Stress at three-month immunization: parents' and infants' salivary cortisol response in relation to the use of pacifier and oral glucose

Eur J Pain. 2009 Feb;13(2):202-8. doi: 10.1016/j.ejpain.2008.03.016. Epub 2008 May 16.


The aims of the present study were to investigate (1) whether the salivary cortisol response could be dampened during a routine three-month immunization if the infant received sweet-tasting solution in combination with a pacifier and (2) stress experienced by parents during immunization of the infant. Ninety-eight infants were included into one of four intervention groups: 'glucose and pacifier', 'water and pacifier', 'glucose', or 'water'. Saliva was collected before and 30 min after the immunization. Infants' crying-time and parents' self-reported stress (VAS) were measured before and after immunization. Infants in the 'pacifier and glucose' group had a significantly smaller change in salivary cortisol than infants in the other groups (F(3,72)=3.1, p<0.05). In the 'glucose and pacifier' group the median salivary cortisol levels decreased 33% after the immunization. In the 'water and pacifier', 'glucose', and 'water' group median cortisol increased with 50%, 42%, and 8%, respectively. No significant differences in crying-time were observed between the intervention groups. If the infant cried before the immunization, the crying-time during the immunization was longer (p<0.01) and cortisol increased more (p<0.05). Median cortisol levels for parents decreased after the immunization (p<0.01). Median VAS increased 50% (p<0.0001) after immunization. First time parents rated higher stress on VAS before immunization (p<0.01). Parents' change in cortisol and VAS were significantly related to infants' crying time. In conclusion, the combination of oral glucose and pacifier dampen infants' salivary cortisol in response to the three-month immunization.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Crying
  • Data Interpretation, Statistical
  • Female
  • Glucose / pharmacology*
  • Humans
  • Hydrocortisone / metabolism*
  • Immunization / adverse effects*
  • Immunization / psychology*
  • Infant
  • Linear Models
  • Logistic Models
  • Male
  • Odds Ratio
  • Pain Measurement
  • Parents / psychology*
  • Saliva / metabolism
  • Stress, Psychological / metabolism*
  • Stress, Psychological / psychology*


  • Glucose
  • Hydrocortisone