Last month, Dr. Weinberg and I, along with our University of Toronto Colleagues, published the results of research that we carried out last year at Kindercare Pediatrics.  Essentially we demonstrated that giving 2 and 4 month-old babies the oral rotavirus vaccine just before injectable vaccines reduces the pain felt by babies from the injection.

This morning, The World Health Organization (WHO) published, in their weekly epidemiological record, global recommendations for reducing pain and distress at the time of vaccination. These recommendations were part of a larger report that came out of a meeting of The Strategic Advisory Group of Experts (SAGE) on immunization (14–16 April 2015, Geneva, Switzerland). The SAGE group assembled a technical consultancy group (TCG) tasked with reviewing the current literature on vaccine pain management and then adapting the relevant findings into a set of global health recommendations.

Based on this work from the WHO SAGE and TCG, the following recommendations were made:

1. For all ages: no aspiration for IM injection; administration of vaccines in order of increasing painfulness; proper positioning, i.e. holding infants and children less than 3 years, and sitting for those over 3 years of age; use of neutral words, avoidance of language that increases anxiety and/or promotes distrust.
2. For infants and children: breastfeeding (if feasible and culturally acceptable) during or just before injection; when part of the schedule, administration of rotavirus vaccine immediately prior to vaccine injection (the formulation of the currently licensed liquid rotavirus vaccines has been shown to have a pain mitigating effect through their sucrose content). For children under 6 years of age, caregiver presence and distraction such as music are recommended.
3. For adults: distraction with coughing or breathholding.

We are very honored and excited that the WHO used the rotavirus vaccine findings (underlined) from our recent paper to inform their recommendations.  This means that our research results will have a very large impact given that these recommendations are likely to be implemented worldwide. It is most exciting to be a part of change implementation around the world that will improve (at least in some small way) health and well-being for children.

A special thank you to Dr. Anna Taddio whose research informed most of these WHO vaccine pain-reduction recommendations and who enabled and supported the rotavirus vaccine research that was carried out at Kindercare Pediatrics.

The post Research Out of Toronto’s Kindercare Pediatrics Informs World Health Organization’s Global Vaccination Recommendations appeared first on Kindercare Pediatrics.

In an attempt at protecting the high standard of care offered to patients at Kindercare Pediatrics, we have developed a policy to help navigate this challenge. I would like to share this policy information with our extended community for 2 main reasons:

1. Kindercare Pediatrics’ patients and clients should have access to this information.  They should know that our team endeavors to make evidence-informed health recommendations without undue bias.
2. I am hoping that by sharing this policy information, fellow physicians might reflect further on this important issue and consider implementing similar policies for their practices.

Summary of Policy Points:

1. Kindercare Pediatrics DOES NOT endorse physicians meetings with industry representatives. 
2. Kindercare Pediatrics DOES accept free medication samples for distribution to patients. These samples are to be reasonably-priced over-the-counter products. To avoid any misperception of preference, reasonable attempts are made at maintaining stock of multiple brand names of the same medication (i.e. Tempra/Tylenol, Advil/Motrin, etc.). All samples are kept behind closed cabinets and without any labels or brand-names visible. Orders for samples and the coordination of deliveries are carried out exclusively by the office manager and/or operations manager.
3. In keeping with the World Health Organization’s International Code of Marketing of Breast-milk Substitutes, Kindercare Pediatrics DOES NOT accept free infant formula samples for distribution to patients. 
4. Kindercare Pediatrics DOES NOT endorse nor promote any industry-sponsored events (sponsored lectures, lunch/dinner meetings, etc). This includes posting advertisements on any walls in clinic and/or conveying any information about industry-sponsored events via email, fax, text, telephone, and/or social media platforms representing Kindercare Pediatrics.
5. There may be extenuating or specific circumstances where Kindercare Pediatrics may make exceptions to these rules. Any such situation will be considered by the managing director.

I am keen to receive feedback about this.  Please feel free to leave comments below.

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