| Breastfeeding compared with other interventions, oral water, or no treatment for pain during vaccination in infants 1 to 12 months |
| Patient or population: Infants 1 to 12 months during vaccination Settings: Diverse community settings Intervention: Breastfeeding Comparison: Other interventions, such as cuddling, sweet solutions, or placebo (oral water) or no treatment |
| Cry duration Seconds cry time during procedure or proportion of crying during procedure. Crying was measured during and up to 3 minutes following completion of vaccination. | 547 (6 studies) | MD (seconds) ‐38 ( ‐49.84 to 26.35) | Moderate | Not further downgraded: Breastfeeding consistently resulted in a reduction of crying time. However, as most trials included infants aged 1 to 6 months, further research including older infants up to 12 months of age may have an important impact on our confidence in the estimate of effect and may change the estimate. |
| All pain scores during injection Due to range of pain scores used, data analysed using SMDs. Pain scores were measured during and up to 3 minutes following completion of vaccination. | 310 (5 studies) | SMD ‐1.7 ( ‐2.2 to ‐1.3) | Moderate | Downgraded once: Breastfeeding consistently resulted in a reduction of pain scores. However, only 5 studies and 310 infants were included, and most of the trials included the younger infants aged 1 to 6 months. Further research including older infants up to 12 months of age and larger sample sizes may have an important impact on our confidence in the estimate of effect. |
| NIPS score during injection The NIPS was measured during and up to 3 minutes following completion of vaccination. | 174 (3 studies) | MD ‐1.89 (‐2.55 to ‐1.24) | Low | Not further downgraded: Grade of evidence already taken into account. Only 3 studies and 174 infants were included. Further studies using this pain assessment score may lead to more certainty and have an important impact on our confidence in the estimate of effect. |
| Heart rate after injection Heart rate in the period following completion of the injections was measured in 2 studies. | 186 (2 studies) | MD (beats per minute) ‐3.6 ( ‐23 to 16) | Low | Not further downgraded: Grade of evidence already taken into account. Breastfeeding did not have an effect on heart rate change from baseline. As only 2 studies were included in this outcome, further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. |
| Adverse events | No studies reported on adverse events. | ‐ | Very low | No studies reported on outcomes such as coughing or gagging. |
| CI: confidence interval; MD: mean difference; NIPS: Neonatal Infant Pain Scale; SMD: standardised mean difference |
| GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate. |
