By Gary M. White, MD
See also lidocaine.
A recent review of methods to reduce pain of procedures in children showed only two had good solid clinical evidence.
Methods of distraction include nonprocedural talk, handheld video games, kaleidoscopes, virtual reality glasses, party blowers, blowing out air, music, and cartoon watching. It is helpful for the parent or nurse to ask questions to occupy the child's mind, e.g., "Where's the bird?" "How many bubbles do you see?" Some have found it useful to have a box of potential distractors and let the child choose.
One report recommended the child "blow the pain away." Quoting from the article [Peds Derm 2014;31;757], say, “I know a trick I can show you that may make this easier. When it's time to freeze the wart, take a long, deep breath in through your nose and then blow it out through your mouth until I say stop.”
From their article, methods section, the following technique was highly effective at injecting without pain in the majority of patients.
"A 3 cc syringe and 30 gauge needle was used and filled with 0.5% lidocaine 1:200,000 epinephrine buffered 1:10 with 8.4% sodium bicarbonate. Constant, light pressure was placed on the plunger before and during insertion of the needle, resulting in the slow extrusion of anesthetic, taking 2 minutes to empty the first syringe. The needle was oriented bevel-down parallel to the skin and with slight downward pressure was slowly advanced into the superficial dermis. The needle tip was kept within the wheal when advancing the needle to anesthetize a broader area."
Sucrose or glucose reduces pain for 5 minutes in infants.