o says.
But it doesn't have to be this way.
Taddio's work has shown a number of relatively simple measures that can be taken to reduce the pain and fear associated with vaccinations. They include: injecting the most painful vaccine last during a series of injections; ensuring older children and adults are sitting upright; breastfeeding infants before or after the injection; and using topical anesthetics.
Taking steps to acknowledge children's pain and distracting them during injections can also be effective.
“Many people are afraid of needles and so avoid getting vaccinated, which is such an important preventative intervention,” says Professor Heather Boon, the dean of the Leslie Dan Faculty of Pharmacy.
“Dr. Taddio’s work helps us understand why that fear develops so we can take simple steps to prevent it.”
Taddio began looking at childhood and infant pain back in the 1990s and was immediately struck at how little research existed on the subject. “People laughed at me,” she recalls. “They thought it was much ado about nothing.”
When it came to infants, she recounts the prevailing thinking at the time as follows: It’s too difficult to assess pain in babies because they’re incapable of communicating; even if their nervous systems are developed enough to feel pain, they’re too small to be administered drugs without side-effects; and, regardless of how much pain they feel, it doesn’t really matter because there are no long-term consequences.
Needless to say, Taddio found such justifications wanting, particularly when it came to “invasive” procedures like circumcision.
“If you were doing something like that in an adult, there’s just no way you would just strap someone down and proceed,” she says. “So I would watch these procedures and these babies were just crying – they had so much pain they would actually stop breathing.
“I thought, ‘This is ridiculous.'’’
So Taddio, who did her PhD in pain management at U of T, began researching ways to reduce the suffering of babies undergoing circumcision and the safety of associated drugs. Then something unexpected happened while she was working on a study that looked at topical anesthetics and children receiving vaccines. She found, to her surprise, boys often had a higher pain score than girls, which, initially, made little sense.
“We later had this a-ha moment which was: Their experience with pain is different because boys are more likely to have been circumcised than girls,” she says.
The finding was bolstered by looking at the differences in pain scores between circumcised and uncircumcised boys in the same study, and another longer-term study that tracked boys who had been given an anesthetic during circumcision and those who hadn’t.
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Taddio continued her research in a similar vein until 2007, when she decided to do a survey on vaccinations in Greater Toronto to see how her work and that of fellow pain researchers had influenced clinical practice.
That’s when Taddio decided to add translational research to her fundamental research. She assembled an interdisciplinary team of clinicians, scientists and policy-makers from across Canada to promote better pain care during vaccine injections. They called the initiative Help ELiminate Pain in Kids, or HELPinKids for short. “I thought it would be a good gateway to talking about pain,” she says.
The HELPinKids team published its first clinical practice guideline on reducing vaccine injection pain in 2010 in the Canadian Medical Association Journal. In 2015, they published an updated and expanded guideline in the same journal. Taddio was also invited to Geneva the same year to present at the WHO, which later adopted about half of the recommendations (some, like the use of topical anesthetics, aren’t applicable in developing countries because of the high costs).
Taddio stresses that her research, and the global vaccine guidelines that ultimately sprung from it, were heavily reliant on public funding. “I primarily depended on CIHR beca