Sugar Water for Immunization Pain Management: Too Much Sweet Stuff?

By Gerges, Sandra; Hogan, Mary-Ellen et al. | Canadian Journal of Public Health, January/February 2011 | Go to article overview

Sugar Water for Immunization Pain Management: Too Much Sweet Stuff?


Gerges, Sandra, Hogan, Mary-Ellen, Girgis, Angela, Dubey, Vinita, Taddio, Anna, Canadian Journal of Public Health


Dear Editor:

Sugar water (also referred to as sucrose solution) is being increasingly used by hospitals across Canada to manage pain in infants undergoing medical procedures involving needle pokes.1 Recently, Toronto Public Health (TPH), in collaboration with The Hospital for Sick Children and the University of Toronto, produced a fact sheet for parents that includes sugar water as a strategy to reduce infant immunization injection pain in infants who are not breastfeeding. The fact sheet is titled: "How to reduce children's pain from immunization", and can be found at: http://www.toronto.ca/ health/immunization_children/howtoreducepain.htm.

The inclusion of sugar water was based on extensive research evidence demonstrating analgesic benefit for immunization injections in infants up to 1 year of age2 and the recommendation to use sugar water in an evidence-based clinical practice guideline about managing childhood vaccine injection pain.3 The exact mechanism of action of sugar water is unknown, but is postulated to involve aspects of distraction as well as endogenous opioid release through sweet taste receptors in the mouth.2

Concerns have been expressed about this recommendation with respect to the amount of sugar that infants may receive if sugar water is used to manage pain from all immunization injections performed in the first year of life. In order to address this concern, we compared the amount of sugar that infants would receive if sugar water were used to manage vaccine injection pain with the amount of sugar that infants would receive if given common medications, such as antibiotics or oral analgesics, which frequently contain sugar as an excipient (flavouring agent). We obtained information about the quantity of sugar in commercial products from our national prescribing reference, CPhA's* online Compendium of Pharmaceuticals and Specialties (CPS),4 and if not included in the CPS, from manufacturer representatives working in medical information departments.

For this comparison, we assumed that infants undergoing immunization injections would be given a single dose of 2 ml of 24% sugar water solution (wt/vol) orally to manage pain - which is equivalent to 0.48 grams of sucrose.2We found that the single dose of sugar ingested as a by-product of using common medications was similar to or higher than the dose ingested when used for analgesia. In fact, some medications exposed infants to more than 5 times the amount of sugar they would receive for pain management (see Table 1 for example). …

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Sugar Water for Immunization Pain Management: Too Much Sweet Stuff?
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