Canadian guidelines endorse simple, evidence-based strategies to reduce vaccination pain and distress

A new Canadian guideline introduces 16 practical strategies, including distraction and topical anaesthetics, to make vaccinations less painful and stressful for children and their families, aiming to boost vaccine confidence and compliance.

A new Canadian guideline says vaccination can be made less frightening and less painful by using simple steps that range from topical numbing cream to music and other distractions. Published in the Canadian Medical Association Journal, the update sets out 16 recommendations aimed at clinicians, vaccinators, organisations and families, and is designed to turn needle appointments into calmer, more manageable experiences. According to Anna Taddio of the University of Toronto and The Hospital for Sick Children in Toronto, “Research shows there are effective ways to reduce distress, but these strategies are still not routinely built into vaccination programs or practices, even though clinical guidelines recommend them.”

The guidance groups its advice into five areas: process, procedural, physical, pharmacological and psychological. Among the practical measures are educating staff and families about pain-reduction options, using fast injections, offering breastfeeding or other oral comfort measures for infants under 12 months, applying topical anaesthetics at injection sites and using distraction methods such as toys, singing, music or digital games. The CDC also recommends several of the same approaches, including rapid injection without aspiration, sweet-tasting liquids for babies and breathing or distraction techniques for older children. Gavi, meanwhile, reported that the Canadian update also advises keeping needles out of sight and giving the least painful vaccine first when more than one injection is needed.

The new recommendations update the HELPinKids&Adults guidance first issued in 2015. The authors say the revision was built on a 10-year evidence review and was shaped by a structured framework that assessed education, injection technique, physical comfort measures, drug-based pain relief and psychological support. The published reviews behind the guideline examined whether education and implementation efforts help clinicians, support people, vaccine recipients and mixed groups adopt distress-reducing practices, while separate reviews looked at injection methods such as no aspiration, faster delivery and reducing fear cues before vaccination.

Taddio said the aim is not only to soften the immediate experience but also to make people more willing to return for future vaccinations. The guideline encourages families and care teams to choose coping strategies before or during the appointment using the CARD approach , Comfort, Ask, Relax and Distract , a tool developed by several of the authors. With vaccine confidence having fallen since the COVID-19 pandemic, the researchers say the update is intended to give providers timely, evidence-based ways to make vaccination less stressful and less stigmatised.