Baby vaccination pain: to limit the tears at the moment of the jab, three simple steps have proven their worth: breastfeeding during the injection, holding your child in your arms rather than laying them down, and keeping the most painful vaccine for last. The World Health Organization has recommended them since 2015. Giving paracetamol before the appointment, on the other hand, is not advised. Here is how to organise the vaccination, from leaving home to getting back.
Baby vaccination pain: what the research says
An injection hurts for a few seconds, and babies cry mostly from surprise and the jab itself. This pain is brief, but it comes back: the French vaccination schedule includes several appointments during the first year. Sometimes two injections are given on the same day. We cover the ages and the compulsory vaccines in detail in our article on the baby vaccination schedule.
In September 2015, the WHO published a position paper on reducing pain at the time of vaccination. It draws on the available trials and distinguishes what works, what is not recommended routinely and what is of no use. Since then, a Cochrane review has clarified the effect of breastfeeding in babies aged 1 to 12 months.
Before the appointment: getting ready
A little preparation at home saves you scrambling around just as your baby starts to fidget.
- Clothes that open easily. In young babies, the injection is usually given in the outer side of the thigh. A bodysuit and trousers that come off quickly cut down the waiting.
- The usual cuddly toy or blanket. The Government of Québec advises bringing them along to comfort children under 3.
- A baby ready to feed. If you breastfeed, avoid a feed just before you leave: your baby will take the breast more willingly during the injection.
- The health record book. It lets the health professional check the vaccines already given and note down today’s.
Numbing cream: useful, but not routine
A lidocaine cream or patch is applied to the skin 30 to 60 minutes before the injection, according to the Government of Québec. If two vaccines are planned, it needs to go on both sites. The WHO acknowledges that these products are effective and do not affect the response to the vaccine. It does not recommend them routinely, because of their cost and the time needed to apply them. Ask your doctor or pharmacist for advice before using one.
Sugar solution, an alternative if you are not breastfeeding
For a child under 2, Québec describes a simple preparation: 5 ml of sugar dissolved in 15 ml of water. Small amounts are given 1 to 2 minutes before the injection, with a spoon, a syringe or on a dipped dummy. It is not needed if the baby is breastfed during the jab. Nor should it become a way of calming a crying baby. And never any honey before 1 year.
During the injection: steps that reduce pain
Breastfeeding during the jab
This is the best-documented step. The WHO recommends that babies be breastfed during or just before vaccination, when this is possible and acceptable. The Cochrane review by Harrison and colleagues, published in October 2016, brought together 10 studies and 1,066 infants. Babies breastfed during the injection cried on average 38 seconds less, with lower pain scores. The quality of evidence is rated moderate, and mainly established before 6 months.
The position Québec advises is the cradle hold: your baby’s head rests on your forearm, on the side of the breast. The arm or leg to be injected stays free. Our article on breastfeeding covers the other key points of this period.
Holding baby close, not laying them down
The WHO recommends that the child be held by the parent throughout the procedure, rather than lying on a table. Sitting on your lap, your baby is cuddled without being squeezed too tightly. For an injection in the thigh, Québec advises sitting them sideways, one arm behind your back, with the leg held firmly.
Distracting and staying calm
Under 3, distraction helps: singing, talking softly, showing a colourful object, holding out the cuddly toy. It should not get in the health professional’s way. Your tone matters too. Québec advises smiling, speaking in a normal voice and avoiding apologising or talking about pain. A tense parent passes on their tension; a relaxed parent reassures.
The order of the vaccines
When several vaccines are planned, the WHO recommends giving them from the least to the most painful. The oral rotavirus vaccine goes first: its liquid formula contains sucrose, which has a mild pain-relieving effect. The health professional decides, but you can ask them about it. The pneumococcal vaccine and those against meningococcus in babies are among these appointments with several injections.
Should you give paracetamol before the vaccine?
No. The WHO does not recommend giving paracetamol or ibuprofen before or at the time of vaccination: their effect on the pain of the jab has not been shown. These medicines can, however, be used in the days that follow if a fever or pain appears. The dose depends on the child’s weight, as we explain in our article on the paracetamol dose for babies. If in doubt, ask your doctor or pharmacist.
After the vaccine: cuddles, a feed and keeping an eye
Straight after the injection, physical contact remains the best comfort: a cuddle, rocking, a breastfeed or a bottle. Québec advises praising your child and staying close. Redness or a small lump at the injection site is common and goes within a few days. A grizzly or sleepier baby that same evening is nothing unusual.
If the crying seems different from usual, or a reaction worries you, call the doctor or the PMI (the French mother and child health service). Our article on crying in young babies helps tell passing tiredness apart from a sign that deserves an appointment.
What doesn’t help, or isn’t recommended
- Warming the vaccine or rubbing the injection site before or after: the WHO does not recommend this, for lack of evidence and because it may affect the vaccine.
- Laying baby alone on the table while holding them at arm’s length: being held against their parent is more reassuring.
- Giving sugar water to soothe outside the appointment: the sugar solution is only for the moment of the injection.
- Holding too tightly: the aim is to steady the limb, not to pin down the whole body.
- Telling an older child that ‘it won’t hurt’: better to talk about a quick jab, without making a drama of it.
Planning the vaccination appointment
In France, babies are vaccinated by the GP, the paediatrician, the midwife or at the PMI. Choosing a time when your baby is neither hungry nor exhausted makes the session easier, when the diary allows. Coming as a pair helps too: one holds and breastfeeds or comforts, the other handles the bags and the health record book. If you don’t yet know your local PMI, our article on the PMI appointment explains how it works.
Key takeaways
- Breastfeeding during the injection reduces crying by around 38 seconds on average in young babies.
- Holding baby in your arms, distracting them and staying calm are among the steps recommended by the WHO.
- The most painful vaccine goes last; the oral rotavirus vaccine, first.
- No paracetamol before the vaccine; it remains an option afterwards, in case of fever or pain.
- Numbing cream or sugar solution: options to discuss, not obligations.
Sources
- World Health Organization, ‘La douleur au moment de la vaccination : note de synthèse de l'OMS’, Relevé épidémiologique hebdomadaire, no. 39, 25 September 2015.
- Harrison D., Reszel J., Bueno M. et al., ‘Breastfeeding for procedural pain in infants beyond the neonatal period’, Cochrane Database of Systematic Reviews, 28 October 2016.
- Government of Québec, ‘Diminuer la douleur et l'anxiété liées à la vaccination chez les enfants’, updated 13 June 2023.
