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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Article Figures & Tables
Tables
Treatment Recommendation Confidence Infants and young children (≤ 3 yr) Children (3–12 yr) Adolescents (12–17 yr) Adults (≥ 18 yr) Strong recommendations Procedural interventions No aspiration We recommend no aspiration during intramuscular vaccine injections Very low Yes Yes Yes Yes Order of injection We recommend injecting the most painful vaccine last during vaccine injections Moderate Yes Yes Yes Yes Physical interventions Breastfeeding* We recommend breastfeeding during vaccine injections Very low Yes (≤ 2 yr) — — — Positioning: skin-to-skin contact† We recommend skin-to-skin contact during vaccine injections Moderate Yes (≤ 1 mo) — — — Positioning: holding† We recommend holding during vaccine injections Very low Yes — — — If holding is not used during vaccine injections, we recommend a combined holding intervention (including patting and/or rocking) after vaccine injections Low Yes — — — Positioning: sitting up We recommend sitting up during vaccine injections Low — Yes Yes Yes Pharmacologic interventions Topical anesthetics We recommend topical anesthetics before vaccine injections Very low Yes Yes —§ —§ Sweet-tasting solutions†‡ We recommend sucrose solutions before vaccine injections Moderate Yes (≤ 2 yr) — — — We recommend glucose solutions before vaccine injections Moderate Yes (≤ 2 yr) — — — Process interventions Education of clinicians We recommend education of clinicians administering vaccine injections about vaccine injection pain management Low Yes Yes Yes Yes Parent presence We recommend presence of parents during vaccine injections Very low Yes Yes (≤ 10 yr) — — Education of parents We recommend education of parents about pain management for vaccine injection before the day of vaccination Low Yes Yes Yes — We recommend education of parents about pain management for vaccine injection on the day of vaccination Very low Yes Yes Yes — Education of individuals undergoing vaccination We recommend education of individuals about pain management for vaccine injection on the day of vaccination Very low — Yes Yes Yes Weak recommendations Procedural interventions Simultaneous injection We suggest simultaneous injections (rather than sequential injections) during vaccine injections Low Yes (≤ 1 yr)§ —§ — — We suggest against simultaneous injections during vaccine injections Very low Yes§ (1–3 yr) Yes (≤ 10 yr) — — Vastus lateralis We suggest the vastus lateralis (rather than the deltoid) as the site of injection during vaccine injections Low Yes (≤ 11 mo) — — — Physical interventions Breastfeeding* If breastfeeding is not used during vaccine injections, we suggest breastfeeding before vaccine injections Low Yes (≤ 2 yr) — — — Nonnutritive sucking† We suggest nonnutritive sucking (using a thumb/finger, pacifier) during vaccine injections Low Yes (≤ 2 yr) — — — Vibrating device with cold We suggest an external vibrating device with cold during vaccine injections Low — Yes Yes — Muscle tension We suggest muscle tension for vaccine injections in individuals with a history of fainting Very low — Yes (≥ 7 yr) Yes Yes Manual tactile stimulation We suggest against manual tactile stimulation during vaccine injections Very low Yes Yes Yes Yes Warming the vaccine We suggest against warming the vaccine before vaccine injections Low Yes Yes Yes Yes Pharmacologic interventions Topical anesthetics We suggest topical anesthetics before vaccine injections Moderate —§ —§ Yes Yes Topical anesthetics and breastfeeding* We suggest combining topical anesthetics before vaccine injections and breastfeeding during vaccine injections Low Yes (≤ 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 injections Very low Yes (≤ 2 yr) — — — Vapocoolants We suggest against applying vapocoolants before vaccine injections Low Yes Yes Yes —§ We suggest that vapocoolant spray be used before vaccine injections Low —§ —§ —§ Yes Acetaminophen We suggest against giving acetaminophen before vaccine injections Low Yes Yes Yes Yes Ibuprofen We suggest against giving ibuprofen before vaccine injections Very low Yes Yes Yes Yes Sweet-tasting solutions and breastfeeding We suggest against using sweet-tasting solutions (sucrose, glucose) and breastfeeding in combination before vaccine injections Low Yes (≤ 2 yr) — — — Psychological interventions Verbal signal of impending procedure We suggest a verbal signal of the impending procedure (v. a signal of impending pain) before vaccine injections Very low Yes Yes Yes Yes Distraction We suggest directed video distraction during vaccine injections Very low Yes —§ — — We suggest directed toy distraction during vaccine injections Very low Yes — — — We suggest nondirected toy distraction during vaccine injections Very low Yes — — — We suggest verbal distraction during vaccine injections Low — Yes — — We suggest video distraction during vaccine injections Very low —§ Yes — — We suggest music distraction during vaccine injections Low — Yes —§ —§ We suggest against music distraction during vaccine injections Very low — —§ Yes Yes We suggest against visual distraction during vaccine injections Very low — — — Yes Breathing distraction We suggest breathing with a toy distraction (e.g., blowing bubbles, pinwheel) during vaccine injections Very low — Yes — — We suggest against breathing without a toy distraction (blowing, deep breathing) during vaccine injections Very low — Yes — — We suggest against breathing interventions (cough) during vaccine injections Low — Yes Yes —§ We suggest breathing interventions (cough, breath-hold) during vaccine injections Very low — —§ —§ Yes Using suggestion We suggest against using false suggestion during vaccine injections Low Yes Yes Yes Yes Using reassurance We suggest against using repeated reassurance during vaccine injections Very low Yes Yes Yes Yes ↵* 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.
In this issue
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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
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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