An End to Infant Crying at the Doctor's Office?

A novel approach may help parents quell their baby's crying at the doctor's.

April 16, 2012— -- Tammy Littlebear of San Leandro, Calif., knows all too well the pains of dealing with a crying infant at the doctor's office. The 46-year-old mother of three recalls the recent experience of taking her 16-month-old granddaughter Leilani to the doctor for routine visits.

She says as soon as Leilani got her shots, "She cried immediately. She was hysterical."

Littlebear tried to calm her down by lightly rubbing her hair, blowing air at the site where she was getting the shot, and providing a kiss to the spot. None of this stopped the crying, though -- and nobody in the doctor's office gave instructions on how she could calm her granddaughter.

Now, a technique that doctors have commonly recommended to parents to deal with the pain of baby colic shows promise in easing the pain associated with infant vaccinations.

In a paper published Monday in the journal Pediatrics, researchers examined the techniques promoted in Dr. Harvey Karp's book Happiest Baby on the Block. They looked at five tactics intended to elicit the calming reflex in infants -- tight swaddling in a blanket, holding the baby on his/her right side face down, shushing with a loud "ssh," gentle swinging of the baby, and giving the baby something on which to suck, such as a pacifier. According to Karp, these actions -- which he terms "the 5 S's," cause instant relaxation for the infants as they are reminded of being in the womb.

Lead study author Dr. John Harrington of Children's Hospital of The King's Daughters says the idea for the study was conceptualized around the time that a study revealed Tylenol, often used for pain relief ahead of immunization, blunted the immune response to several different vaccines. He had attended a lecture delivered by Karp, but was skeptical the idea would work in this setting.

He and a team of researchers in Virginia tested the 5 S's approach in more than 200 infants undergoing routine immunizations at two and four months. Some received the 5 S's approach, while others received the comfort measures normally provided by their parents after vaccines. Half of the infants also received a sugar solution prior to vaccination, while the other half received only water.

As the babies were receiving their shots, the researchers looked for certain telltale signs of pain, as indicated by a common pain scoring system known as the Modified Riley Pain Score.

The infants who received the 5 S's had less pain that infants that did not and scored just as well on the pain scale as infants who received sugar along with the 5 S approaches. At one minute following immunization, 30 percent of the infants who received sugar but not the 5 S techniques were still crying, while nearly none of the infants in the 5 S's group were crying.

"The parents noted a difference," Harrington says. "A lot of the parents wanted to learn the technique when they found their child calm quicker than usual."

Karp says that the techniques can be applied in situations other than just at the doctor's office -- indeed, anywhere your infant might be crying.

And Karp says that there are broader implications to a baby's crying than many parents realize.

"Crying infants is a much more serious public health problem," he says. "It turns out that babies crying, and the fatigue and demoralization are leading triggers for an entire spectrum of very serious public health issues, like marital stress and postpartum depression."

Studies are underway that investigate the 5 S's in treating baby colic, preventing postpartum depression, and as part of an intervention to reduce childhood obesity.

Not all doctors are convinced that there is anything special about the 5 S's approach.

"What the study shows is that soothing your baby is more effective than giving sugar," says Dr. Ari Brown, Texas-based pediatrician and author of Baby 411. "I don't think it makes the case that Dr. Karp's method itself is superior to other simple maneuvers that parents can be taught that have been commonly used for years and part of the '5 S's'."

Brown adds that there are other methods which, if studied rigorously, might also show a benefit.

Still, the new study could lend additional weight to the 5 S's system -- particularly for parents and other caregivers who regularly deal with crying infants.

Littlebear, for one, says she will give it a shot.

"I would have done that if I had known that technique," she says. "That actually sounds awesome. I am going to share that with a few new mommy friends."

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