Effects of a skin refrigerant/anesthetic and age on the pain responses of infants receiving immunizations

Res Nurs Health. 1991 Dec;14(6):397-403. doi: 10.1002/nur.4770140603.


Although pain management is an important nursing responsibility, few interventions for minimizing distress of infants during painful procedures have been studied. Sixty infants, 2 through 6 months of age, were studied during a routine DPT immunization in order to examine (a) the effectiveness of cooling the skin in reducing distress behaviors and (b) the relationship between age and distress behavior. Infants were randomly assigned to experimental or control groups. Prior to the injection, the sites were sprayed for 2 to 3 s with either a skin refrigerant/anesthetic or compressed air. Behaviors were video- and audio-taped during and 60 s post injection, and coded for (a) facial expression, (b) cry, and (c) body movements. MANOVA revealed fewer distress behaviors following refrigerant spray and more complex, varied behavioral responses for older infants. The findings provide further evidence that infants perceive pain and that nursing interventions for pain reduction should be tested and extended to the very young.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Administration, Topical
  • Chlorofluorocarbons, Ethane
  • Chlorofluorocarbons, Methane / standards*
  • Cryotherapy*
  • Female
  • Humans
  • Infant
  • Infant, Newborn / physiology*
  • Male
  • Pain / diagnosis
  • Pain / drug therapy*
  • Pain / physiopathology
  • Pain Measurement
  • Videotape Recording


  • Chlorofluorocarbons, Ethane
  • Chlorofluorocarbons, Methane
  • Freon 114