Kids' shots may hurt less with "cough trick"

Asking children to cough as they receive an injection may help reduce the pain from immunizations.

The "cough trick" is easily taught and requires no additional cost, equipment or staff time, according to a study published online Jan. 11 in Pediatrics (link).

After a single warm-up cough, children in the study were instructed to cough again, and the shot was administered during the second cough.

Some children, their parents and clinic nurses who gave the shots thought coughing reduced the pain. The technique may be effective because of the distraction provided by coughing on cue or perhaps because of competing sensory stimuli.

"The children feel the cough in their bodies, and that makes them feel the pain from the injection less than they would otherwise," said lead author Dustin Wallace, PhD, a pediatric psychology fellow at the Mayo Clinic in Rochester, Minn.

The strategy was tested on 68 children: 22 were 4- and 5-year-olds receiving their prekindergarten immunizations and 46 were 11- to 13-year-olds getting shots before entering junior high school. The shots were administered at the University of Nebraska Medical Center in Omaha.

Children were asked to describe their pain using a 100-mm visual analog scale. Older children were asked to rate their pain from "no pain at all," or zero, to "the worst imaginable pain," or 100. The younger children were asked to rate their pain from "no hurt at all" to "really bad hurt."

Researchers were surprised that coughing seemed more effective for white children than black children. Among white children, the cough trick was associated with a 40% reduction in pain. But black children said they did not experience a significant change in pain when they coughed.

Since most of the nurses were white, "we thought the children may not have trusted a strategy offered by someone who looked different from themselves," Wallace said. But, he added, a definitive answer was not available, since the study was not designed to answer that question.

Among white children, the average self-reported pain intensity was 48.8 mm on the scale for injections given without the cough and 29.2 mm for injections with the cough.

Parents and nurses were asked to indicate their perception of the child's pain after each injection, and those responses correlated well with the children's rating.

Wallace tried the technique himself, testing it when getting his seasonal and H1N1 flu shots last year. Wallace coughed as he was immunized for seasonal flu but not for the H1N1 shot. The seasonal shot seemed to hurt less. "I thought it worked," he said.