Until more research is done, pediatricians “should do what they're comfortable with—there is nothing definitive at this point,” Dr. Schechter said in the interview. “I think if evidence emerges, it will add pluses and minuses and not be powerful one way or the other.”
Pressure at the injection site, applied either manually or with the aid of a mechanical device, has some support in the literature and, because pressure has no adverse effects, it may have value, the reviewers said.
“The adolescents and young women coming in for the Gardasil vaccine are even anxious about these shots,” which says something about the anxiety and distress that routine immunizations cause, Dr. Corcoran said. “The pain [of immunization] is real, and it's magnified significantly by anxiety.”
Since finishing the review, Dr. Schechter has launched the “Injection Protection Project,” an educational effort to bring information and tools—from a poster and video for staff to a brochure for parents—into pediatric practices. Thus far, he has visited about 20 offices, including the three-pediatrician practice of Dr. Corcoran.