A reader on Facebook asks:
“If breastfeeding reduces the pain, why do the nurses ALWAYS require me to hold the baby down on the table?!?!?”
That’s a great question! I asked one of my medical assistants that very same question and she answered: “Because you taught us to do it that way!”
It wasn’t very long ago that the pediatricians were the ones who gave the shots and not the nurses or medical assistants. As pediatric residents, we were taught to give shots to infants in their thighs while they lay on a firm exam table, presumably to allow maximum control over the thrashing and screaming baby, thereby minimizing accidental “sticks” to the baby, parent, or ourselves. Most pediatricians have since delegated the vaccine-giving duties to nurses and medical assistants, who learned that skill from — you guessed it — pediatricians!
So after explaining the evidence that breastfeeding may reduce an infant’s pain during a vaccine injection, I asked the question a different way: If a mother asked you if she could hold her baby and nurse while the shots were being given, would you agree to do so? All of my medical assistants said of course they would, especially at the 2-month visit and the 4-month visit. There was some hesitation at 6 months because they said babies are bigger and stronger then, and they would be concerned about not having adequate control to administer the vaccines safely. Still, they all said they would do the best they could to accomplish it at 6 months old if the mom really wanted to nurse.
One other concern they expressed to me was that the baby might reflexively inhale and choke or aspirate breast milk when the shot is given. This was addressed in the guidelines published in the Canadian Medical Association Journal:
There are no reports of adverse events, such as gagging or spitting up.
A logical next question might be: What about allowing a baby to suck on a bottle during vaccine injections? The guidelines state:
Offering breast milk or formula via a bottle should not be considered a substitute for breastfeeding as a method of reducing pain.
Gagging and spitting up were reported in less than five percent of infants who received sugar water from a spoon, medicine cup, or syringe during a shot.
One point I want to make: Your baby is going to cry whether she is on the table or being held while breastfeeding. It’s going to hurt in either case! The evidence points to possibly less pain (or, at least, less protest from the baby) if the mom is allowed to hold her baby and nurse, or administer a little bit of sugar water (or suck a sugar-soaked pacifier) during the procedure.
My guess is that most doctors, nurses, and medical assistants would prefer to lie a baby on the firm exam table with nothing in their mouths while giving shots. It’s easier, faster, and more controlled from a (perceived?) safety standpoint. It might continue to be our default method of giving shots. But there is no reason to deny a mother the opportunity to comfort her baby by holding and nursing during shots if she requests it.
Previous PediaBlog post on reducing infant pain during vaccines here.