"Hush, little baby, don't you cry."
Calming techniques for colicky babies, as popularized by Dr. Harvey Karp, pediatrician to the stars, have now been shown to reduce pain measurably in infants receiving routine vaccinations at 2 months and 4 months.
In a 2010 study published Monday in Pediatrics, lead author Dr. John Harrington of Children's Hospital of the King's Daughters and Eastern Virginia Medical School, found that use of Karp's 5S techniques was as effective as the commonly used analgesic sucrose. For the study, he had medical residents watch YouTube videos of the 5S techniques and train in performing them in less than 15 seconds:
• Swaddling — the infant is swaddled in a receiving blanket using a triangular fold to hold the arms and legs secure, but not rigid;
• Side-lying — the caretaker then holds the infant on its side in their arms;
• Shake — this employs a gentle motion in which the head is jiggled back and forth, "a sort of hey, hey, you, you," says Harrington;
• Shushing — the caretaker simultaneously "shushes" into the baby's ear;
• Sucking — the caretaker places a pacifier in the infant's mouth — this often proves unnecessary as most babies have already calmed by this point.
The results of the study of 230 children over a six-month period found that the "physical non-pharmacological intervention provides significant pain reduction." It's the first quantifiable medical test of Karp's techniques.
Two separate triggers prompted Harrington to undertake the study. The pediatrician learned of a study in Lancet in 2009 that showed that Tylenol caused a blunting of the immune response after vaccines in infants — "we were administering it and then telling parents to give more at home if necessary," he says; and he attended a lecture by Karp promoting 5S. "He used it for colic. I thought maybe I could use it for immunization," says Harrington, whose Norfolk practice sees thousands of primarily low-income African-American children annually.
The study showed that using the 5S physical interventions were the most effective both in reducing the length of time a baby cried after a vaccination and also in the pain they experienced as measured on a modified Riley pain scale.
Infants receiving sucrose in combination with 5S scored the same, showing no synergistic effect; typically, they calmed within 45 seconds. However, there was a significant difference between the two physical intervention groups and those receiving sucrose only; they, in turn, scored better than the control group.
"This is a nice procedure to do immediately following immunization," says Harrington, who is hesitant to use sucrose with stressed babies in light of increasing problems with obesity. "Instead of saying to a parent 'here's something you can give to a child, we're giving them something they can do.' It's very empowering."
Harrington acknowledges that 2-month-olds outnumbered 4-month-olds in the study and that the 5S techniques are easier to implement with the younger, smaller infants. Another very effective way of reducing infants' pain during vaccinations, he says, is to have a mother breastfeed during the procedure. "It's a nice alternative."
Dr. Harvey Karp to visit
Harvey Karp, MD, author of "The Happiest Baby on the Block" will visit the Baby Expo sponsored by Children's Hospital of the King's Daughters, Kohl's Cares and Tidewater Parent Magazine on Sunday, May 20. The free event takes place from noon to 3 p.m. at the Marriott Chesapeake, 725 Woodlake Drive, Chesapeake.
To watch a video of the 5S calming technique, go to http://www.youtube.com and search for 'Harvey Karp 5S.'