy (Bowles), Dalhousie University, Halifax, NS; Immunization Programs and Vaccine Preventable Diseases Service (Halpert), BC Centre for Disease Control, Vancouver, BC; Department of Paediatrics (Ipp), The Hospital for Sick Children, and Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Asmundson), Faculty of Arts, University of Regina, Regina, Sask.; Departments of Paediatrics (Rieder), Physiology and Pharmacology, and Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ont.; Canadian Family Advisory Network (Robson), Toronto, Ont.; E.M. Uleryk Consulting (Uleryk), Mississauga, Ont.; Department of Psychology (Antony), Ryerson University, Toronto, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Communicable Disease Control (Hanrahan), Alberta Health Services, Edmonton, Alta.; Bodhi Seed Center for Healing and Conscious Living (Lockett), Milton, Ont.; Department of Emergency Medicine (Scott), IWK Health Centre, Halifax, NS; Science Directorate (Votta Bleeker), Canadian Psychological Association, Ottawa, Ont.
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Melanie Noel
Leslie Dan Faculty of Pharmacy (Taddio), University of Toronto, and The Hospital for Sick Children, Toronto, Ont.; Department of Psychology (McMurtry), University of Guelph, Children’s Health Research Institute, and Department of Paediatrics, Western University, London, Ont.; Mount Sinai Hospital (Shah), and Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Pillai Riddell), York University, Toronto, Ont.; Departments of Pediatrics (Chambers), and Psychology and Neuroscience, Dalhousie University, and Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS; Center for Child Health, Behavior and Development (Noel), Seattle Children’s Research Institute, Seattle, Wash.; Department of Pediatrics (MacDonald), Dalhousie University, IWK Health Centre and Canadian Center for Vaccinology, Halifax, NS; Centre for Effective Practice (Rogers), and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont.; Immunize Canada (Bucci), Canadian Public Health Association, Ottawa, Ont.; Child and Adolescent Health Program Committee (Mousmanis), The College of Family Physicians of Canada, Mississauga, Ont.; Alberta Health Services (Lang), and Cumming School of Medicine, University of Calgary, Calgary, Alta.; Departments of Pediatrics (Halperin), and Microbiology and Immunology, and Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, Halifax, NS; College of Pharmacy (Bowles), Dalhousie University, Halifax, NS; Immunization Programs and Vaccine Preventable Diseases Service (Halpert), BC Centre for Disease Control, Vancouver, BC; Department of Paediatrics (Ipp), The Hospital for Sick Children, and Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Asmundson), Faculty of Arts, University of Regina, Regina, Sask.; Departments of Paediatrics (Rieder), Physiology and Pharmacology, and Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ont.; Canadian Family Advisory Network (Robson), Toronto, Ont.; E.M. Uleryk Consulting (Uleryk), Mississauga, Ont.; Department of Psychology (Antony), Ryerson University, Toronto, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Communicable Disease Control (Hanrahan), Alberta Health Services, Edmonton, Alta.; Bodhi Seed Center for Healing and Conscious Living (Lockett), Milton, Ont.; Department of Emergency Medicine (Scott), IWK Health Centre, Halifax, NS; Science Directorate (Votta Bleeker), Canadian Psychological Association, Ottawa, Ont.
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Noni E. MacDonald
Leslie Dan Faculty of Pharmacy (Taddio), University of Toronto, and The Hospital for Sick Children, Toronto, Ont.; Department of Psychology (McMurtry), University of Guelph, Children’s Health Research Institute, and Department of Paediatrics, Western University, London, Ont.; Mount Sinai Hospital (Shah), and Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Pillai Riddell), York University, Toronto, Ont.; Departments of Pediatrics (Chambers), and Psychology and Neuroscience, Dalhousie University, and Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS; Center for Child Health, Behavior and Development (Noel), Seattle Children’s Research Institute, Seattle, Wash.; Department of Pediatrics (MacDonald), Dalhousie University, IWK Health Centre and Canadian Center for Vaccinology, Halifax, NS; Centre for Effective Practice (Rogers), and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont.; Immunize Canada (Bucci), Canadian Public Health Association, Ottawa, Ont.; Child and Adolescent Health Program Committee (Mousmanis), The College of Family Physicians of Canada, Mississauga, Ont.; Alberta Health Services (Lang), and Cumming School of Medicine, University of Calgary, Calgary, Alta.; Departments of Pediatrics (Halperin), and Microbiology and Immunology, and Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, Halifax, NS; College of Pharmacy (Bowles), Dalhousie University, Halifax, NS; Immunization Programs and Vaccine Preventable Diseases Service (Halpert), BC Centre for Disease Control, Vancouver, BC; Department of Paediatrics (Ipp), The Hospital for Sick Children, and Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Asmundson), Faculty of Arts, University of Regina, Regina, Sask.; Departments of Paediatrics (Rieder), Physiology and Pharmacology, and Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ont.; Canadian Family Advisory Network (Robson), Toronto, Ont.; E.M. Uleryk Consulting (Uleryk), Mississauga, Ont.; Department of Psychology (Antony), Ryerson University, Toronto, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Communicable Disease Control (Hanrahan), Alberta Health Services, Edmonton, Alta.; Bodhi Seed Center for Healing and Conscious Living (Lockett), Milton, Ont.; Department of Emergency Medicine (Scott), IWK Health Centre, Halifax, NS; Science Directorate (Votta Bleeker), Canadian Psychological Association, Ottawa, Ont.
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Jess Rogers
Leslie Dan Faculty of Pharmacy (Taddio), University of Toronto, and The Hospital for Sick Children, Toronto, Ont.; Department of Psychology (McMurtry), University of Guelph, Children’s Health Research Institute, and Department of Paediatrics, Western University, London, Ont.; Mount Sinai Hospital (Shah), and Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Pillai Riddell), York University, Toronto, Ont.; Departments of Pediatrics (Chambers), and Psychology and Neuroscience, Dalhousie University, and Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS; Center for Child Health, Behavior and Development (Noel), Seattle Children’s Research Institute, Seattle, Wash.; Department of Pediatrics (MacDonald), Dalhousie University, IWK Health Centre and Canadian Center for Vaccinology, Halifax, NS; Centre for Effective Practice (Rogers), and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont.; Immunize Canada (Bucci), Canadian Public Health Association, Ottawa, Ont.; Child and Adolescent Health Program Committee (Mousmanis), The College of Family Physicians of Canada, Mississauga, Ont.; Alberta Health Services (Lang), and Cumming School of Medicine, University of Calgary, Calgary, Alta.; Departments of Pediatrics (Halperin), and Microbiology and Immunology, and Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, Halifax, NS; College of Pharmacy (Bowles), Dalhousie University, Halifax, NS; Immunization Programs and Vaccine Preventable Diseases Service (Halpert), BC Centre for Disease Control, Vancouver, BC; Department of Paediatrics (Ipp), The Hospital for Sick Children, and Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Asmundson), Faculty of Arts, University of Regina, Regina, Sask.; Departments of Paediatrics (Rieder), Physiology and Pharmacology, and Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ont.; Canadian Family Advisory Network (Robson), Toronto, Ont.; E.M. Uleryk Consulting (Uleryk), Mississauga, Ont.; Department of Psychology (Antony), Ryerson University, Toronto, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Communicable Disease Control (Hanrahan), Alberta Health Services, Edmonton, Alta.; Bodhi Seed Center for Healing and Conscious Living (Lockett), Milton, Ont.; Department of Emergency Medicine (Scott), IWK Health Centre, Halifax, NS; Science Directorate (Votta Bleeker), Canadian Psychological Association, Ottawa, Ont.
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Lucie M. Bucci
Leslie Dan Faculty of Pharmacy (Taddio), University of Toronto, and The Hospital for Sick Children, Toronto, Ont.; Department of Psychology (McMurtry), University of Guelph, Children’s Health Research Institute, and Department of Paediatrics, Western University, London, Ont.; Mount Sinai Hospital (Shah), and Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Pillai Riddell), York University, Toronto, Ont.; Departments of Pediatrics (Chambers), and Psychology and Neuroscience, Dalhousie University, and Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS; Center for Child Health, Behavior and Development (Noel), Seattle Children’s Research Institute, Seattle, Wash.; Department of Pediatrics (MacDonald), Dalhousie University, IWK Health Centre and Canadian Center for Vaccinology, Halifax, NS; Centre for Effective Practice (Rogers), and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont.; Immunize Canada (Bucci), Canadian Public Health Association, Ottawa, Ont.; Child and Adolescent Health Program Committee (Mousmanis), The College of Family Physicians of Canada, Mississauga, Ont.; Alberta Health Services (Lang), and Cumming School of Medicine, University of Calgary, Calgary, Alta.; Departments of Pediatrics (Halperin), and Microbiology and Immunology, and Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, Halifax, NS; College of Pharmacy (Bowles), Dalhousie University, Halifax, NS; Immunization Programs and Vaccine Preventable Diseases Service (Halpert), BC Centre for Disease Control, Vancouver, BC; Department of Paediatrics (Ipp), The Hospital for Sick Children, and Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Asmundson), Faculty of Arts, University of Regina, Regina, Sask.; Departments of Paediatrics (Rieder), Physiology and Pharmacology, and Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ont.; Canadian Family Advisory Network (Robson), Toronto, Ont.; E.M. Uleryk Consulting (Uleryk), Mississauga, Ont.; Department of Psychology (Antony), Ryerson University, Toronto, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Communicable Disease Control (Hanrahan), Alberta Health Services, Edmonton, Alta.; Bodhi Seed Center for Healing and Conscious Living (Lockett), Milton, Ont.; Department of Emergency Medicine (Scott), IWK Health Centre, Halifax, NS; Science Directorate (Votta Bleeker), Canadian Psychological Association, Ottawa, Ont.
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Patricia Mousmanis
Leslie Dan Faculty of Pharmacy (Taddio), University of Toronto, and The Hospital for Sick Children, Toronto, Ont.; Department of Psychology (McMurtry), University of Guelph, Children’s Health Research Institute, and Department of Paediatrics, Western University, London, Ont.; Mount Sinai Hospital (Shah), and Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Pillai Riddell), York University, Toronto, Ont.; Departments of Pediatrics (Chambers), and Psychology and Neuroscience, Dalhousie University, and Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS; Center for Child Health, Behavior and Development (Noel), Seattle Children’s Research Institute, Seattle, Wash.; Department of Pediatrics (MacDonald), Dalhousie University, IWK Health Centre and Canadian Center for Vaccinology, Halifax, NS; Centre for Effective Practice (Rogers), and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont.; Immunize Canada (Bucci), Canadian Public Health Association, Ottawa, Ont.; Child and Adolescent Health Program Committee (Mousmanis), The College of Family Physicians of Canada, Mississauga, Ont.; Alberta Health Services (Lang), and Cumming School of Medicine, University of Calgary, Calgary, Alta.; Departments of Pediatrics (Halperin), and Microbiology and Immunology, and Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, Halifax, NS; College of Pharmacy (Bowles), Dalhousie University, Halifax, NS; Immunization Programs and Vaccine Preventable Diseases Service (Halpert), BC Centre for Disease Control, Vancouver, BC; Department of Paediatrics (Ipp), The Hospital for Sick Children, and Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Asmundson), Faculty of Arts, University of Regina, Regina, Sask.; Departments of Paediatrics (Rieder), Physiology and Pharmacology, and Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ont.; Canadian Family Advisory Network (Robson), Toronto, Ont.; E.M. Uleryk Consulting (Uleryk), Mississauga, Ont.; Department of Psychology (Antony), Ryerson University, Toronto, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Communicable Disease Control (Hanrahan), Alberta Health Services, Edmonton, Alta.; Bodhi Seed Center for Healing and Conscious Living (Lockett), Milton, Ont.; Department of Emergency Medicine (Scott), IWK Health Centre, Halifax, NS; Science Directorate (Votta Bleeker), Canadian Psychological Association, Ottawa, Ont.
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Eddy Lang
Leslie Dan Faculty of Pharmacy (Taddio), University of Toronto, and The Hospital for Sick Children, Toronto, Ont.; Department of Psychology (McMurtry), University of Guelph, Children’s Health Research Institute, and Department of Paediatrics, Western University, London, Ont.; Mount Sinai Hospital (Shah), and Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Pillai Riddell), York University, Toronto, Ont.; Departments of Pediatrics (Chambers), and Psychology and Neuroscience, Dalhousie University, and Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS; Center for Child Health, Behavior and Development (Noel), Seattle Children’s Research Institute, Seattle, Wash.; Department of Pediatrics (MacDonald), Dalhousie University, IWK Health Centre and Canadian Center for Vaccinology, Halifax, NS; Centre for Effective Practice (Rogers), and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont.; Immunize Canada (Bucci), Canadian Public Health Association, Ottawa, Ont.; Child and Adolescent Health Program Committee (Mousmanis), The College of Family Physicians of Canada, Mississauga, Ont.; Alberta Health Services (Lang), and Cumming School of Medicine, University of Calgary, Calgary, Alta.; Departments of Pediatrics (Halperin), and Microbiology and Immunology, and Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, Halifax, NS; College of Pharmacy (Bowles), Dalhousie University, Halifax, NS; Immunization Programs and Vaccine Preventable Diseases Service (Halpert), BC Centre for Disease Control, Vancouver, BC; Department of Paediatrics (Ipp), The Hospital for Sick Children, and Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Asmundson), Faculty of Arts, University of Regina, Regina, Sask.; Departments of Paediatrics (Rieder), Physiology and Pharmacology, and Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ont.; Canadian Family Advisory Network (Robson), Toronto, Ont.; E.M. Uleryk Consulting (Uleryk), Mississauga, Ont.; Department of Psychology (Antony), Ryerson University, Toronto, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Communicable Disease Control (Hanrahan), Alberta Health Services, Edmonton, Alta.; Bodhi Seed Center for Healing and Conscious Living (Lockett), Milton, Ont.; Department of Emergency Medicine (Scott), IWK Health Centre, Halifax, NS; Science Directorate (Votta Bleeker), Canadian Psychological Association, Ottawa, Ont.
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Scott A. Halperin
Leslie Dan Faculty of Pharmacy (Taddio), University of Toronto, and The Hospital for Sick Children, Toronto, Ont.; Department of Psychology (McMurtry), University of Guelph, Children’s Health Research Institute, and Department of Paediatrics, Western University, London, Ont.; Mount Sinai Hospital (Shah), and Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Pillai Riddell), York University, Toronto, Ont.; Departments of Pediatrics (Chambers), and Psychology and Neuroscience, Dalhousie University, and Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS; Center for Child Health, Behavior and Development (Noel), Seattle Children’s Research Institute, Seattle, Wash.; Department of Pediatrics (MacDonald), Dalhousie University, IWK Health Centre and Canadian Center for Vaccinology, Halifax, NS; Centre for Effective Practice (Rogers), and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont.; Immunize Canada (Bucci), Canadian Public Health Association, Ottawa, Ont.; Child and Adolescent Health Program Committee (Mousmanis), The College of Family Physicians of Canada, Mississauga, Ont.; Alberta Health Services (Lang), and Cumming School of Medicine, University of Calgary, Calgary, Alta.; Departments of Pediatrics (Halperin), and Microbiology and Immunology, and Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, Halifax, NS; College of Pharmacy (Bowles), Dalhousie University, Halifax, NS; Immunization Programs and Vaccine Preventable Diseases Service (Halpert), BC Centre for Disease Control, Vancouver, BC; Department of Paediatrics (Ipp), The Hospital for Sick Children, and Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Asmundson), Faculty of Arts, University of Regina, Regina, Sask.; Departments of Paediatrics (Rieder), Physiology and Pharmacology, and Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ont.; Canadian Family Advisory Network (Robson), Toronto, Ont.; E.M. Uleryk Consulting (Uleryk), Mississauga, Ont.; Department of Psychology (Antony), Ryerson University, Toronto, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Communicable Disease Control (Hanrahan), Alberta Health Services, Edmonton, Alta.; Bodhi Seed Center for Healing and Conscious Living (Lockett), Milton, Ont.; Department of Emergency Medicine (Scott), IWK Health Centre, Halifax, NS; Science Directorate (Votta Bleeker), Canadian Psychological Association, Ottawa, Ont.
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Susan Bowles
Leslie Dan Faculty of Pharmacy (Taddio), University of Toronto, and The Hospital for Sick Children, Toronto, Ont.; Department of Psychology (McMurtry), University of Guelph, Children’s Health Research Institute, and Department of Paediatrics, Western University, London, Ont.; Mount Sinai Hospital (Shah), and Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Pillai Riddell), York University, Toronto, Ont.; Departments of Pediatrics (Chambers), and Psychology and Neuroscience, Dalhousie University, and Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS; Center for Child Health, Behavior and Development (Noel), Seattle Children’s Research Institute, Seattle, Wash.; Department of Pediatrics (MacDonald), Dalhousie University, IWK Health Centre and Canadian Center for Vaccinology, Halifax, NS; Centre for Effective Practice (Rogers), and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont.; Immunize Canada (Bucci), Canadian Public Health Association, Ottawa, Ont.; Child and Adolescent Health Program Committee (Mousmanis), The College of Family Physicians of Canada, Mississauga, Ont.; Alberta Health Services (Lang), and Cumming School of Medicine, University of Calgary, Calgary, Alta.; Departments of Pediatrics (Halperin), and Microbiology and Immunology, and Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, Halifax, NS; College of Pharmacy (Bowles), Dalhousie University, Halifax, NS; Immunization Programs and Vaccine Preventable Diseases Service (Halpert), BC Centre for Disease Control, Vancouver, BC; Department of Paediatrics (Ipp), The Hospital for Sick Children, and Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Asmundson), Faculty of Arts, University of Regina, Regina, Sask.; Departments of Paediatrics (Rieder), Physiology and Pharmacology, and Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ont.; Canadian Family Advisory Network (Robson), Toronto, Ont.; E.M. Uleryk Consulting (Uleryk), Mississauga, Ont.; Department of Psychology (Antony), Ryerson University, Toronto, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Communicable Disease Control (Hanrahan), Alberta Health Services, Edmonton, Alta.; Bodhi Seed Center for Healing and Conscious Living (Lockett), Milton, Ont.; Department of Emergency Medicine (Scott), IWK Health Centre, Halifax, NS; Science Directorate (Votta Bleeker), Canadian Psychological Association, Ottawa, Ont.
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Christine Halpert
Leslie Dan Faculty of Pharmacy (Taddio), University of Toronto, and The Hospital for Sick Children, Toronto, Ont.; Department of Psychology (McMurtry), University of Guelph, Children’s Health Research Institute, and Department of Paediatrics, Western University, London, Ont.; Mount Sinai Hospital (Shah), and Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Pillai Riddell), York University, Toronto, Ont.; Departments of Pediatrics (Chambers), and Psychology and Neuroscience, Dalhousie University, and Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS; Center for Child Health, Behavior and Development (Noel), Seattle Children’s Research Institute, Seattle, Wash.; Department of Pediatrics (MacDonald), Dalhousie University, IWK Health Centre and Canadian Center for Vaccinology, Halifax, NS; Centre for Effective Practice (Rogers), and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont.; Immunize Canada (Bucci), Canadian Public Health Association, Ottawa, Ont.; Child and Adolescent Health Program Committee (Mousmanis), The College of Family Physicians of Canada, Mississauga, Ont.; Alberta Health Services (Lang), and Cumming School of Medicine, University of Calgary, Calgary, Alta.; Departments of Pediatrics (Halperin), and Microbiology and Immunology, and Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, Halifax, NS; College of Pharmacy (Bowles), Dalhousie University, Halifax, NS; Immunization Programs and Vaccine Preventable Diseases Service (Halpert), BC Centre for Disease Control, Vancouver, BC; Department of Paediatrics (Ipp), The Hospital for Sick Children, and Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Asmundson), Faculty of Arts, University of Regina, Regina, Sask.; Departments of Paediatrics (Rieder), Physiology and Pharmacology, and Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ont.; Canadian Family Advisory Network (Robson), Toronto, Ont.; E.M. Uleryk Consulting (Uleryk), Mississauga, Ont.; Department of Psychology (Antony), Ryerson University, Toronto, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Communicable Disease Control (Hanrahan), Alberta Health Services, Edmonton, Alta.; Bodhi Seed Center for Healing and Conscious Living (Lockett), Milton, Ont.; Department of Emergency Medicine (Scott), IWK Health Centre, Halifax, NS; Science Directorate (Votta Bleeker), Canadian Psychological Association, Ottawa, Ont.
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Moshe Ipp
Leslie Dan Faculty of Pharmacy (Taddio), University of Toronto, and The Hospital for Sick Children, Toronto, Ont.; Department of Psychology (McMurtry), University of Guelph, Children’s Health Research Institute, and Department of Paediatrics, Western University, London, Ont.; Mount Sinai Hospital (Shah), and Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Pillai Riddell), York University, Toronto, Ont.; Departments of Pediatrics (Chambers), and Psychology and Neuroscience, Dalhousie University, and Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS; Center for Child Health, Behavior and Development (Noel), Seattle Children’s Research Institute, Seattle, Wash.; Department of Pediatrics (MacDonald), Dalhousie University, IWK Health Centre and Canadian Center for Vaccinology, Halifax, NS; Centre for Effective Practice (Rogers), and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont.; Immunize Canada (Bucci), Canadian Public Health Association, Ottawa, Ont.; Child and Adolescent Health Program Committee (Mousmanis), The College of Family Physicians of Canada, Mississauga, Ont.; Alberta Health Services (Lang), and Cumming School of Medicine, University of Calgary, Calgary, Alta.; Departments of Pediatrics (Halperin), and Microbiology and Immunology, and Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, Halifax, NS; College of Pharmacy (Bowles), Dalhousie University, Halifax, NS; Immunization Programs and Vaccine Preventable Diseases Service (Halpert), BC Centre for Disease Control, Vancouver, BC; Department of Paediatrics (Ipp), The Hospital for Sick Children, and Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Asmundson), Faculty of Arts, University of Regina, Regina, Sask.; Departments of Paediatrics (Rieder), Physiology and Pharmacology, and Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ont.; Canadian Family Advisory Network (Robson), Toronto, Ont.; E.M. Uleryk Consulting (Uleryk), Mississauga, Ont.; Department of Psychology (Antony), Ryerson University, Toronto, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Communicable Disease Control (Hanrahan), Alberta Health Services, Edmonton, Alta.; Bodhi Seed Center for Healing and Conscious Living (Lockett), Milton, Ont.; Department of Emergency Medicine (Scott), IWK Health Centre, Halifax, NS; Science Directorate (Votta Bleeker), Canadian Psychological Association, Ottawa, Ont.
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Gordon J.G. Asmundson
Leslie Dan Faculty of Pharmacy (Taddio), University of Toronto, and The Hospital for Sick Children, Toronto, Ont.; Department of Psychology (McMurtry), University of Guelph, Children’s Health Research Institute, and Department of Paediatrics, Western University, London, Ont.; Mount Sinai Hospital (Shah), and Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Pillai Riddell), York University, Toronto, Ont.; Departments of Pediatrics (Chambers), and Psychology and Neuroscience, Dalhousie University, and Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS; Center for Child Health, Behavior and Development (Noel), Seattle Children’s Research Institute, Seattle, Wash.; Department of Pediatrics (MacDonald), Dalhousie University, IWK Health Centre and Canadian Center for Vaccinology, Halifax, NS; Centre for Effective Practice (Rogers), and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont.; Immunize Canada (Bucci), Canadian Public Health Association, Ottawa, Ont.; Child and Adolescent Health Program Committee (Mousmanis), The College of Family Physicians of Canada, Mississauga, Ont.; Alberta Health Services (Lang), and Cumming School of Medicine, University of Calgary, Calgary, Alta.; Departments of Pediatrics (Halperin), and Microbiology and Immunology, and Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, Halifax, NS; College of Pharmacy (Bowles), Dalhousie University, Halifax, NS; Immunization Programs and Vaccine Preventable Diseases Service (Halpert), BC Centre for Disease Control, Vancouver, BC; Department of Paediatrics (Ipp), The Hospital for Sick Children, and Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Asmundson), Faculty of Arts, University of Regina, Regina, Sask.; Departments of Paediatrics (Rieder), Physiology and Pharmacology, and Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ont.; Canadian Family Advisory Network (Robson), Toronto, Ont.; E.M. Uleryk Consulting (Uleryk), Mississauga, Ont.; Department of Psychology (Antony), Ryerson University, Toronto, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Communicable Disease Control (Hanrahan), Alberta Health Services, Edmonton, Alta.; Bodhi Seed Center for Healing and Conscious Living (Lockett), Milton, Ont.; Department of Emergency Medicine (Scott), IWK Health Centre, Halifax, NS; Science Directorate (Votta Bleeker), Canadian Psychological Association, Ottawa, Ont.
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Michael J. Rieder
Leslie Dan Faculty of Pharmacy (Taddio), University of Toronto, and The Hospital for Sick Children, Toronto, Ont.; Department of Psychology (McMurtry), University of Guelph, Children’s Health Research Institute, and Department of Paediatrics, Western University, London, Ont.; Mount Sinai Hospital (Shah), and Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Pillai Riddell), York University, Toronto, Ont.; Departments of Pediatrics (Chambers), and Psychology and Neuroscience, Dalhousie University, and Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS; Center for Child Health, Behavior and Development (Noel), Seattle Children’s Research Institute, Seattle, Wash.; Department of Pediatrics (MacDonald), Dalhousie University, IWK Health Centre and Canadian Center for Vaccinology, Halifax, NS; Centre for Effective Practice (Rogers), and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont.; Immunize Canada (Bucci), Canadian Public Health Association, Ottawa, Ont.; Child and Adolescent Health Program Committee (Mousmanis), The College of Family Physicians of Canada, Mississauga, Ont.; Alberta Health Services (Lang), and Cumming School of Medicine, University of Calgary, Calgary, Alta.; Departments of Pediatrics (Halperin), and Microbiology and Immunology, and Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, Halifax, NS; College of Pharmacy (Bowles), Dalhousie University, Halifax, NS; Immunization Programs and Vaccine Preventable Diseases Service (Halpert), BC Centre for Disease Control, Vancouver, BC; Department of Paediatrics (Ipp), The Hospital for Sick Children, and Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Asmundson), Faculty of Arts, University of Regina, Regina, Sask.; Departments of Paediatrics (Rieder), Physiology and Pharmacology, and Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ont.; Canadian Family Advisory Network (Robson), Toronto, Ont.; E.M. Uleryk Consulting (Uleryk), Mississauga, Ont.; Department of Psychology (Antony), Ryerson University, Toronto, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Communicable Disease Control (Hanrahan), Alberta Health Services, Edmonton, Alta.; Bodhi Seed Center for Healing and Conscious Living (Lockett), Milton, Ont.; Department of Emergency Medicine (Scott), IWK Health Centre, Halifax, NS; Science Directorate (Votta Bleeker), Canadian Psychological Association, Ottawa, Ont.
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Kate Robson
Leslie Dan Faculty of Pharmacy (Taddio), University of Toronto, and The Hospital for Sick Children, Toronto, Ont.; Department of Psychology (McMurtry), University of Guelph, Children’s Health Research Institute, and Department of Paediatrics, Western University, London, Ont.; Mount Sinai Hospital (Shah), and Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Pillai Riddell), York University, Toronto, Ont.; Departments of Pediatrics (Chambers), and Psychology and Neuroscience, Dalhousie University, and Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS; Center for Child Health, Behavior and Development (Noel), Seattle Children’s Research Institute, Seattle, Wash.; Department of Pediatrics (MacDonald), Dalhousie University, IWK Health Centre and Canadian Center for Vaccinology, Halifax, NS; Centre for Effective Practice (Rogers), and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont.; Immunize Canada (Bucci), Canadian Public Health Association, Ottawa, Ont.; Child and Adolescent Health Program Committee (Mousmanis), The College of Family Physicians of Canada, Mississauga, Ont.; Alberta Health Services (Lang), and Cumming School of Medicine, University of Calgary, Calgary, Alta.; Departments of Pediatrics (Halperin), and Microbiology and Immunology, and Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, Halifax, NS; College of Pharmacy (Bowles), Dalhousie University, Halifax, NS; Immunization Programs and Vaccine Preventable Diseases Service (Halpert), BC Centre for Disease Control, Vancouver, BC; Department of Paediatrics (Ipp), The Hospital for Sick Children, and Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Asmundson), Faculty of Arts, University of Regina, Regina, Sask.; Departments of Paediatrics (Rieder), Physiology and Pharmacology, and Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ont.; Canadian Family Advisory Network (Robson), Toronto, Ont.; E.M. Uleryk Consulting (Uleryk), Mississauga, Ont.; Department of Psychology (Antony), Ryerson University, Toronto, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Communicable Disease Control (Hanrahan), Alberta Health Services, Edmonton, Alta.; Bodhi Seed Center for Healing and Conscious Living (Lockett), Milton, Ont.; Department of Emergency Medicine (Scott), IWK Health Centre, Halifax, NS; Science Directorate (Votta Bleeker), Canadian Psychological Association, Ottawa, Ont.
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Elizabeth Uleryk
Leslie Dan Faculty of Pharmacy (Taddio), University of Toronto, and The Hospital for Sick Children, Toronto, Ont.; Department of Psychology (McMurtry), University of Guelph, Children’s Health Research Institute, and Department of Paediatrics, Western University, London, Ont.; Mount Sinai Hospital (Shah), and Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Pillai Riddell), York University, Toronto, Ont.; Departments of Pediatrics (Chambers), and Psychology and Neuroscience, Dalhousie University, and Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS; Center for Child Health, Behavior and Development (Noel), Seattle Children’s Research Institute, Seattle, Wash.; Department of Pediatrics (MacDonald), Dalhousie University, IWK Health Centre and Canadian Center for Vaccinology, Halifax, NS; Centre for Effective Practice (Rogers), and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont.; Immunize Canada (Bucci), Canadian Public Health Association, Ottawa, Ont.; Child and Adolescent Health Program Committee (Mousmanis), The College of Family Physicians of Canada, Mississauga, Ont.; Alberta Health Services (Lang), and Cumming School of Medicine, University of Calgary, Calgary, Alta.; Departments of Pediatrics (Halperin), and Microbiology and Immunology, and Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, Halifax, NS; College of Pharmacy (Bowles), Dalhousie University, Halifax, NS; Immunization Programs and Vaccine Preventable Diseases Service (Halpert), BC Centre for Disease Control, Vancouver, BC; Department of Paediatrics (Ipp), The Hospital for Sick Children, and Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Asmundson), Faculty of Arts, University of Regina, Regina, Sask.; Departments of Paediatrics (Rieder), Physiology and Pharmacology, and Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ont.; Canadian Family Advisory Network (Robson), Toronto, Ont.; E.M. Uleryk Consulting (Uleryk), Mississauga, Ont.; Department of Psychology (Antony), Ryerson University, Toronto, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Communicable Disease Control (Hanrahan), Alberta Health Services, Edmonton, Alta.; Bodhi Seed Center for Healing and Conscious Living (Lockett), Milton, Ont.; Department of Emergency Medicine (Scott), IWK Health Centre, Halifax, NS; Science Directorate (Votta Bleeker), Canadian Psychological Association, Ottawa, Ont.
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Martin M. Antony
Leslie Dan Faculty of Pharmacy (Taddio), University of Toronto, and The Hospital for Sick Children, Toronto, Ont.; Department of Psychology (McMurtry), University of Guelph, Children’s Health Research Institute, and Department of Paediatrics, Western University, London, Ont.; Mount Sinai Hospital (Shah), and Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Pillai Riddell), York University, Toronto, Ont.; Departments of Pediatrics (Chambers), and Psychology and Neuroscience, Dalhousie University, and Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS; Center for Child Health, Behavior and Development (Noel), Seattle Children’s Research Institute, Seattle, Wash.; Department of Pediatrics (MacDonald), Dalhousie University, IWK Health Centre and Canadian Center for Vaccinology, Halifax, NS; Centre for Effective Practice (Rogers), and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont.; Immunize Canada (Bucci), Canadian Public Health Association, Ottawa, Ont.; Child and Adolescent Health Program Committee (Mousmanis), The College of Family Physicians of Canada, Mississauga, Ont.; Alberta Health Services (Lang), and Cumming School of Medicine, University of Calgary, Calgary, Alta.; Departments of Pediatrics (Halperin), and Microbiology and Immunology, and Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, Halifax, NS; College of Pharmacy (Bowles), Dalhousie University, Halifax, NS; Immunization Programs and Vaccine Preventable Diseases Service (Halpert), BC Centre for Disease Control, Vancouver, BC; Department of Paediatrics (Ipp), The Hospital for Sick Children, and Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Asmundson), Faculty of Arts, University of Regina, Regina, Sask.; Departments of Paediatrics (Rieder), Physiology and Pharmacology, and Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ont.; Canadian Family Advisory Network (Robson), Toronto, Ont.; E.M. Uleryk Consulting (Uleryk), Mississauga, Ont.; Department of Psychology (Antony), Ryerson University, Toronto, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Communicable Disease Control (Hanrahan), Alberta Health Services, Edmonton, Alta.; Bodhi Seed Center for Healing and Conscious Living (Lockett), Milton, Ont.; Department of Emergency Medicine (Scott), IWK Health Centre, Halifax, NS; Science Directorate (Votta Bleeker), Canadian Psychological Association, Ottawa, Ont.
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Vinita Dubey
Leslie Dan Faculty of Pharmacy (Taddio), University of Toronto, and The Hospital for Sick Children, Toronto, Ont.; Department of Psychology (McMurtry), University of Guelph, Children’s Health Research Institute, and Department of Paediatrics, Western University, London, Ont.; Mount Sinai Hospital (Shah), and Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Pillai Riddell), York University, Toronto, Ont.; Departments of Pediatrics (Chambers), and Psychology and Neuroscience, Dalhousie University, and Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS; Center for Child Health, Behavior and Development (Noel), Seattle Children’s Research Institute, Seattle, Wash.; Department of Pediatrics (MacDonald), Dalhousie University, IWK Health Centre and Canadian Center for Vaccinology, Halifax, NS; Centre for Effective Practice (Rogers), and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont.; Immunize Canada (Bucci), Canadian Public Health Association, Ottawa, Ont.; Child and Adolescent Health Program Committee (Mousmanis), The College of Family Physicians of Canada, Mississauga, Ont.; Alberta Health Services (Lang), and Cumming School of Medicine, University of Calgary, Calgary, Alta.; Departments of Pediatrics (Halperin), and Microbiology and Immunology, and Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, Halifax, NS; College of Pharmacy (Bowles), Dalhousie University, Halifax, NS; Immunization Programs and Vaccine Preventable Diseases Service (Halpert), BC Centre for Disease Control, Vancouver, BC; Department of Paediatrics (Ipp), The Hospital for Sick Children, and Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Asmundson), Faculty of Arts, University of Regina, Regina, Sask.; Departments of Paediatrics (Rieder), Physiology and Pharmacology, and Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ont.; Canadian Family Advisory Network (Robson), Toronto, Ont.; E.M. Uleryk Consulting (Uleryk), Mississauga, Ont.; Department of Psychology (Antony), Ryerson University, Toronto, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Communicable Disease Control (Hanrahan), Alberta Health Services, Edmonton, Alta.; Bodhi Seed Center for Healing and Conscious Living (Lockett), Milton, Ont.; Department of Emergency Medicine (Scott), IWK Health Centre, Halifax, NS; Science Directorate (Votta Bleeker), Canadian Psychological Association, Ottawa, Ont.
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Anita Hanrahan
Leslie Dan Faculty of Pharmacy (Taddio), University of Toronto, and The Hospital for Sick Children, Toronto, Ont.; Department of Psychology (McMurtry), University of Guelph, Children’s Health Research Institute, and Department of Paediatrics, Western University, London, Ont.; Mount Sinai Hospital (Shah), and Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Pillai Riddell), York University, Toronto, Ont.; Departments of Pediatrics (Chambers), and Psychology and Neuroscience, Dalhousie University, and Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS; Center for Child Health, Behavior and Development (Noel), Seattle Children’s Research Institute, Seattle, Wash.; Department of Pediatrics (MacDonald), Dalhousie University, IWK Health Centre and Canadian Center for Vaccinology, Halifax, NS; Centre for Effective Practice (Rogers), and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont.; Immunize Canada (Bucci), Canadian Public Health Association, Ottawa, Ont.; Child and Adolescent Health Program Committee (Mousmanis), The College of Family Physicians of Canada, Mississauga, Ont.; Alberta Health Services (Lang), and Cumming School of Medicine, University of Calgary, Calgary, Alta.; Departments of Pediatrics (Halperin), and Microbiology and Immunology, and Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, Halifax, NS; College of Pharmacy (Bowles), Dalhousie University, Halifax, NS; Immunization Programs and Vaccine Preventable Diseases Service (Halpert), BC Centre for Disease Control, Vancouver, BC; Department of Paediatrics (Ipp), The Hospital for Sick Children, and Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Asmundson), Faculty of Arts, University of Regina, Regina, Sask.; Departments of Paediatrics (Rieder), Physiology and Pharmacology, and Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ont.; Canadian Family Advisory Network (Robson), Toronto, Ont.; E.M. Uleryk Consulting (Uleryk), Mississauga, Ont.; Department of Psychology (Antony), Ryerson University, Toronto, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Communicable Disease Control (Hanrahan), Alberta Health Services, Edmonton, Alta.; Bodhi Seed Center for Healing and Conscious Living (Lockett), Milton, Ont.; Department of Emergency Medicine (Scott), IWK Health Centre, Halifax, NS; Science Directorate (Votta Bleeker), Canadian Psychological Association, Ottawa, Ont.
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Donna Lockett
Leslie Dan Faculty of Pharmacy (Taddio), University of Toronto, and The Hospital for Sick Children, Toronto, Ont.; Department of Psychology (McMurtry), University of Guelph, Children’s Health Research Institute, and Department of Paediatrics, Western University, London, Ont.; Mount Sinai Hospital (Shah), and Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Pillai Riddell), York University, Toronto, Ont.; Departments of Pediatrics (Chambers), and Psychology and Neuroscience, Dalhousie University, and Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS; Center for Child Health, Behavior and Development (Noel), Seattle Children’s Research Institute, Seattle, Wash.; Department of Pediatrics (MacDonald), Dalhousie University, IWK Health Centre and Canadian Center for Vaccinology, Halifax, NS; Centre for Effective Practice (Rogers), and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont.; Immunize Canada (Bucci), Canadian Public Health Association, Ottawa, Ont.; Child and Adolescent Health Program Committee (Mousmanis), The College of Family Physicians of Canada, Mississauga, Ont.; Alberta Health Services (Lang), and Cumming School of Medicine, University of Calgary, Calgary, Alta.; Departments of Pediatrics (Halperin), and Microbiology and Immunology, and Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, Halifax, NS; College of Pharmacy (Bowles), Dalhousie University, Halifax, NS; Immunization Programs and Vaccine Preventable Diseases Service (Halpert), BC Centre for Disease Control, Vancouver, BC; Department of Paediatrics (Ipp), The Hospital for Sick Children, and Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Asmundson), Faculty of Arts, University of Regina, Regina, Sask.; Departments of Paediatrics (Rieder), Physiology and Pharmacology, and Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ont.; Canadian Family Advisory Network (Robson), Toronto, Ont.; E.M. Uleryk Consulting (Uleryk), Mississauga, Ont.; Department of Psychology (Antony), Ryerson University, Toronto, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Communicable Disease Control (Hanrahan), Alberta Health Services, Edmonton, Alta.; Bodhi Seed Center for Healing and Conscious Living (Lockett), Milton, Ont.; Department of Emergency Medicine (Scott), IWK Health Centre, Halifax, NS; Science Directorate (Votta Bleeker), Canadian Psychological Association, Ottawa, Ont.
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Jeffrey Scott
Leslie Dan Faculty of Pharmacy (Taddio), University of Toronto, and The Hospital for Sick Children, Toronto, Ont.; Department of Psychology (McMurtry), University of Guelph, Children’s Health Research Institute, and Department of Paediatrics, Western University, London, Ont.; Mount Sinai Hospital (Shah), and Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Pillai Riddell), York University, Toronto, Ont.; Departments of Pediatrics (Chambers), and Psychology and Neuroscience, Dalhousie University, and Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS; Center for Child Health, Behavior and Development (Noel), Seattle Children’s Research Institute, Seattle, Wash.; Department of Pediatrics (MacDonald), Dalhousie University, IWK Health Centre and Canadian Center for Vaccinology, Halifax, NS; Centre for Effective Practice (Rogers), and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont.; Immunize Canada (Bucci), Canadian Public Health Association, Ottawa, Ont.; Child and Adolescent Health Program Committee (Mousmanis), The College of Family Physicians of Canada, Mississauga, Ont.; Alberta Health Services (Lang), and Cumming School of Medicine, University of Calgary, Calgary, Alta.; Departments of Pediatrics (Halperin), and Microbiology and Immunology, and Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, Halifax, NS; College of Pharmacy (Bowles), Dalhousie University, Halifax, NS; Immunization Programs and Vaccine Preventable Diseases Service (Halpert), BC Centre for Disease Control, Vancouver, BC; Department of Paediatrics (Ipp), The Hospital for Sick Children, and Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Asmundson), Faculty of Arts, University of Regina, Regina, Sask.; Departments of Paediatrics (Rieder), Physiology and Pharmacology, and Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ont.; Canadian Family Advisory Network (Robson), Toronto, Ont.; E.M. Uleryk Consulting (Uleryk), Mississauga, Ont.; Department of Psychology (Antony), Ryerson University, Toronto, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Communicable Disease Control (Hanrahan), Alberta Health Services, Edmonton, Alta.; Bodhi Seed Center for Healing and Conscious Living (Lockett), Milton, Ont.; Department of Emergency Medicine (Scott), IWK Health Centre, Halifax, NS; Science Directorate (Votta Bleeker), Canadian Psychological Association, Ottawa, Ont.
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Elizabeth Votta Bleeker
Leslie Dan Faculty of Pharmacy (Taddio), University of Toronto, and The Hospital for Sick Children, Toronto, Ont.; Department of Psychology (McMurtry), University of Guelph, Children’s Health Research Institute, and Department of Paediatrics, Western University, London, Ont.; Mount Sinai Hospital (Shah), and Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Pillai Riddell), York University, Toronto, Ont.; Departments of Pediatrics (Chambers), and Psychology and Neuroscience, Dalhousie University, and Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS; Center for Child Health, Behavior and Development (Noel), Seattle Children’s Research Institute, Seattle, Wash.; Department of Pediatrics (MacDonald), Dalhousie University, IWK Health Centre and Canadian Center for Vaccinology, Halifax, NS; Centre for Effective Practice (Rogers), and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont.; Immunize Canada (Bucci), Canadian Public Health Association, Ottawa, Ont.; Child and Adolescent Health Program Committee (Mousmanis), The College of Family Physicians of Canada, Mississauga, Ont.; Alberta Health Services (Lang), and Cumming School of Medicine, University of Calgary, Calgary, Alta.; Departments of Pediatrics (Halperin), and Microbiology and Immunology, and Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, Halifax, NS; College of Pharmacy (Bowles), Dalhousie University, Halifax, NS; Immunization Programs and Vaccine Preventable Diseases Service (Halpert), BC Centre for Disease Control, Vancouver, BC; Department of Paediatrics (Ipp), The Hospital for Sick Children, and Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Asmundson), Faculty of Arts, University of Regina, Regina, Sask.; Departments of Paediatrics (Rieder), Physiology and Pharmacology, and Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ont.; Canadian Family Advisory Network (Robson), Toronto, Ont.; E.M. Uleryk Consulting (Uleryk), Mississauga, Ont.; Department of Psychology (Antony), Ryerson University, Toronto, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Communicable Disease Control (Hanrahan), Alberta Health Services, Edmonton, Alta.; Bodhi Seed Center for Healing and Conscious Living (Lockett), Milton, Ont.; Department of Emergency Medicine (Scott), IWK Health Centre, Halifax, NS; Science Directorate (Votta Bleeker), Canadian Psychological Association, Ottawa, Ont.
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Leslie Dan Faculty of Pharmacy (Taddio), University of Toronto, and The Hospital for Sick Children, Toronto, Ont.; Department of Psychology (McMurtry), University of Guelph, Children’s Health Research Institute, and Department of Paediatrics, Western University, London, Ont.; Mount Sinai Hospital (Shah), and Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Pillai Riddell), York University, Toronto, Ont.; Departments of Pediatrics (Chambers), and Psychology and Neuroscience, Dalhousie University, and Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS; Center for Child Health, Behavior and Development (Noel), Seattle Children’s Research Institute, Seattle, Wash.; Department of Pediatrics (MacDonald), Dalhousie University, IWK Health Centre and Canadian Center for Vaccinology, Halifax, NS; Centre for Effective Practice (Rogers), and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont.; Immunize Canada (Bucci), Canadian Public Health Association, Ottawa, Ont.; Child and Adolescent Health Program Committee (Mousmanis), The College of Family Physicians of Canada, Mississauga, Ont.; Alberta Health Services (Lang), and Cumming School of Medicine, University of Calgary, Calgary, Alta.; Departments of Pediatrics (Halperin), and Microbiology and Immunology, and Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, Halifax, NS; College of Pharmacy (Bowles), Dalhousie University, Halifax, NS; Immunization Programs and Vaccine Preventable Diseases Service (Halpert), BC Centre for Disease Control, Vancouver, BC; Department of Paediatrics (Ipp), The Hospital for Sick Children, and Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Asmundson), Faculty of Arts, University of Regina, Regina, Sask.; Departments of Paediatrics (Rieder), Physiology and Pharmacology, and Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ont.; Canadian Family Advisory Network (Robson), Toronto, Ont.; E.M. Uleryk Consulting (Uleryk), Mississauga, Ont.; Department of Psychology (Antony), Ryerson University, Toronto, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Communicable Disease Control (Hanrahan), Alberta Health Services, Edmonton, Alta.; Bodhi Seed Center for Healing and Conscious Living (Lockett), Milton, Ont.; Department of Emergency Medicine (Scott), IWK Health Centre, Halifax, NS; Science Directorate (Votta Bleeker), Canadian Psychological Association, Ottawa, Ont.
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    Table 1:

    Recommendations for reducing pain during vaccine injections

    TreatmentRecommendationConfidenceInfants and young children (≤ 3 yr)Children (3–12 yr)Adolescents (12–17 yr)Adults (≥ 18 yr)
    Strong recommendations
    Procedural interventions
    No aspirationWe recommend no aspiration during intramuscular vaccine injectionsVery lowYesYesYesYes
    Order of injectionWe recommend injecting the most painful vaccine last during vaccine injectionsModerateYesYesYesYes
    Physical interventions
    Breastfeeding*We recommend breastfeeding during vaccine injectionsVery lowYes (≤ 2 yr)———
    Positioning: skin-to-skin contact†We recommend skin-to-skin contact during vaccine injectionsModerateYes (≤ 1 mo)———
    Positioning: holding†We recommend holding during vaccine injectionsVery lowYes———
    If holding is not used during vaccine injections, we recommend a combined holding intervention (including patting and/or rocking) after vaccine injectionsLowYes———
    Positioning: sitting upWe recommend sitting up during vaccine injectionsLow—YesYesYes
    Pharmacologic interventions
    Topical anestheticsWe recommend topical anesthetics before vaccine injectionsVery lowYesYes—§—§
    Sweet-tasting solutions†‡We recommend sucrose solutions before vaccine injectionsModerateYes (≤ 2 yr)———
    We recommend glucose solutions before vaccine injectionsModerateYes (≤ 2 yr)———
    Process interventions
    Education of cliniciansWe recommend education of clinicians administering vaccine injections about vaccine injection pain managementLowYesYesYesYes
    Parent presenceWe recommend presence of parents during vaccine injectionsVery lowYesYes (≤ 10 yr)——
    Education of parentsWe recommend education of parents about pain management for vaccine injection before the day of vaccinationLowYesYesYes—
    We recommend education of parents about pain management for vaccine injection on the day of vaccinationVery lowYesYesYes—
    Education of individuals undergoing vaccinationWe recommend education of individuals about pain management for vaccine injection on the day of vaccinationVery low—YesYesYes
    Weak recommendations
    Procedural interventions
    Simultaneous injectionWe suggest simultaneous injections (rather than sequential injections) during vaccine injectionsLowYes (≤ 1 yr)§—§——
    We suggest against simultaneous injections during vaccine injectionsVery lowYes§ (1–3 yr)Yes (≤ 10 yr)——
    Vastus lateralisWe suggest the vastus lateralis (rather than the deltoid) as the site of injection during vaccine injectionsLowYes (≤ 11 mo)———
    Physical interventions
    Breastfeeding*If breastfeeding is not used during vaccine injections, we suggest breastfeeding before vaccine injectionsLowYes (≤ 2 yr)———
    Nonnutritive sucking†We suggest nonnutritive sucking (using a thumb/finger, pacifier) during vaccine injectionsLowYes (≤ 2 yr)———
    Vibrating device with coldWe suggest an external vibrating device with cold during vaccine injectionsLow—YesYes—
    Muscle tensionWe suggest muscle tension for vaccine injections in individuals with a history of faintingVery low—Yes (≥ 7 yr)YesYes
    Manual tactile stimulationWe suggest against manual tactile stimulation during vaccine injectionsVery lowYesYesYesYes
    Warming the vaccineWe suggest against warming the vaccine before vaccine injectionsLowYesYesYesYes
    Pharmacologic interventions
    Topical anestheticsWe suggest topical anesthetics before vaccine injectionsModerate—§—§YesYes
    Topical anesthetics and breastfeeding*We suggest combining topical anesthetics before vaccine injections and breastfeeding during vaccine injectionsLowYes (≤ 2 yr)———
    Sweet-tasting solutions and nonnutritive sucking†‡We suggest sweet-tasting solutions (sucrose, glucose) before vaccine injections and nonnutritive sucking (thumb/finger, pacifier) during vaccine injectionsVery lowYes (≤ 2 yr)———
    VapocoolantsWe suggest against applying vapocoolants before vaccine injectionsLowYesYesYes—§
    We suggest that vapocoolant spray be used before vaccine injectionsLow—§—§—§Yes
    AcetaminophenWe suggest against giving acetaminophen before vaccine injectionsLowYesYesYesYes
    IbuprofenWe suggest against giving ibuprofen before vaccine injectionsVery lowYesYesYesYes
    Sweet-tasting solutions and breastfeedingWe suggest against using sweet-tasting solutions (sucrose, glucose) and breastfeeding in combination before vaccine injectionsLowYes (≤ 2 yr)———
    Psychological interventions
    Verbal signal of impending procedureWe suggest a verbal signal of the impending procedure (v. a signal of impending pain) before vaccine injectionsVery lowYesYesYesYes
    DistractionWe suggest directed video distraction during vaccine injectionsVery lowYes—§——
    We suggest directed toy distraction during vaccine injectionsVery lowYes———
    We suggest nondirected toy distraction during vaccine injectionsVery lowYes———
    We suggest verbal distraction during vaccine injectionsLow—Yes——
    We suggest video distraction during vaccine injectionsVery low—§Yes——
    We suggest music distraction during vaccine injectionsLow—Yes—§—§
    We suggest against music distraction during vaccine injectionsVery low——§YesYes
    We suggest against visual distraction during vaccine injectionsVery low———Yes
    Breathing distractionWe suggest breathing with a toy distraction (e.g., blowing bubbles, pinwheel) during vaccine injectionsVery low—Yes——
    We suggest against breathing without a toy distraction (blowing, deep breathing) during vaccine injectionsVery low—Yes——
    We suggest against breathing interventions (cough) during vaccine injectionsLow—YesYes—§
    We suggest breathing interventions (cough, breath-hold) during vaccine injectionsVery low——§—§Yes
    Using suggestionWe suggest against using false suggestion during vaccine injectionsLowYesYesYesYes
    Using reassuranceWe suggest against using repeated reassurance during vaccine injectionsVery lowYesYesYesYes
    • ↵* Alternatively, bottle feeding with expressed breast milk or formula can be used, or combined interventions that simulate breastfeeding (e.g., holding, sweet-tasting solution, sucking), as appropriate.

    • ↵† If not breastfeeding.

    • ↵‡ Alternatively, if oral rotavirus vaccine is being administered at the same time as injectable vaccines, rotavirus vaccine can be given first as it contains sucrose.

    • ↵§ See elsewhere in the table for a recommendation in this age group.

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Canadian Medical Association Journal: 187 (13)
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22 Sep 2015
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Reducing pain during vaccine injections: clinical practice guideline
Anna Taddio, C. Meghan McMurtry, Vibhuti Shah, Rebecca Pillai Riddell, Christine T. Chambers, Melanie Noel, Noni E. MacDonald, Jess Rogers, Lucie M. Bucci, Patricia Mousmanis, Eddy Lang, Scott A. Halperin, Susan Bowles, Christine Halpert, Moshe Ipp, Gordon J.G. Asmundson, Michael J. Rieder, Kate Robson, Elizabeth Uleryk, Martin M. Antony, Vinita Dubey, Anita Hanrahan, Donna Lockett, Jeffrey Scott, Elizabeth Votta Bleeker, HELPinKids&Adults
CMAJ Sep 2015, 187 (13) 975-982; DOI: 10.1503/cmaj.150391

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Reducing pain during vaccine injections: clinical practice guideline
Anna Taddio, C. Meghan McMurtry, Vibhuti Shah, Rebecca Pillai Riddell, Christine T. Chambers, Melanie Noel, Noni E. MacDonald, Jess Rogers, Lucie M. Bucci, Patricia Mousmanis, Eddy Lang, Scott A. Halperin, Susan Bowles, Christine Halpert, Moshe Ipp, Gordon J.G. Asmundson, Michael J. Rieder, Kate Robson, Elizabeth Uleryk, Martin M. Antony, Vinita Dubey, Anita Hanrahan, Donna Lockett, Jeffrey Scott, Elizabeth Votta Bleeker, HELPinKids&Adults
CMAJ Sep 2015, 187 (13) 975-982; DOI: 10.1503/cmaj.150391
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