Easy ways to reduce pain at paediatric clinics

06.2025
Author Dr. Martin Claßen, Bremen

Although paediatric clinics manage to build up trust with many young children and create a relaxed environment for examinations, vaccinations often lead to negative, painful experiences. A study was conducted in Japan on 60 children between 3 and 6 years old to investigate how pain can be reduced in subcutaneous injections during vaccinations. The children were randomised into two groups of 30, and the intervention group was given a gel-based, flexible cool pack on their upper arm for 30-60 seconds before being vaccinated (Japanese encephalitis or influenza) no later than 60 seconds afterwards. Expressions of pain were measured blind on video over 10 seconds using the FLACC scale (Facial expression, Leg movement, Activity, Crying, Consolability). The control group was given the gel pack at room temperature.
The median FLACC score in the group with the cool pack was significantly lower (1 [IQR 0-1.25]) than in the group where the gel pack was at room temperature (2.5 [IQR 1-6]) (p = 0.011).
 

Comment: The idea is not exactly new, but the prospective analysis reinforces its relevance and serves as a reminder that there are easy things we can do to help reduce pain and thus anxiety. In my experience, the reduced discussions, higher vaccination rates and improved levels of trust in the long term mean that the additional time and energy spent organising these measures (including the local anaesthesia plaster before taking blood samples) is always worth it, and not just with young children. In particular, I found the short application period for the cool packs of 30-60 seconds remarkable – I’m sure that’s something every clinic can incorporate into its vaccinations, so they should have a supply of cool packs in their freezer. 
The discussion in the publication states that cooling spray has not produced good results in studies because the sudden cold sensation can be painful. 
The principle can, of course, also be applied to subcutaneous injections regularly required at home (e.g. for biologics to be injected once a week or once every two weeks) to increase acceptance. We should recommend that this group also use cool packs from the outset.
 

Reference:
Okafuji, I, Washio, R, Okafuji, T, Tanaka, Y, Kagimura, T. Use of a cooling pack to reduce subcutaneous vaccine injection pain in children aged 3-6 years: A single-blind, randomized, parallel-group multicenter study. PLOS One. 2025 Mar 26;20(3):e0318322. DOI: 10.1371/journal.pone.0318322]