Non-Pharmacological Strategies Used by Nurses In Pain Management During Childhood Vaccination: A Comparative Study
DOI:
https://doi.org/10.12707/RVI25.40.41002Keywords:
family nurse practitioners, pain management, vaccination, infant, child, preschool, childAbstract
Background: Childhood vaccination is associated with fear and pain, and non-pharmacological strategies are effective in reducing them.
Objective: To describe the non-pharmacological strategies used by family health nurses to relieve pain during the vaccination of children up to 10 years of age and to assess their knowledge of the guidelines issued by the Ordem dos Enfermeiros (Portuguese Nursing Regulator) and the Portuguese Directorate-General of Health.
Methodology: An observational and comparative study was conducted using convenience sampling and a digital questionnaire that included variables such as socioprofessional characteristics, knowledge, and non-pharmacological pain control strategies, which were analyzed according to children’s age.
Results: Sixty-four family health nurses participated. Most were unaware of the recommendations of the Ordem dos Enfermeiros and the Portuguese Directorate-General of Health. The most frequently reported strategies were rocking and gentle stroking (75%), distraction (67.2%), positioning (59.4%), and breastfeeding (50%) for children up to 6 months of age; after 5 years of age, cognitive-behavioral strategies predominated.
Conclusion: Family health nurses demonstrated limited knowledge regarding non-pharmacological strategies for pediatric pain control, highlighting the need for targeted training in this area.
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References
Australian and New Zealand College of Anaesthetists. (2023). National strategy for health practitioner pain management education. Australian Government. https://www.health.gov.au/sites/default/files/2023-10/national-strategy-for-health-practitioner-pain-management-education.pdf~
Bezerra, M. A., Brito, M. A., Fernandes, L. S., Lopes, T. P., Carneiro, C. T., Rocha, R. C., Carvalho, I. L., & Moura, M. Á. (2024). Métodos não farmacológicos para o alívio da dor no recém-nascido: Revisão integrativa da literatura. Revista de Enfermagem UFPE Online, 18(1), e259317. https://doi.org/10.5205/1981-8963.2024.259317
Gorrotxategi Gorrotxategi, P., Zabaleta Rueda, A., Urberuaga Pascual, A., Aizpurua Galdeano, P., Juaristi Irureta, S., & Larrea Tamayo, E. (2022). Nonpharmacological pain management in vaccination. Perception of paediatricians, patients and guardians. Anales de Pediatría, 97(3), 199-205. https://doi.org/10.1016/j.anpede.2022.07.002
Guarda, L. E., Vieira, G. B., Castral, T. C., Fernandes, A. M., Santos, J. M., Leite, A. M., & Ribeiro, L. M. (2022). Efeito da estratégia multifacetada EPIQ para melhoria da gestão da dor na vacinação em crianças. Revista de Enfermagem Referência, 6(1), e21125. https://doi.org/10.12707/RV21125
Guillari, A., Giordano, V., Catone, M., Gallucci, M., & Rea, T. (2024). Non-pharmacological interventions to reduce procedural needle pain in children (6-12 years): A systematic review. Journal of Pediatric Nursing, 78, e102-e116. https://doi.org/10.1016/j.pedn.2024.06.025
McMurtry, C. M., Riddell, R. P., Taddio, A., Racine, N., Asmundson, G. J., Noel, M., Chambers, C. T., Shah, V., & HELPinKids&Adults Team. (2015). Far from “just a poke”: Common painful needle procedures and the development of needle fear. The Clinical Journal of Pain, 31(Sup. 10), S3-S11. https://doi.org/10.1097/AJP.0000000000000272
Mendes, B. V., Furlan, M. S., & Sanches, M. B. (2022). Intervenções não farmacológicas em procedimentos dolorosos com agulha em crianças: Revisão integrativa. Brazilian Journal of Pain, 5(1), 61-67. https://doi.org/10.5935/2595-0118.20220004
Ordem dos Enfermeiros. (2013). Guia orientador de boa prática: Es não farmacológicas no controlo da dor na criança. https://www.ordemenfermeiros.pt/media/8899/gobp_estrategiasnaofarmacologicascontroldorcrianca.pdf
Rossi, S., Larafa, M., & Ruocco, M. (2020). Emotional and behavioural distraction by a social robot for children anxiety reduction during vaccination. International Journal of Social Robotics, 12(3), 765-777. https://doi.org/10.1007/s12369-019-00616-w
Royal College of Nursing. (2019). The role of nursing associates in vaccination and immunization: Position statement (april 2019). https://www.rcn.org.uk/-/media/royal-college-of-nursing/documents/publications/2019/april/007-565.pdf
Sánchez-López, M. I., Lluesma-Vidal, M., Ruiz-Zaldibar, C., Tomás- Saura, I., Martínez-Fleta, M. I., Gutiérrez-Alonso, G., & García-Garcés, L. (2025). The effect of virtual reality versus standard- of-care treatment on pain perception during paediatric vaccination: A randomised controlled trial. Journal of Clinical Nursing, 34(3), 1045-1062. https://doi.org/10.1111/jocn.17287
Schurman, J. V., Deacy, A. D., Johnson, R. J., Parker, J., Williams, K., Wallace, D., Connelly, M., Anson, L., & Mroczka, K. (2017). Using quality improvement methods to increase use of pain prevention strategies for childhood vaccination. World Journal of Clinical Pediatrics, 6(1), 81-88. https://doi.org/10.5409/WJCP.V6.I1.81
Serviço Nacional de Saúde. (2025). Programa nacional de vacinação. https://www.sns24.gov.pt/tema/vacinas/programa-nacional-de-vacinacao/#qual-o-programa-nacional-de-vacinacao-que-esta-em-vigor
Slater, R., Walker, S., Eccleston, C., Bellieni, C., Hirekodi, T., Carbajal, R., Smart, L., Laughey, W., Cobo, M. M., & Friedrichsdorf, S. (2025). Moments that matter: Childhood pain treatment shapes pain for life-we can do better every time in every child. BMC Medicine, 23, 64. https://doi.org/10.1186/s12916-025-03869-7
Taddio, A., McMurtry, C. M., Logeman, C., Gudzak, V., Boer, A., Constantin, K., Lee, S., Moline, R., Uleryk, E., Chera, T., Mac- Donald, N. E., & Pham, B. (2022). Prevalence of pain and fear as barriers to vaccination in children - systematic review and meta-analysis. Vaccine, 40(52), 7526-7537. https://doi.org/10.1016/j.vaccine.2022.10.026
Viggiano, C., Occhinegro, A., Siano, M. A., Mandato, C., Adinolfi, M., Nardacci, A., Caiazzo, A. L., Viggiano, D., & Vajro, P. (2021). Analgesic effects of breast- and formula feeding during routine childhood immunizations up to 1 year of age. Pediatric Research, 89(5), 1179-1184. https://doi.org/10.1038/s41390-020-0939-x
Waisman, A., & Katz, J. (2024). The autobiographical memory system and chronic pain: A neurocognitive framework for the initiation and maintenance of chronic pain. Neuroscience & Biobehavioral Reviews, 162, 105736. https://doi.org/10.1016/j.neubiorev.2024.105736
Wang, Y., Aaron, R., Attal, N., & Colloca, L. (2025). An update on non-pharmacological interventions for pain relief. Cell Reports Medicine, 6(2), 101940. https://doi.org/10.1016/j.xcrm.2025.101940
World Health Organization. (2016). Reducing pain at the time of vaccination: WHO position paper, september 2015-recommendations. Vaccine, 34(32), 3629-3630. https://doi.org/10.1016/j.vaccine.2015.11.005
World Health Organization. (2025). Vaccines and immunization. https://www.who.int/health-topics/vaccines-and-immuntab_1
Wu, Y., Zhao, Y., Wu, L., Zhang, P., & Yu, G. (2022). Non-pharmacological management for vaccine-related pain in children in the healthcare setting: A scoping review. Journal of Pain Research, 15, 2773-2782. https://doi.org/10.2147/JPR.S371797















