Children's responses to sequential versus simultaneous immunization injections

J Pediatr Health Care. 1999 Jan-Feb;13(1):18-23. doi: 10.1016/s0891-5245(99)90096-2.


Introduction: The purpose of this study was to compare distress behaviors and perceptions of distress in 4- to 6-year-old children who received two immunization injections simultaneously with those in children who received their immunizations sequentially.

Method: This experimental study used a convenience sample of 46 children scheduled for pre-kindergarten examinations. The children were randomly assigned to either a sequential injection or a simultaneous injection group. Direct observation and videotapes were made of the children's behaviors before and after injection. Distress behaviors were analyzed with the Observation Scale of Behavioral Distress-Revised, and perceptions of distress were obtained from both children (with the Wong-Baker Pain Rating Scale [FACES]) and parents (with the Visual Analog Scale).

Results: Results of the Observation Scale of Behavioral Distress-Revised showed no significant differences in children's distress behaviors between the two groups either before or after injection. The children's self-reports of distress also showed no group differences. Parents' perceptions of the children's distress before and after injection were lower for the sequential group but were judged to be unrelated to the intervention. Given the opportunity to state a preference, however, parents preferred the simultaneous method.

Discussion: The simultaneous procedure was not found to be associated with reduced distress behaviors; however, parents preferred the simultaneous method.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Attitude to Health*
  • Child
  • Child, Preschool
  • Fear
  • Humans
  • Immunization / adverse effects
  • Immunization / methods*
  • Immunization / psychology*
  • Pain / etiology
  • Pain / psychology
  • Pain Measurement
  • Parents / psychology
  • Psychology, Child*
  • Stress, Psychological / etiology
  • Stress, Psychological / psychology*
  • Videotape Recording