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EFFECTIVENESS OF ORAL SUCROSE SOLUTION ON

PAIN PERCEPTION AMONG INFANTS RECEIVING
IMMUNIZATION INJECTION IN ASHWIN
HOSPITAL AT COIMBATORE.
By
Reg. No: 301616102
A DISSERTATION
DISSERTAT SUBMITTED TO THE TAMILNADU
Dr. M.G.R. MEDICAL UNIVERSITY, CHENNAI IN
PARTIAL FULFILLMENT
MENT OF REQUIREMENT
FOR THE DEGREE OF MASTER OF
SCIENCE IN NURSING
OCTOBER 2018
By
Reg. No: 301616102
Approved by
___________ __________
EXTERNAL INTERNAL
A DISSERTATION
DISSERTAT SUBMITTED TO THE TAMILNADU
PARTIAL FULFILLMENT
MENT OF REQUIREMENT
SCIENCE IN NURSING
OCTOBER 2018
CERTIFIED THAT THIS IS THE BONAFIED WORK OF
Reg. No: 301616102

P.P.G COLLEGE OF NURSING,
COIMBATORE
SIGNATURE: COLLEGE SEAL
Dr.P.MUTHULAKSHMI.M.SC (N)., M.Phil., Ph.D.,

Principal,
P.P.G College of nursing,
Coimbatore.
A DISSERTATION SUBMITTED TO THE TAMILNADU

PARTIAL FULFILLMENT OF REQUIREMENT
SCIENCE IN NURSING
OCTOBER 2018
APPROVED BY THE DISSERTATION COMMITTEE ON OCT 2017
RESEARCH GUIDE: ____________________________

Dr.P.MUTHULAKSHMI.M.SC (N).,M.Phil., Ph.D.,
Principal,
P.P.G College of nursing,
Coimbatore -35.
SUBJECT GUIDE : ________________________________

Dr. K. JEYABARATHI, M.Sc(N)., Ph.D.,
HOD, Child Health Nursing.
PPG College of Nursing,
Coimbatore - 35.
MEDICAL GUIDE : __________________________________

Dr. ASHOK KUMAR, M.D.,
Consultant Pediatrician,
Ashwin Hospital,
Coimbatore - 12
A DISSERTATION SUBMITTED TO THE TAMILNADU

PARTIAL FULFILLMENT OF REQUIREMENT
SCIENCE IN NURSING
OCTOBER 2018
ACKNOWLEDGEMENT
Whole heartedly convey the gratitude to Lord Almighty for his abiding grace,
love, compassionate and immense showers and blessings on me, which gave me the
strength and courage to overcome all the difficulties and whose salutary benison
enabled me to achieve this target.
I am highly obliged to my beloved father Mr. K.P. Mohanan, my mother

Mrs. Kunjumol mohanan and dear friends for their constant support, love, prayer,
motivation and evergreen memorable help and care throughout my life.
I express my deep sense of gratitude to Dr. L. P. Thangavelu, MS., F.R.C.S.,

Chairman and Mrs. Shanthi Thangavelu, M.A., Correspondant, PPG group of
institutions and our trustees for encouragement and providing the sources of the success
of the study.
It is my long felt desire to express my profound gratitude and exclusive thanks

to Dr. P. Muthulakshmi, MSc(N)., MPhil., Ph.D., Principal and our research guide
with professional competence. It is obvious that without her esteemed suggestion,
highly scholarly touch and perching insight at every stage of the study, this work could
not have been presented in the manner it has been made. I also express my gratitude for
her valuable guidance and help in the statistical analysis of data which is the core of the
study.
The present study has been completed under the expert guidance and support of
Dr. K. Jeyabarathi, MSc(N)., Ph.D., HOD, Child Health Nursing. If not the present
study would have missed much of its presence and substance. Her keen support,
guidance, encouragement, sustained patience, valuable suggestions and constrictive
evaluation have enabled me to shape up this research as a worthy contribution to the
field.
My sincere thanks to Prof. L. Kalaivani., MSc(N)., MPhil., Prof. Andria.
MSc(N)., Prof. Uma Maheswari. MSc(N)., and other faculty members of other
departments in PPG college of nursing for their valuable suggestion in research.
My work will not have attained perfection without the constant persuasion and
guidance rendered by Mrs. Blessy Pramila, Msc (N)., Mrs. Jenifer, Msc (N).,
Lectures, Department of Child Health Nursing in my every minute move.
I express my sincere thanks to Dr. T. Ashwin., M.S, Laproscopic Surgeon,

Ashwin hospital, Coimbatore for granting permission to conduct the study in their
hospital and staffs for their cooperation and help for completing my work successfully.
I profusely thank Dr. Ashok Kumar., M.D , Consultant Pediatrician, Ashwin

Hospital, Coimbatore for his support and valuable suggestions in completing this study.
I am indebted to Prof. Venugopal for his scientific advice and help in research
and bio statistics without which the course of work would have been meaningless.
I take this opportunity to thank the Experts who have done the content validity
and valuable suggestions in modification of tool.
I express my thanks to the Dissertation Committee Members for their healthy
criticism, supportive suggestions which moulded the research.
I express my special thanks to my dearest sister Ms. Binu Thomas and my

dearest friends Mr. Mansoor, Mr. Akhil, Ms. Princy Eldo, Ms. Roshni Marium
Mathew , Ms. Josmy, and Ms. Joo for the constant encouragement and support.
I extend thanks to Librarian and Assistant Librarian PPG institute of health

science for leading their help for my literature review.
I express my heartiest thanks to the Mothers of the samples who have

supported and co-operated with me throughout the study.
Last but not the least, my sincere thanks to my Colleagues for their kind
cooperation and effort in making my study great success.
No research dissertation can be completed without the unrelenting support of all

those good hearted people who have help me tirelessly to make the thesis work a
possible one.
Above all I owe my success to GOD.

LIST OF CONTENTS
CHAPTER CONTENT PAGE NO
I INTRODUCTION 1
Need for study 4
Statement of the problem 9
Objectives of the study 9
Hypothesis 9
Operational definitions 10
Assumption 10
II REVIEW OF LITERATURE 11
Conceptual framework 21
III METHODOLOGY 24
Research approach 24
Research design 24
Setting of study 25
Variables 25
Population 26
Sample size 26
Sampling techniques 26
Criteria for selection of samples 26
Description of the tools 27
Testing of the Tool 27
Pilot Study 28
Data collection of Procedure 28
Plan for data analysis 29
IV DATA ANALYSIS AND INTERPRETATION 31
V RESULTS AND DISCUSSION 58
VI SUMMARY,CONCLUSION, LIMITATIONS AND 61
RECOMMENDATION
REFERENCES
ABSTRACT
APPENDICES
LIST OF TABLES
S.NO CONTENT PAGE NO
1. Distribution of Demographic variables in experimental and 32

control Group.
2. Data on assessment of level of pain perception of infants during 46

Injection among experimental and control group.
3. Data on the effectiveness of sucrose solution among experimental 48

and control group.
4. Data on the association between the level of post test pain 50

perception with selected demographic variables among
experimental group.
Data on the association between the level of post test pain

5. 54
perception with selected demographic variables among control
group.
.
LIST OF FIGURES
S.NO CONTENTS PAGE.NO
1. Conceptual Frame Work Based on Modified 23

Weidenbach’s Theory (1969).
2. The Schematic Representation of the Research Design. 25
3. The Schematic Representation of Variables. 25
4. The Overall View of Research Methodology 30
5. Distribution of Demographic variables according to 38

Age of infants.

Gender Of infants.

weight of infants.
8. Distribution of Demographic variables according to the 41
birth order of the infants.
9. Distribution of Demographic variables according to the 42

number Of children.
10. Distribution of infants according to the Types of 43

Vaccines.
11. 44
Distribution of infants according to the route of
immunization.
45
Distribution of infants according to the Religion.
12.
Distribution of statistical value of post test score for 47
13. experimental and control group regarding level of pain
during vaccination among infants.
Comparison of pain level in experimental and control 49

14. group according to modified NIPS
LIST OF APPENDICES
APPENDIX TITLE
1. Abstract
2. Letter seeking permission for conducting the study
3. Letter seeking permission from experts for content validity of

the tool
4. Format for the content validity
5. List of experts for content validity
6. Questionnaire
English
CHAPTER – I
INTRODUCTION
“ To live is to suffer , to survive is to find some meaning in the suffering.”
- Friedrich Nietzsche ,1875.
Infancy is a period of rapid growth and development. At no other time in life
are physical changes and developmental achievements so dramatic as during infancy. In
the early months baby’s sense sharpens and, with the process of attachment to primary
care givers, they form their first social relationships. Because of these rapid changes
first year of life becomes a very crucial one. (Marilyn J et al. 2009).
An infant is a word derived from a Latin word ‘in fans’ which means unable to
speak or speechless very young offspring of a human.
Children are our future leaders of India. They are the treasure to the nation. The
health of the children is of vital importance to any nation and it is impossible to achieve
human development without addressing the basic issues of their health. Children,
especially infants are the high risk population for deadly diseases that they highly
infectious. But the development and administration of immunization is the greatest
achievement of the 20th century and immunization agents have an enormous positive
impact on disease prevention and reduction of human suffering. To provide this
protection, there are about 14 injections recommended by the current centre for disease
control and prevention, before the age of 2yrs. (Marilyn J, 2009).
The government of India has introduced a new vaccine in the national
immunization programme. Pentavalent vaccine provides protection to a child from 5-
1
life threatening diseases like Diphtheria, Pertussis, Tetanus, Hepatitis B, and HIB
(Haemophilus influenza type b).DPT (Diphtheria+ Pertussis + Tetanus) and Hep B are
already part of routine immunization in India.
Immunization is one of the most important preventive measures in children’s
lives, as it provides protection against the most dangerous childhood diseases. First
priority of giving immunization vaccines to boys and girls, because if they have not
been vaccinated they are at major risk of contracting diseases such as measles,
whooping cough and others, which may be fatal in some cases and may lead to long-
term debilitating effects on survivors. (David Wilson, 2009).
Immunizations are the important part of health promotion and disease
prevention strategy for all children. Despite of recent advances in the assessment and
management of acute pediatric pain, outlined in the clinical practice guidelines in
agency for Health Care Policy and Research (AHCPR), children continue to be
subjected to pain and distress during immunization. Reports from children, parents and
nurses consistently indicate that many children do fear the “shot”. This finding is also
supported by research indicating that a minority of the adult population also suffer from
fear involving needles. ( Jatana.S, 2003).
Preterm and critically ill newborns admitted to a NICU undergo repeated skin-
breaking procedures that are necessary for their survival. Pain medicine is usually given
for major painful events (such as surgery) but may not be given for more minor events
(such as taking blood or needles). (Anand.KJS , 2011).
2
Pain is a bitter experience to all individual. Every individual experiencing pain
needs care and warmth. Infants are more sensitive to pain than older children and adults
because of their still in the process of development both physically and mentally. This
is the reason that most of the children seek medical care (David Wilson, 2009).
Acute pain is one of the most common side effects experienced by infants
occurring as a result of injury or illness and they need necessary medical procedures.
The pediatric pain experience involves the interaction of physiologic, psychologic,
behavioral and situational factors (Anamarai, 2002).
An infant’s anxiety and fear for the procedure and actual pain experience during
the procedure are often manifested by the infant’s distress behavior such as crying,
flailing and refusal to cooperate. The infant’s distress is upsetting not only for the infant
but also for the adult involved, both parents and professionals, and it often makes
difficult to complete the needed procedure. In addition to undue pain distress, lack of
pain control for injection is barrier to immunization. ( Larisa, 2010)
Nurse’s work is always associated with people who suffer from the pain. They
spend a lot of time with infant’s who are dealing with pain in a daily task for nurse.
They are not only agents, who carry out doctor’s order, but also who implement the
orders and who work closely with patients to facilitate healing processes
(Achar, 2005).
Pain is common among children. Pain is the most important single cause leading
to temper tantrums and behavioral changes in children. Recent progress in the
3
management of children’s pain in the result of the development and validation of
effective measurement tools. Pain is a subjective experience and self report often is
considered the good standard in the pain measurement. (David Wilson, 2009).
Park K (2014) coded that one of the most dramatic advances in pediatrics has
been the decline of infectious diseases during the twentieth century because of the wide
spread use of immunization for preventable diseases. Immunization is the right of every
child. Immunizations are the safest and most effective way to prevent serious illness
and death. In fact, immunization prevents approximately 2.5 million deaths every year.
Mc. Caffery .M and Pasora C (2000) stated that nowadays more concern is
given to the painful medical procedures that infants must undergo the potential risk of
alleviating infant pain with conventional pharmacologic agents. Studies have shown
that sucrose with or without non-nutritive sucking (NNS) have analgesic effect on
procedural pain in infants.
Treatment of infants will improve the pain management education. It improves
and the issue of pediatric pain is brought into greater public awareness. Education of
parents and others in the community who deal with children in pain is an important
pediatric issue (Luca A Rameghi, 2002).
The concept of pain is a challenge to understand the diverse effect of pain
perception and to provide relief for all types of pain. The external and internal factors
that cause pain and the physiological mechanism that convey pain message must be
understood for the normal circumstances in which healthy infants perceive pain.
4
Accurate knowledge about pain perception in infants and interventions that modify pain
provides a framework for designing methods to relieve pain (Patricia A
,Mc.Garth,1990).
Sucrose solution has demonstrated efficacy in pain relief during puncture
procedures on samples of preterm and full term neonates. The recommendation is to
administer oral sucrose, to the front of the tongue, 2 minutes before the painful
procedure. Other non-pharmacological interventions, such as human breast milk via
Naso-gastric tube, non-nutritional suckling and being held at the breast, also
demonstrated some analgesic effects when administered in association with sucrose.
The majority of studies demonstrated a positive pain relief effect with a single 2 ml
dose of 25% sucrose ( McKechnie, 2008).
Despite these advances, the challenge remains to achieve universal vaccination
coverage for at least 95% of children. The PAI has a technical advice committee made
up of high level Dominican professionals and an inter-agency committee comprising
JICA, USAID, PAHO/WHO, UNICEF, Project Hope, Plan International, the World
Bank and other international development agencies.
Sucrose is one of the simplest, safe, and effective techniques for pain reduction.
Clinicians often attribute greater importance to non-pharmacological interventions than
medical interventions.
NEED FOR THE STUDY
Pain management is the major aspect o nursing care. As a caregiver for children,
5
nurses are need to minimize the emotional and physical effects of painful procedures.
The main responsibility of pediatric nurse is to ease pain and to provide comfort to
children. Nurses are in a unique position to improve the management of pain because
children and parents often express their feelings to nurses than to physicians.
Pain due to painful procedures places an enormous burden on children. Inadequate pain
management could lead to an increase in child’s discomfort, stress and decreased coping
abilities.
Parents and health care professionals have a joint responsibility for immunizing
the children. The pain associated with immunization is a source of anxiety and distress
for the children receiving the immunization, their parents, and the providers who must
administer them.
In India, 77.2% of rural and 80% of urban children receive vaccines annually.
However the infants vaccinated will experience severe to moderate pain. Pain is a
global health problem which exists from the birth to the last stage of the life. It is a very
unpleasant sensation that cannot be shared with others. Pain is defined as “an
unpleasant sensory and emotional experience arising from actual or potential tissue
damage or described in terms of such damage.”
Taylor R.C, and Lillis .C (2010) stated some bills of rights for people with pain
that is (1) The Right to have my reports of pain accepted and acted by health care
professionals. (2) The Right to be treated with respect at all the times.
6
Potana .N et al. (2015) stated that inadequately managed pain have multiple
adverse effects. Pharmacological agents, due to their side effects are usually reserved
for severe pain. These factors possibly prevent health care providers from addressing
procedural pain.
A study conducted for the epidemiology of procedural pain in Neonates in the
Paris region of France assessed all painful and stressful procedures and the
corresponding analgesic therapy from the first 14 days of admission within a 6 week
period from 430 neonates admitted to tertiary care wards. Results showed that neonates
experienced 60,969 first attempt procedures, 42,413 (69.6%) painful and 18,556
(30.4%) stressful procedures. Of the 42,413 painful procedures, 2.1% were performed
with pharmacological only therapy; 18.2% with non-pharmacological or both 79.2%
without specific analgesia.
The majority of the health care professionals recognize that there is a lack of
intervention to decrease the unpleasantness of procedural pain. Unnecessary pain can
also erode the therapeutic relationship with the child. The knowledge of alternative
techniques in pain management can improve infant care and satisfaction.
Vetriselvi (2007) said psychological safety is one of the person needs. Pain due
to painful procedures places an enormous burden on children. Evidences clearly
indicates that untreated procedural pain produces emotional and behavioral
consequences, including altered pain sensitivity and permanent neuro-anatomic
anomalies.
7
Deodari.A (2013) coded that children are known to have adverse short and long
term effects of prolonged or repeated unmanaged pain which increases the response
elicited by future painful stimuli and even by usually non painful stimuli. The
consequences also include altered pain sensitivity and permanent neuro-anatomical,
behavioral, emotional and learning disabilities.
According to research study funded by the Canadian Institute of Health
Research “more than three quarters of the children in the study which is 78.2% had at
least one painful procedure day, with an average of 6.3 procedures per child per day.
It is important to analyze the painful experience while the child is hospitalized
or receiving medical treatment. Hence the painful experience may cause physical and
physiological changes in infants. Most acute pain experience in medical setting can be
prevented or substantially relieved. Prevention of pain whenever possible is the best
thing on pain management in infants. (American Academy of Pediatrics and
American Pain Society-1979).
Harrison .D et al. (2010) conducted a study to assess the use of oral sucrose
which has been the most extensively studied pain intervention in infants care to date.
The aim of his article is to review what is known about the mechanisms of sucrose
caused analgesia, highlight existing evidence and knowledge gaps, current controversies
and provide directions for future research and practice. More than 150 published studies
relating to sweet taste induced calming and analgesia in human infants have been
identified. Sucrose has been widely recommended for routine use during painful
procedures in newborn and young infants.
8
The investigator during her clinical experience has found the distress and
discomfort shown by the babies during immunization. While the researcher was
searching for the best method for pain reduction during immunization the investigator
found that oral sucrose administration was one of the method that reduce pain
perception in infants during immunization. This motivated the investigator to take up
this study. The purpose of the study was to assess the effectiveness of oral sucrose
solution on level of pain during immunization among infants.
STATEMENT OF THE PROBLEM
Effectiveness of oral sucrose solution on pain perception among infants
receiving immunization injection in Ashwin hospital at Coimbatore.
OBJECTIVES
To assess the level of pain perception among infants receiving immunization after
administering the oral sucrose solution.
To assess the effectiveness of oral sucrose solution on pain perception among
experimental group and control group infants.
To find out the association between post test level of pain perception with selected
demographic variables among experimental group infants.
To find out the association between post test level of pain perception with selected
demographic variables among control group infants.
HYPOTHESIS
H: There will be a significant difference in pain perception after oral sucrose
administration among infants receiving immunization in experimental group.
9
OPERATIONAL DEFINITIONS
Effectiveness
It refers to the extent to which 24% sucrose become successful in reducing pain during
and after procedure.
Sucrose
Commonly known as table sugar. White, odorless, crystalline powder with a sweet
taste.
24% sucrose
Commercially prepared sterile solution by dissolving 24 gm of sucrose in 100 ml of
water.
Pain perception
It is an unpleasant sensory and emotional experience associated with actual or potential
tissue damage which is measured with NIPS scale.
Infant
Refers life period from 28 days to one year of age.
Immunization
It is administering the vaccine through injection into the tissue.
ASSUMPTIONS
Infants perceiving pain while administering injection.
Having sucrose solution is likely may reduce pain perception among infants.
10
CHAPTER II
REVIEW OF LITERATURE
Review of literature is a broad, comprehensive, systematic, and critical view of
scholarly publications, unpublished scholarly print materials, audio visual materials and
personnel communications. The process of reviewing research literature includes
identification, selection and critical assessment and written description of existing
information on topic (POLIT, 2003).
Literature review begins with collecting as many relevant materials as possible
and ends with writing a summary of available knowledge (JUDITH,1980).
A literature review is an evaluative report of information found in the literature
related to selected area of study. An extensive review of literature was done to gain
insight into the selected problem to have a logical sequence and easy understanding.
The Related Review of Literature has been organized Under the Following
Headings;
Literature related to sucrose
Literature related to Non-Pharmacological intervention for pain relief in infants
Literature related to sucrose solution to reduce pain in infants
Literature related to sucrose
Karlharrison (1996) explained that Sucrose, ordinary table sugar, is probably
the single most pure organic chemical in the world. A white, odorless, crystalline
powder with a sweet taste. Sucrose is a disaccharide that yields one equivalent of
glucose and one equivalent of fructose on acidic hydrolysis.
11
Blass (1999) stated that the greatest analgesic effect occurs when sucrose is
administered approximately 2 minutes before the painful stimulus. These intervals
thought to coincide with release of endogenous opioids reported increased analgesia
when sucrose solution was repeatedly administered in small aliquots that is 0.05 ml of
24% sucrose at 2 minutes intervals.
Budavari.S (2004) pointed that sucrose is a non-reducing disaccharide
composed of glucose and fructose linked via their anomeric carbons. It is obtained
commercially from sugarcane, sugar beet, and other plants and used extensively as a
food and a sweetener. Sucrose is also receive from sorghum.
Elena timofeeva and Arojit mitra (2014) conducted a study on The effect of
sucrose on Neuronal activity and stated that Once consumed, sucrose sends signals to
the brain via specialized taste receptors and gluco-sensing mechanisms. Sucrose intake
boosts brain the primary gustatory pathway and the brain reward system, which
recognizes sweet taste of sucrose as rewarding. The gluco-sensing mechanisms
stimulate or inhibit food intake according to energy needs. The stress-induced neuronal
expression of stress neuro-peptides as well as the release of plasma stress hormones is
blunted by sucrose consumption.
Shreshtha banga et al., ( 2015) mentioned that the use of sucrose for single
painful event is safe. There was no significant difference in the rate of adverse effects
either immediate or long term across the study. The use of repeated doses of sucrose for
procedural pain reduction in preterm neonates is devoid of any significant immediate or
long term adverse effects.
12
Stevens B et al., (2016) conducted a study on sucrose for analgesia in newborn
infants undergoing painful procedures and concluded that Sucrose is effective for
reducing procedural pain from single events such as heel lance, venipuncture and
intramuscular injection in both preterm and term infants. No big side effects or harms
have been documented with this intervention.
Literature related to Non-pharmacological intervention for pain relief in infants.
Fieder (2010) conducted a comparative study was conducted in two Swedish
hospitals among 201 infants with gestational age of 36 weeks or more and a postnatal
age less than 30 days to assess pain reducing effect of orally administered glucose with
that of Eutectic mixture of local anesthetic (EMLA) cream during venipuncture by
using controlled randomized, and double blind trial. Ninety nine infants of control
group were given EMLA on the skin and orally administered placebo, and 102 infants
of experimental group received 30% glucose orally and placebo on the skin. Symptoms
associated with pain at venipuncture were measured with the premature infant pain
profile scale. The result revealed that the premature infant pain profile scores were
significantly lower in the glucose group than in the EMLA group.
Lee TY (2010) conducted a study to compare efficiencies of Non-nutritive
sucking and glucose solution as pain relief intervention for infants undergoing a
venipuncture procedure. A total of 105 babies were selected. When a infant underwent a
venipuncture his or her pain manifestation was videotaped and subsequently measured
using the infant pain scale. Both the non-nutritive sucking and glucose solutions had
significantly lower pain scores than the control group during venipuncture.
13
Yang M H (2011) conducted a prospective study to compare the effectiveness of
three non-pharmacological pain relief strategies on newborn pain, physiological
parameters and cry duration before, during and after hepatitis B (IM) injection. The
three treatment groups are non-nutritive sucking (NNS), 20% oral sucrose or routine
care. NNS and oral sucrose can provide analgesic effects and need to be given before
painful procedures as brief as one-minute IM injection. Sucrose orally administered 2
minute before injection more effectively reduced infants pain during injection than
NNS. Both non-pharmacological methods more effectively relieved newborns pain.
Nicholas Rouben (2013) conducted a quasi experimental study on effects of
sucrose in pain relief during venipuncture in infants .30 infants aging from 6-12 months
were taken who were undergoing venipuncture . 2 ml of 50% w/v sucrose solution was
given just 2 minutes before venipuncture .pain level was assessed using NIPS. A highly
significant reduction of pain during venipuncture in experimental group was seen .
Rebecca R et al., (2015) conducted a study on Non-pharmacological
management of infant and young children procedural pain. Sixty-three studies, with
4905 participants, were analyzed. The most commonly studied acute procedures were
heel sticks (32 studies) and needles (17 studies). The largest SMD for treatment
improvement over control conditions on pain reactivity were; non-nutritive sucking –
related interventions ( neonates: SMD -1.20) and swaddling / facilitated tucking
(preterm: SMD-0.089) for immediate pain regulation, the largest SMD’s were: non-
nutritive sucking –related interventions (preterm:SMD-0.43; neonate: SMD-0.90; older
infants : SMD-1.34) swaddling/ facilitated tucking (preterm : SMD-0.71) rocking/
holding (neonate:SMD-0.75)fifty two out of our 63 trials did not report adverse events.
14
There is evidence that different non-pharmacological interventions can be used with
preterms, neonates, and older infants to significantly manage pain behaviors associated
with acutely painful procedures. The most established evidence was for non-nutritive
sucking, swaddling /facilitated tucking, and rocking/holding.
Saul R (2017) conducted a study on Non-pharmacological treatment of pain in
neonates and infants. And pointed some non-pharmacological approaches like sucrose,
breastfeeding, non-nutritive sucking, facilitated sucking, swaddling and skin to skin
care. Sucrose is unlikely to influence the modulation of pain through Opioid
mechanisms. Breastfeeding should be started 2 minutes before, continued during the
painful procedures. Non-nutritional sucking thought to stimulate Oro-tactile and
mechanoreceptors in the neonates mouth, causing the modulation of pain transmission
by endogenous non-opioid mechanisms. Facilitated sucking thought to have a calming
effect, reducing the energy expenditure and oxygen consumption associated with
painful procedures. Swaddling reducing physiological responses to pain such as
increase heart rate and reduced oxygen saturation. SSC is thought to provide an
analgesic effect by enhancing endogenous opioid activity.
Literature related to sucrose solution to reduce pain in infants
Joung K H, Cho S C (2010) conducted a study to determine the effect of
sucrose on infants during a painful procedure. 103 newborn infants were enrolled in the
study. The control group (n=63) and the experimental group (n=40) receive 2 ml of 24%
sucrose solution. The pain was assessed by measurements of physiological changes
[e.g.: pulse rate, oxygen saturation,] and behavioral changes [e.g.: crying time, and
neonatal infant pain scale (NIPS). There was significant group difference in behavioral
15
changes to pain.
Bueno (2010) conducted a true experimental study to assess the effectiveness of
sucrose solution prior to immunization in reduction of pain among infants in Toronto,
Canada. Infants aged 1-12 months were selected randomly and score was given for the
experimental group infants 2 minutes prior to immunization. The study findings
revealed that 70% of the infants in experimental group had mild pain perception after
administering sucrose and infants in control group had moderate to severe pain.
Kosha (2011) double blind randomized control trial was done in France to
evaluate the effectiveness of sucrose use in the prevention of pain during venipuncture
in neonates. A total of 111 neonates were taken. Five minutes before venipuncture, the
neonates in the study group received 1cc of oral sucrose 12% sucrose while those in the
control group received distilled water. During the procedure the pain level was
evaluated with neonatal infant pain scale. Results showed that neonates who received
the oral solution of sucrose before venipuncture had an average pain score lower than
the placebo controlled group.
Fowler C (2012) a randomized control trial was done to determine the
effectiveness of oral sucrose solution for pain relief in 2 month old infants undergoing
immunization. Data were collected from 120 infants attending clinic in Jordan. 2ml of
sucrose was given orally before the procedure (prior to 2 minute of injection). Pain was
measured with modified behavioral pain scale. Children provided with sucrose solution
had a lower degree of pain than who were not provided with this intervention.
(p<0.001).
16
Sheehy (2012) conducted a randomized controlled trial to determine the
effectiveness of 25% oral glucose for pain relief in 2 months old infants in Jordan. A
total of 120 healthy infants were randomized to receive 2 ml of 25% oral glucose
solution immediately prior to their immunization. Pain was measured using modified
behavioral pain scale (MBPS). Crying was registered. Infants in the intervention group
experienced statistically and clinically significant reduction in behavioral pain
responses (p<0.001), and spent less time crying up to 2 minute after the procedure
( mean difference 38 Vs. 77.9s). Glucose was shown to be significant in pain reduction.
Nicholas Rouben, Rupinder Kaur, K . L.N Rao (2013) conducted a study on
effect of sucrose in pain relief during venipuncture in infants. The study was carried out
in pediatric surgery ward and NICU of advanced pediatric centre, PGIMER ,
Chandigarh over a period of 2 months in this Quasi experimental study, 30 infants
ageing from 6-12 months were taken who were undergoing venipuncture. The infants
were chosen by purposive sampling and assessed for pain levels with routine care
during venipuncture and then same infants were given sucrose when they were
undergoing venipuncture second time. 2 ml of 50% w/v sucrose solution was given just
2 min before venipuncture. Pain level was assessed by using NIPS. A highly significant
reduction of pain during venipuncture in experimental group was seen (p<0.001).
Mc Call, J M Decristofaro C, and Elliott L (2013) conducted a data based
study to provide information regarding the effective use of oral sucrose as an analgesic
for immunization and venipuncture procedures in the older infants. Data’s were
collected from evidenced based literature including original clinical trials, reviews and
clinical practice guidelines. These study concluded that oral sucrose solution in a 24%
17
concentration at dose of 2 ml approximately 2 minute prior to the painful procedure has
been shown effective in reducing pain during immunizations and venipuncture in the
outpatient setting in infants aged 1-12 months old.
Stevens B et al., (2013) conducted a study on effect of sucrose for analgesia in
newborn infants undergoing painful procedures. The conclusion was that sucrose is safe
and effective for reducing procedural pain from single events. Further investigations on
repeated administration of sucrose in neonates and use of sucrose in combination with
other non pharmacological intervention is needed.
Suhrabi Z et al., (2014) conducted a comparative study on the efficacy of
glucose and sucrose on the vaccination pain on 90 neonates who were vaccinated
against hepatitis B. Who were assigned to glucose, sucrose and control groups. Patients
who received sucrose or glucose had lower pain intensity in comparison with others.
Rashmita Sethi, Geetarani Nayak (2015) conducted a study on effect of 24%
oral sucrose in pain reduction during venipuncture in neonates infants. Neonate infants
frequently undergo various painful procedures without analgesia are routinely
experienced pain in the neonatal intensive care units. The issue of pain management
among newborn has been largely neglected and commonly overlooked in most of the
clinical setting can led to long term adverse consequences and deleterious effects.
Administrating sucrose before painful procedure like venipuncture can relief pain in
newborn. The present study was carried out in NICU of IMS and SUM hospital,
Bhubaneswar with the purpose to determine the effect of 24% oral sucrose
administrating on pain reduction during venipuncture. 30 neonates undergoing
18
venipuncture were selected through purposive sampling. The pain level was assessed by
using NIPS with routine care during venipuncture and then same neonates were
administered 24% sucrose solution orally just 2 minute before undergoing venipuncture
second time. A highly significant reduction of pain during venipuncture in experimental
group was observed at (p<0.001, t= 9.38).
Gray .L et al., (2015) conducted a study to examine the analgesic effect of
sucrose combined with radiant warmth compared with the taste of sucrose alone during
a painful procedure in healthy full term newborn infants. A randomized, controlled trial
includes 29 healthy, full term newborn infants. Both groups of infants were given 1.0 ml
of 25% sucrose solution 2 minutes before the vaccination, and I group additionally was
given radiant warmth from an infant warmer before the vaccination. The pain level was
known in comparing differences in cry, grimace, heart rate variability, and it was
concluded that the combination of sucrose and radiant warmth is an effective analgesic
in newborn infants and reduces pain better than sucrose alone.
Stevens B et al., (2016) conducted a study on sucrose for analgesia (pain relief)
in newborn infants undergoing painful procedures. Sucrose is effective for reducing
procedural pain from single events such as heel lance, venipuncture and intramuscular
injections in both preterm and term infants. No serious side effects or harms has been
documented with this intervention.
Yilmaz G, et al. (2014) conducted a randomized control trial on oral sucrose
administration to reduce pain response during immunization in 16-19 months infants.
The purpose of the study to determine the effects of sucrose solution given orally on
19
infant crying times and measure the distress in a 16-19 month age group. A total of 537
healthy, 16-19 month old infants attending for their immunizations with IM diphtheria,
Tetanus, and cellular Pertussis (DTaP) / Haemophilus influenza type b / IPV (along with
OPV), Intramuscular Pneumococcus and Intramuscular Hepatitis A were randomized to
receive 2 ml of 75% sucrose solution, a 25% sucrose solution or sterile water 2 minute
before injection. Infants receiving 75% sucrose solution had significantly reduced total
crying times & children’s hospital Eastern Ontario Pain Scale (CHEOPS) compared
with infants in the control & 25% sucrose solution groups (p<0.001). Sucrose solution
reduces infant distress & is safe and clinically useful even for 16-19 month old infants.
Evelyn Cohen Reis et al. (2003) conducted a study on effective pain reduction
for multiple immunization injections young infants. Infants receiving their 2 nd month
immunization consisting of 4 injections, 116 infants participated. The median first cry
duration was 19.0 second for the intervention group compared with 57.5 seconds for
the control group (p=.002) parents of intervention group reported a stronger preference
for future use of the injection procedure. For intervention Vs control, the median parent
preference visual analog scale was 97.0 Vs 44. Combining sucrose, oral tactile
stimulation and parental holding was associated with significantly reduced crying in
infants receiving multiple immunization injections.
20
CONCEPTUAL FRAMEWORK
A Conceptual framework is a theoretical approach to study the problems that
emphasize the selection, arrangement and classification of its contents.
Conceptual framework is made up of abstract, general ideas and propositions
that specify their relationship. Conceptual framework, conceptual model or conceptual
scheme deals with abstractions that are assembled by the virtue of their relevance to the
common theme. The purpose of conceptual framework is to organize a concept that
represents essential knowledge that might be used by many disciplines (Basavanthappa,
2007).
Nursing theory is very important to the profession of nursing therefore the
theorists give a great importance to nursing. Nursing art is comprised of not only
rational or reactionary actions but also deliberative action- Widenbach’s (1969).
Ernestine Widen Bach was a nursing leader, known for her Theory development and
maternal infant nursing.
The present study is aimed to assess the effectiveness of oral sucrose solution
among infants receiving immunization injection. As this study is based on the concept
of health, the investigator has modified the Widen Bach’s Helping Art Clinical Theory.
According to widen Bach’s nursing theory it consist of central purpose, Reality and
Prescription which comprises of:
21
THE THREE COMPONENTS are;
• Identifying patients need for help
• Ministering the needed help
• Validating the needed help was met
Step I : Identifying patients need for help
According to wiedenbach, identification involves individualization of patient,
observation of presenting symptoms, behaviors, discomfort, and also assessment of the
child such as facial expression, cry, breathing patterns, arms, legs, state of arousal. In
this the investigator identifies the need of infants through assessment of pain perception
using NIPS during immunization. The central purpose is to manage the pain effectively
during injection.
Step II : Ministering the needed help
Provide the needed help by reducing immunization pain by administering 24%
of oral solution to the infants to relieve pain perception during immunization injection.
Step III : Validation
According to wiedenbach, there is a goal for validation, as a result of the help
that has provided. It refers to a collection of evidence that shows patient’s need had
been met, which is the assessment of pain response in infants receiving immunization.
22
GENERAL INFORMATION
Infants experiencing pain during immunization

IDENTIFICATION
Control Realities Prescription

purpose
Factors Plan of care
Reduction of involving administration
pain in infants nursing of sucrose
receiving
immunization
(experimental
group)
MEANS FRAMEWORK
AGENT GOAL RECEIPIENT
MINISTRATION
NURSE Administration (Hospital set up)

Reduction of Experimental
Administering & control of oral sucrose
pain in infants ASHWIN
oral sucrose group infants to the
receiving HOSPITAL
solution to receiving experimental
immunization group
experimental immunization
group
Assessment of pain response in both experimental & control group - NIPS

VALIDATION
Comparison of two groups for reduction of pain

(experimental & control group)
Figurie. 1: MODIFIED WEIDENBACH’S THEORY (1969)
23
CHAPTER III
METHODOLOGY
Research methodology is a way to systematically solve the research problem. It
is necessary for the researcher to know not only the research methods and technologies
but also methodology. Methodology of the study indicates the general pattern of the
research approach and research design that includes the steps of procedures, strategies,
and analyzing the data in the investigation.
In this section, the researcher discusses the research approach, research design,
setting of the study, population, sample size, sampling technique, criteria for selection
of sample, description of tool, content validity, reliability, pilot study, data collection
procedure and plan for data analysis.
RESEARCH APPROACH
The research approach indicates the basic procedure for conducting research. In
the view of the nature of the problem, to accomplish the objectives and to test
hypothesis of the study, a quantitative evaluative research approach is adopted. Quasi
experimental involves manipulation and control. This approach was used to evaluate the
effectiveness of oral sucrose solution for infants undergoing immunization.
RESEARCH DESIGN
The research design provides an overall plan for conducting the study. Quasi
experimental post test only design was used for the study.
24
Experimental 24% Assessing the pain
group sucrose level after
immunization
Random
assignment
Control Assessing the pain
group level after
immunization
Figure. 2 The schematic representation of the Research Design
SETTING OF THE STUDY
The study was conducted at Ashwin hospital.
VARIABLES
Independent variable was 24 % sucrose oral solution and the dependent variable
is the pain of infants undergoing immunization. The influencing variables are
demographic variables such as age of the baby, sex, weight, birth order, route of
administration.
Influencing Dependent Independent

variables variables variables
Demographic Pain of infants 24% sucrose

variable undergoing solution
Age, sex, immunization administered 2
weight, birth minutes prior
order, route of to
administration immunization
Figure. 3 The Schematic Representation of Variables
25
POPULATION
The population of the study includes children in the age group of 45 days to 12
months who are undergoing immunization
SAMPLE SIZE
The sample size for the study includes 60 infants (30 samples for experimental
group and 30 samples for control group).
SAMPLING TECHNIQUE
Non probability convenient sampling technique was used to select the samples from the
population of the study.
CRITERIA FOR SELECTION OF SAMPLE
Inclusive criteria
Infants who are undergoing immunization
Infants between 45 days -12 months
Mothers of infants who were willing to participate in the study.
Exclusive criteria
Low birth weight or MR
Infants who were sick
Infants who cry more
Lactose and sucrose intolerance baby
26
DESCRIPTION OF THE TOOL
The researcher has used neonatal or infant pain scale and physiologic parameter
to assess the effectiveness of 24% oral sucrose in pain reduction among infants
undergoing immunization.
Description of the tool
Section I Description of demographic variables
Demographic variables including age, sex, birth order, weight, birth illness or
complications, prolonged exposure to pain.
Section II Pain score
Neonatal or infant pain scale (NIPS) was used for infants to assess pain. The
parameters included facial expression, cry, breathing pattern, arms, legs, state of
arousal, heart rate, and O2 saturation.
Scoring: 0-3 – No pain
4-6 – mild pain
7-9 – moderate pain
10-12 – severe pain
TESTING OF THE TOOL
CONTENT VALIDITY
The tool was given to five experts in the field of pediatric nursing and medicine
for content validity. All comments and suggestions given by the experts were duly
considered and corrections were made after discussion with research guide.
27
RELIABILITY
The reliability of the tool was determined by spearman split half technique
showing for physiologic parameters +0.89. The reliability of the tool was satisfactory.
PILOT STUDY
Pilot study is a trial run for major study to test the reliability, practicability,
appropriateness, and flexibility of the study and the tool. Pilot study was conducted in 6
infants (both experimental and control group) in Ashwin hospital.
24% sucrose solution was administered 2 minutes prior to the immunization for
the infants of the experimental group and no intervention was done for control group.
The level of pain was assessed 2 minute following immunization using NIPS. The data
was analyzed using descriptive and inferential statistics. It revealed there was a
significant difference exist between the experimental and control group. The post test
score for pain were low in experimental group suggesting 24% oral sucrose solution
was effective in reducing pain.
DATA COLLECTION PROCEDURE
The study was conducted in Ashwin hospital at Coimbatore. The data were
collected for a period of 4 weeks. Individuals oral informed consent was obtained from
the infants parents. The study samples were selected by Nonprobability convenient
sampling technique based on the sample criteria. 30 samples were selected for
experimental group and 30 samples were selected for control group. The samples
assigned first for experimental and second infant assigned for control group, like ways
following days infants were assigned. Demographic variables of infant and mother were
28
collected from mother. Researcher administered oral sucrose solution 2 minutes prior to
immunization to 30 samples in the experimental group and assessed level of pain 2
minutes after receiving immunization injection by using NIPS.
In control group the demographic variables of mother and infants collected from
mothers. Normal routine comfort measures provided during immunization and pain
assessed by using NIPS. Thus the investigator was able to complete the data collection
within the given period.
PLAN FOR DATA ANALYSIS

The investigator adopted descriptive and inferential statistics to analyze the data.
The demographic variables were analyzed by using frequency and percentage. The
effectiveness of 24% oral sucrose solution and association between the demographic
variables were analyzed by using ‘t’ test ߯2 test resepectively.
29
Research Approach
Quantitative Approach
Research Design
Post test only control group design
Population
Infants who receives vaccination in Ashwin Hospital, Coimbatore.
Sampling Technique
Non probability convenient sampling technique
Sample Size
N=60
Experimental group (n=30) Control group (n=30)
24% oral sucrose solution No intervention

given
Pain Assessment - NIPS
Data Analysis
Descriptrive and inferential statistics
Interpretation and conclusion
Figure.4 The overall view of Research Methodology
30
CHAPTER IV
DATA ANALYSIS AND INTERPRETATION
According to Denic polit (2005) analysis is the method of organizing, sorting
and scrutinizing data in such a way that the research question can be answered.
This chapter deals with analysis and interpretation of the collected data. In this
study, evaluative approach was adopted to assess the effectiveness of sucrose solution to
the mouth, prior to immunization injection on pain perception among infants in Ashwin
hospital at Coimbatore. The data were computed using descriptive inferential statistics
based on the objectives of the study.
The findings based on the descriptive and inferential statistical analysis
tabulated as follows:
Section I: Distribution of demographic variables in experimental and control group.
Section II: Data on assessment of level of pain perception of infants during injection
among experimental & control group.
Section III: Data on the effectiveness of sucrose solution among experimental and
control group.
Section IV: Data on the association between the level of post test pain perception with
selected demographic variables among experimental group.
Section V: Data on the association between the level of post test pain perception with
selected demographic variables among control group
31
SECTION – I
Table. 1 Distribution of demographic variables for infants in experimental and control
group.
(N=60)
Demographic Experimental group Control group
S.No variables (n=30) (n=30)
Frequency Percentage Frequency Percentage
(f) (%) (f) (%)
1. Age of the infant
a) 45 days – 3 months 6 20% 3 10%
b) 4-6 months 12 40% 9 30%
c) 7-9 months 9 30% 9 30%
d) 10-12 months 3 10% 9 30%
2. Gender
a) Male 15 50% 18 60%
b) Female 15 50% 12 40%
3. Education of father
a) Graduate 18 60% 15 50%
b) Higher secondary 6 20% 12 40%
c) High school 6 20% 3 10%
d) Primary 0 0% 0 0%
e) Illiterate 0 0% 0 0%
4. Education of mother
a) Graduate 15 50% 9 30%
b) Higher secondary 12 40% 15 50%
c) High school 3 10% 6 20%
d) Primary 0 0% 0 0%
e) Illiterate 0 0% 0 0%
(Table 1 continues)
32
(Table 1 continued)
S.No Demographic Experimental group Control group

variables (n=30) (n=30)

(f) (%) (f) (%)
5. Occupation of father
a) Professional 18 60% 12 40%
b) Clerical 6 20% 12 40%
c) Skilled 6 20% 6 20%
d) Semiskilled 0 0% 0 0%
e) Unemployed 0 0% 0 0%
6. Occupation of mother
a) Professional 12 40% 15 50%
b) Clerical 9 30% 3 10%
c) Skilled 3 10% 3 10%
d) Semiskilled 6 20% 0 0%
e) Unemployed 0 0% 9 30%
7. Monthly income
a) Below Rs. 5000/- 0 0% 0 0%
b) Rs. 5001-10,000/- 3 10% 0 0%
c) Rs.10001-20,000/- 12 40% 15 50%
d) Rs.20,001 & 15 50% 15 50%
above
8. No. of children
a) 1 18 60% 15 50%
b) 2 9 30% 12 40%
c) 3 3 10% 3 10%
d) 4 & above 0 0% 0 0%
(Table 1 continues)
33
(Table 1 continued)
S.No Demographic Experimental group Control group

variables (n=30) (n=30)
(f) (%) (f) (%)
9. Birth order
a) I 18 60% 15 50%
b) II 9 30% 12 40%
c) III 3 10% 3 10%
d) IV & above 0 0% 0 0%
10. Religion
a) Hindu 15 50% 15 50%
b) Christian 6 20% 12 40%
c) Muslim 9 30% 3 10%
11. Types of family
a) Nuclear 21 70% 27 90%
b) Joint 9 30% 3 10%
12. Place of residence

a) urban 24 80% 21 70%
b) rural 6 20% 9 30%
13. Types of vaccine
a) Penta 15 50% 18 60%
b) IPV 6 20% 3 10%
c) MMR 9 30% 9 30%
d) Optional 0 0% 0 0%
14. Route of vaccine
a) IM 21 70% 21 70%
b) SC 9 30% 9 30%
c) ID 0 0% 0 0%
15. Weight of the baby
a) 4-6 kg 3 10% 12 40%
b) 7-9 kg 12 40% 15 50%
c) 10-12 kg 15 50% 3 10%
34
Table .1 Reveals distribution of demographic variables for infants in experimental and
control group.
Regarding the age there were 6 (20%) infants belongs to 45days- 3 months,
were more 12 (40%) infants belongs to 4-6 months , were 9 (30%) infants belongs to 7-
9 months and were less 3 (10%) infants belongs to 10-12 months in experimental group.
There were less 3(10%) infants belongs to 45days-3months, were 9 (30%)
infants belongs to 4-6month, 7-9 month, and 10-12 months in control group.
Regarding sex there were 15 (50%) males and 15 (50%) females in experimental
group. There were 18 (60%) males and 12 (40%) females in control group.
Regarding education of father there were 18 (60%) graduates, 6(20%) were
higher secondary , 6 (20%) were high school and were no primary and illiterates in
experimental group. There were 15 (50%) graduates, 12 (40%) higher secondary, 3
(10%) high school and were no primary and illiterates in control group.
Regarding education of mother there were 15 (50%) graduates, 12 (40%)
higher secondary, 3(10%) high school, and were no primary and illiterates in
experimental group. There were 9(30%) graduates, 15 (50%) higher secondary, 6 (20%)
high school and were no primary and illiterates in control group.
Regarding occupation of father there were 18 (60%) professionals, 6(20%)
clerical, 6(20%) skilled, and were no semi skilled and unemployed fathers in
experimental group. There were 12(40%) professionals, 12 (40%) clerical, 6 (20%)
35
skilled and were no i semiskilled and unemployed fathers in control group.
Regarding occupation of mother there were 12 (40%) professionals, 9(30%)
clerical, 3(10%) skilled, 6(20%) semi skilled and no unemployed mothers in
experimental group. There were 15(50%) professionals, 3 (10%) clerical, 3 (10%)
skilled, 9 (30%) unemployed and no semiskilled mothers in control group.
Regarding monthly income there were no infants below Rs.5000/-, 3 (10%)
between Rs. 5001-10000/-, 12 (40%) between Rs.10001-2000/- and 15 (50%) Rs.20001
& above in experimental group. There were no infants below Rs.5000/- and between
Rs.5001-10000/-, were 15 (50%) between Rs.10001-20000/- and 15 (50%) Rs.20000 &
above in experimental group.
Regarding number of children there were 18(60%) 1child, 9 (30%) 2 children,
3(10%) 3 children and 4 and above no children’s in experimental group. There were 15
(50%) 1 child, 12 (40%) 2 children,3 (10%) 3children, 4 and above no children’s in
control group.
Regarding birth order there were 18 (60%) were first born, 9 (30%) were second
born, 3 (10%) were third born and no one born after 3 in experimental group. There
were 15 (50%) were first born, 12 (40%) were second born, 3 (10%) were third born
and no one born thereafter I control group.
Regarding religion there were 18(60%) belongs to Hindu, 6 (20%) belongs to
Christian, and 6 (20%) belongs to Muslim in experimental group. There were 15 (50%)
36
belongs to Hindu, 12 (40%) belongs to Christian, and 3 (10%) belongs to Muslim in
control group.
Regarding types of family there were 21 (70%) from nuclear and 9 (30%)
from joint family in experimental group. There were 27 (90%) from nuclear and 3
(10%) from joint family in control group.
Regarding place of residence there were 24 (80%) from urban and 6 (20%) from rural in
experimental group. There were 21 (70%) from urban and 9 (30%) from rural in control
group.
In relation to types of vaccine 15 (50%) get Pentavalent, 6 (20%) get IPV, 9
(30%) get MMR, and no one get any optional vaccines in experimental group. There
were 18 (60%) get pentavalent immunizations, 3 (10%) get IPV, 9(30%) get MMR, and
no one immunized with optional vaccines in control group.
While considering route of vaccines 21 (70%) undergone IM injections and
9(30%) were undergone subcutaneous both in experimental and in control group.
In relation to weight of the baby 3 (10%) were between 4-6kg, 12 (40%) were between
7-9 kg, 15 (50%) between 10-12kg in experimental group. 12 (40%) were between 4-
6kg , 15 (50%) between 7-9kg, and 3 (10%) between 10-12kg in control group.
37
38
39
40
41
42
43
44
45
SECTION – II
Data on The Assessment of Level of Pain Perception of Infants During Injection
among Experimental and Control Group
Table .2 Frequency and percentage distribution of level of pain perception among
experimental and control group in post test.
(N=60)
Experimental group Control group

Level of pain
F % F %
Mild pain 21 70 0 0
Moderate pain 9 30 1 3
Severe pain 0 0 29 97
Infants in experimental group were administered sucrose solution 2 min prior
to injection. Pain perception was assessed after the intervention while giving injection.
Among experimental group the majority 21 infants (70%) perceived mild pain and the
least 9 infants (30%) perceived moderate pain. No infant perceived severe pain after
administering sucrose solution.
Among control group the majority 29 infants (97%) perceived severe pain and
the least 1 (3%) perceived moderate pain. This shows that sucrose solution was
effective in reducing pain.
46
47
SECTION – III
Data on The Effectiveness of Oral Sucrose Solution among Experimental and
Control Group.
Table. 3 Distribution of Mean, Mean Difference, Standard Deviation and t value
regarding post test pain perception.
(N=60)
Post test
Effectiveness
‘t’ value
Mean M.D S.D
Experimental group
5.13 1.43
6.07 19.54*
Control group
11.2 0.89
(* significant)
Table-3 Revealed that there was a significant difference between post test pain
perception of experimental and control group. The mean difference was 6.07. The
obtained ‘t’ value , t=19.54 (p>0.05) was significant. There was significant reduction in
pain perception after the administration of sucrose solution. So the Alternative
Hypothesis accepted. It was inferred that the sucrose solution was effective in reducing
the pain perception.
48
49
SECTION – IV
Table. 4 Data On Association Between The Level of Post Test Pain Perception
With Demographic Variables among Experimental Group.
(N=30)
Demographic Moderate
S.No Mild Pain χ2
Variables Pain
a) 45 days – 3 months 3 3
b) 4-6 months 9 3
c) 7-9 months 6 3 2.6
d) 10-12 months 3 0
2. Gender
a) Male 12 3 1.42
b) Female 9 6
a) Graduate 12 6
b) Higher secondary 6 0
c) High school 3 3 3.79
d) Primary 0 0
e) Illiterate 0 0
a) Graduate 10 5
d) Primary 0 0
e) Illiterate 0 0
(Table 4 continues)
50
(Table 4 continued)
Moderate
S.No Demographic variables Mild Pain χ2
Pain
a) Professional 12 6
b) Clerical 3 3 3.79
c) Skilled 6 0
d) Semiskilled 0 0
e) Unemployed 0 0
a) Professional 9 3
b) Clerical 6 3
c) Skilled 3 0 2.6
d) Semiskilled 3 3
e) Unemployed 0 0
7. Monthly income
a) Below Rs. 5000/- 0 0
b) Rs. 5001-10,000/- 3 0
c) Rs.10001-20,000/- 9 3 2.13
d) Rs.20,001 & above 9 6
8. No. of children
a) 1 14 4
b) 2 6 3 2.46
c) 3 1 2
d) 4 & above 0 0
Twqfdfr7yrygy (Table 4 continues)
51
(Table 4 continued)
S.No Mild pain χ2
Variables Pain
9. Birth order
a) I 14 4
b) II 6 3
c) III 1 2 2.46
d) IV & above 0 0
10. Religion
a) Hindu 12 3
b) Christian 3 3
c) Muslim 6 3 1.89
11. Types of family

a) Nuclear 16 5
b) Joint 5 4 1.11

a) urban 18 6
b) rural 3 3 1.42

a) Penta 12 3
b) IPV 3 3
c) MMR 6 3
d) Optional 0 0 1.89

a) IM 16 5
b) SC 5 4
c) ID 0 0 1.11

a) 4-6 kg 3 0
b) 7-9 kg 9 3 2.13
c) 10-12 kg 9 6
52
Table -4 Revealed the association between the level of post test pain and their
demographic variables as age=2.6, gender=1.42, education of father=3.79, education of
mother=1.4, occupation of father=3.79, occupation of mother=2.6, monthly
income=2.13, number of children=2.46, birth order=2.46, religion=1.89, types of
family=1.11, place of residence=1.42, types of vaccine=1.89, route of vaccine=1.11,
weight of baby=2.13 were not significant at the level of 0.05.
It was inferred that there was no significant association between the post test
pain perception and selected demographic variables like age, gender, education of
father, education of mother, occupation of father, occupation of mother, monthly
income, number of children, birth order, religion, types of family, place of residence,
types of vaccine , route of vaccine, weight of baby. So the administration of oral sucrose
solution was independently effective in reducing pain perception among infants during
immunization.
53
SECTION – V
Table. 5 Data On Association Between The Level of Post Test Pain Perception with
Demographic Variables Among Control Group.
(N=30)
S.No Mild Pain χ2
Variables Pain
a) 45 days – 3 months 0 3
b) 4-6 months 1 8 2.40
c) 7-9 months 0 9
d) 10-12 months 0 9
2. Gender
a) Male 0 18 1.55
b) Female 1 11
a) Graduate 0 15
d) Primary 0 0
e) Illiterate 0 0
a) Graduate 0 9
d) Primary 0 0
e) Illiterate 0 0
(Table 5 continues)
54
(Table 5 continued)
S.No Mild Pain χ2
Variables Pain
b) Clerical 0 12
c) Skilled 0 6 1.54
d) Semiskilled 0 0
e) Unemployed 0 0
b) Clerical 0 3
c) Skilled 0 3 1.02
d) Semiskilled 0 0
e) Unemployed 0 9
7. Monthly income
a) Below Rs. 5000/- 0 0
b) Rs. 5001-10,000/- 0 0 1.02
c) Rs.10001-20,000/- 1 14
d) Rs.20,001 & above 0 15
8. No. of children
a) 1 1 14
b) 2 0 12 1.02
c) 3 0 3
d) 4 & above 0 0
+ (Table 4 continues)
55
(Table 5 continued)
S.No Mild Pain χ2
Variables Pain
9. Birth order
a) I 1 14
b) II 0 12 1.02
c) III 0 3
d) IV & above 0 0
10. Religion
a) Hindu 0 15 1.54
b) Christian 1 11
c) Muslim 0 3
11. Types of family
a) Nuclear 1 26
b) Joint 0 3 0.11
a) urban 0 21
b) rural 1 8 2.41

a) Penta 0 18
b) IPV 0 3 2.40
c) MMR 1 8
d) Optional 0 0
a) IM 1 20
b) SC 0 9 0.43
c) ID 0 0
a) 4-6 kg 1 11
b) 7-9 kg 0 15 1.54
c) 10-12 kg 0 3
56
Table -5 Revealed the association between the level of post test pain and their
demographic variables as age=2.40, gender=1.55, education of father=9.22, education
of mother=1.02, occupation of father=1.54, occupation of mother=1.02, monthly
income=1.02, number of children=1.02, birth order=1.023, religion=1.54, types of
family=0.11, place of residence=2.41, types of vaccine=2.40, route of vaccine=0.43,
weight of baby=1.54 were not significant at the level of 0.05.
It was inferred that there was no significant association between the post test
pain perception and selected demographic variables like age, gender, education of
father, education of mother, occupation of father, occupation of mother, monthly
income, number of children, birth order, religion, types of family, place of residence,
types of vaccine , route of vaccine, weight of baby. So the administration of oral sucrose
solution was independently effective in reducing pain perception among infants during
immunization.
57
CHAPTER V
RESULTS AND DISCUSSION
This is a quasi experimental study indented to evaluate the effectiveness of
administering oral sucrose solution prior to immunization injection on pain perception
among infants in Ashwin hospital Coimbatore.
The first objective of the study was to assess the level of pain among infants
receiving immunization after administering the oral sucrose solution.
To infants in experimental group sucrose solution was administered 2 minutes
prior to injection. Pain perception was assessed after the intervention while giving
injection. Among experimental group the majority 20 infants (67%) perceived mild pain
and the least 10 infants (33%) perceived moderate pain. No infant perceived severe pain
after administering sucrose solution. Among control group the majority 29 infants
(97%) perceived severe pain and the least 1 infant (3%) perceived moderate pain. It was
inferred that the pain level was reduced after the administration of oral sucrose solution
prior to injection among infants.
A similar study was conducted by Bueno (2010) to assess the effectiveness of
sucrose solution prior to immunization in reduction of pain among infants in Toronto,
Canada. Infants aged 1month-12 months were selected randomly and sucrose was given
for the experimental group infants 2 minutes before to immunization. The study
findings revealed that 70% of the infants in experimental group had mild pain
perception after administering sucrose and infants in control group had moderate to
severe pain.
58
The second objective of the study was to assess the effectiveness of oral
sucrose solution on pain perception in experimental group and control group
infants.
The present study revealed the post test mean difference was 4.55. The ‘t’ value
17.08. The pain perception was comfortably less with oral sucrose solution than with
usual procedure among infants. It could be inferred that sucrose solution prior to
injection was effective in decreasing pain perception among infants.
A similar study was conducted by Fowler C (2012) to determine the
effectiveness of oral sucrose solution for pain relief in 2 month old infants receiving
immunization. Data were collected from 120 infants attending clinic in Jordan. 2 ml of
sucrose was given orally before the procedure ( prior to 2 minutes of injection). Pain
was measured with modified behavioral pain scale. Children provided with sucrose
solution had a lower degree of pain than who were not provided with this intervention.
(p<0.001).
The third objective of the study was to find out the association between post
test level of pain with selected demographic variables among experimental group
infants.
The association between the level of post test pain and their demographic
variables like as age x2 = 2.6, gender x2 = 1.42, education of father x2 = 3.79, education
of mother x2= 1.4, occupation of father x2 = 3.79, occupation of mother x2= 2.6,
monthly income x2 = 2.13, number of children x2= 2.46, birth order x2= 2.46, religion
x2= 0.08, types of family x2= 1.11, place of residence x2= 1.42, types of vaccine
59
x2= 1.89, route of administration x2= 1.11, weight of baby x2= 2.13, were not
significant at the level of 0.05.
It was inferred that there was no significant association between post test pain
perception and selected demographic variables like age, gender, education of father &
mother, occupation of father & mother, monthly income, number of children, birth
order, religion, types of family, place of residence, types of vaccine, route of
administration, weight of baby. So the administration of oral sucrose solution was
independently effective in reducing pain perception among infants during
immunization.
60
CHAPTER VI
SUMMARY, CONCLUSION, NURSING IMPLICATIONS,
LIMITATIONS AND RECOMMENDATIONS
SUMMARY
The study was conducted to assess the effectiveness of administering 24%
sucrose orally prior to immunization injection on pain perception among infants in
Ashwin hospital at Coimbatore.
The following objectives were set for the study
• To assess the level of pain perception among infants receiving immunization after
administering the oral sucrose solution.
• To assess the effectiveness of oral sucrose solution on pain perception among
experimental and control group infants.
• To find out the association between post test level of pain perception with selected
demographic variables among experimental group infants.
• To find out the association between post test level of pain perception with selected
demographic variables among control group infants.
The alternative hypothesis set for the study as follows
H: There will be a significant difference in pain perception after oral sucrose
administration among infants receiving immunization in experimental group.
61
Major findings of the study were follows
To infants in experimental group sucrose solution was administered 2 minutes prior to
injection. Pain perception was assessed after the intervention while giving injection.
Among experimental group the majority 21 infants (70%) perceived mild pain and the
least 9 infants (30%) perceived moderate pain. No infants perceived severe pain after
administering sucrose solution. Among control group the majority 29 infants (97%)
perceived severe pain and the least 1 infant (3%) perceived moderate pain. It was
inferred that the pain level was reduced after the administration of oral sucrose solution
prior to injection among infants.
The study revealed that the post test mean difference was 6.07. The ‘t’ value was
19.54. The pain perception was significantly less with oral sucrose solution than with
usual procedure among infants. It could be inferred that sucrose solution prior to
injection was effective in decreasing pain perception among infants.
There was no significant association between the post test pain perception and selected
demographic variables.
CONCLUSION
The administration of oral sucrose solution was effective in the reduction of pain
perception among infants undergoing immunization injection. Majority 21 (70%) of
infants in experimental group experienced mild pain after administering oral sucrose
solution, where as majority 29 (97%) of the infants in control group had severe pain. So
sucrose solution should be used as supportive therapy for reducing pain perception
among infants undergoing immunization injection.
62
NURSING IMPLICATIONS
The findings of the study have implications in various areas of nursing
education, practice, administration and nursing research.
NURSING EDUCATION
Nurse as the educator can conduct seminar/workshop to nursing students to gain
information and to update their knowledge about sucrose solution and other
complimentary therapies and their benefits.
Nursing as a person working in pediatric ward should be given in service education
regarding pain reduction therapies.
The practice of sucrose solution should be included in the hospital settings.
The students should be moulded in such a way that they should be able to recognize the
factors responsible for immunization pain and thereby able to take an active role in
reducing the pain.
NURSING PRACTICE
The findings of the study clearly visualizes that oral sucrose are effective in reducing
pain perception among infants undergoing immunization.
A structured teaching programme must be emphasized in the nursing curriculum. It
helps the nursing students to develop attitude towards the Importance of management of
infant pain.
The nurse should also be specific in identifying the effects of sucose solution.
63
The nurse should act as a facilitator to create awareness among the parents regarding
sucrose solution and its techniques.
NURSING ADMINISTRATION
Nursing administration should implement outreach programmes to make the people
aware and prevent false assumptions about the society.
Nurse administrator have the power and authority to conduct various training programs
for nurses aimed at developing kwoledge, skill, and attitude towards caring infants
withpain and anxiety.
Nurse administrator should plan and implement collaborating training to employ
qualified nurses in rendering service in hospitals.
Nurse administrator should take initiative to teach mothers regarding the different
intervention methods to reduce pain.
NURSING RESEARCH
The findings of the study will help to motivate the nurses to conduct research about
sucrose solution in future.
It also provide a base for nursing professional to undertake more extensive studies on
various factors influencing immunization pain.
Nurse researcher should be motivated to conduct more studies to know the attitudes of
patients receiving sucrose solution when they have pain.
The nurse researcher should disseminate her research findings through journels,
conferences to identify the strengths and weakness of the study.
LIMITATIONS
64
Study was limited only to infants.
Samples were selected by convenient sampling technique, reduce generalizibility.
The study was conducted among the patients undergoing immunization in Ashwin
hospital at Coimbatore only, so generalizations must be done with caution.
This study was done on a small sample size of 60.
RECOMMENDATIONS
The same study in larger group of homogenous members may be tried.
This study can be conducted by combining with other alternative therapy.
A comparative study can also be done between the effectiveness of various non-
pharmacological measures on reducing pain perception among infants such as play
therapy, breast feeding.
65
APPENDICES
SECTION - I
DEMOGRAPHIC VARIABLES
Instructions
Read the following questions carefully and give () in a given boxes for correct answer.
Sample number: …………………….
1. Age of the baby
a) 45 days-3 months
b) 4-6 months
c) 7-9 months
d) 10-12 months
2. Gender
a) Male
b) Female
a) Graduate
b) Higher secondary / diploma
c) High school
d) Primary school
e) Illiterate
a) Graduate
b) Higher secondary / diploma
c) High school
d) Primary school
e) Illiterate
a) Professional
b) Clerical
c) Skilled
d) Semiskilled
e) Unemployed
a) Professional
b) Clerical
c) Skilled
d) Semiskilled
e) Unemployed
7. Family monthly income
a) Below Rs. 5000/-
b) Rs .5001 – Rs.10,000/-
c) Rs. 10,001- Rs.20,000/-
d) Rs.20,001 & above
8. Number of children in the family
a) 1
b) 2
c) 3
d) 4 & above
9. Birth order
a) I
b) II
c) III
d) Others
10. Religion
a) Hindu
b) Christian
c) Muslim
11. Type of family
a) Nuclear
b) Joint
12. Area of residence
a) Urban
b) Rural
13. Type of vaccination
a) Penta
b) DPT
c) Measles
d) Others
14. Site of vaccination
a) IM
b) Subcutaneous
c) Intradermal
a) 4 – 6 kg
b) 7 – 9 kg
c) 10 – 12 kg
SECTION –II
NEONATAL / INFANT PAIN SCALE (NIPS)
CRITERIA SCORE 0 SCORE 1 SCORE 2

Facial Relaxed muscles
expression Restful face , neutral Grimace _
expression Tight facial muscles;
Whimper , mild Vigorous cry , loud

Cry No cry , Quiet moaning , scream ; rising ,
intermittent shrill , continuous.
Change in breathing ,
Breathing Relaxed indrawing , gagging,
pattern breathe holding _
Arms Relaxed / restrained Flexed /extended _
Legs Relaxed / restrained Flexed /extended _
State of Sleeping / awake Fussy _

arousal
Within 10% of
Heart Rate 11-12% of baseline >20% of baseline
baseline
Additional O2
O2 No additional o2 required to maintain _
Saturation needed to maintain saturation.
saturation
Limitation : A falsely low score may be seen in an infant who is too ill to respond or
who is receiving a paralyzing agent .
(A score greater than 3 indicates pain )
Maximum score = 12
Considering pain = ≥3
GRADING
SCORE INTERPRETATIONS
0-3 Relaxed and comfortable
4-6 Mild pain
7-9 Moderate pain
10-12 Severe pain

PROTOCOL FOR THE USE OF SUCROSE SOLUTION FOR PROCEDURAL
PAIN MANAGEMENT
INTRODUCTION
Sucrose is the chemical name for table sugar .It consist of a combination of
glucose and fructose and is usually obtained from sugar cane or sugar beets. Oral
sucrose is safe and effective for reducing procedural pain from a single event .Oral
sucrose is a mild analgesic which is effective in decreasing short term pain and distress
during minor procedures. Small amounts of oral sucrose are placed on infant’s tongue to
reduce procedural pain.
DEFINITION OF TERMS
• Oral sucrose for procedural pain management is a sweet solution which reduces
pain in neonates and infants. By providing taste stimulation to the cellular membrane
receptor in the brain, in which the endogenous opioid system is located , the sweet
solution may be effective in pain reduction.
• Pain is a subjective experience. “An unpleasant sensory and emotional experience
associated with actual or potential tissue damage or described in terms of such
damage.”
OBJECTIVE
Oral sucrose administration is clinically indicated for the reduction of
procedural pain and distress in infants 0-18 months .

MECHANISM OF ACTION
The initial effect is Orotactile stimulation by administering sucrose solution.
The Orogustatory stimulation by the sweet taste prolongs the effect for upto 10
minutes through Endomorphin release .
Endomorphin in pain : Beta endomorphins are neuropeptides involve in
pain management possessing morphin like effect and are involved in natural reward
circuit such as feeding , drinking . ( It is synthesized and stored in the anterior pituitary
gland and are precursor protein PROOPIOMELANOCORTIN – POMC ) Large
protein breaks to Beta – endorphin. In the peripheral nervous system Beta –
endorphin produce analgesia by binding opioid receptors by both pre and post
synaptic nerve terminals , primarily existing their effect through pre-synaptic binding .
When bound, a cascade of interactions results in inhibition of release of Tachykinins
particularly P ,a key protein involved in the transmission of pain .
In the CNS , Beta – endorphins similarly bind mu – opiod receptors and exert
their primary action at pre synaptic nerve terminals . However , instead of inhibiting
substance P , they exert their analgesic effect by inhibiting the release of GABA , an
inhibitory neurotransmitter , resulting in excess production of dopamine . It is
associated with pleasure .

Prior to vaccination
One to two drops of 24 % sucrose via orally
Strong taste of sucrose rapid absorption of sucrose
Release of endogenous endorphin from
Arcuate nucleus of hypothalamus & from anterior pituitary
Immediate and short acting effect by having
Strong affinity towards opiod receptors located
In brain ( periaqueductal gray and claustrum)
Inhibit the release of pain signals from the nerve cells
Analgesic effect
PREPARATION
• 24 % SUCROSE SOLUTION ( sucrose & water )
• 100 ml of water was boiled and 10 gm of parry’s sugar was dissolved and cooled. The
sucrose solution was poured into a small cup.
INDICATIONS
• Heel pricks
• Venepuncture / Cannulation
• Urinary catheterization
• Eye examination
• Naso-gastric tube insertion
• Lumbar puncture
• IM / IV Injections
It can also be used for procedures likely to cause distress such as,
• Colostomy bag change
• Dressing change
• Removing tape
• Scalp electrode placement
• Suturing
• Painful physiotherapy.
CONTRAINDICATIONS
• Fructose or sucrose intolerance.
• Direct administration onto tongue or buccal surface is unavailable (not effective via any
other route )
• Paralysed and sedated.
• Glucose- galactose malabsorption .
CAUTIONS
• Premature infants
• Suspected or confirmed necrotizing enterocolitis
• Intubated childs
• Neonates & infants with Hypoglycaemia or Hyperglycaemia .
ADMINISTRATION
• Check for contraindications or risk requiring medical cosult .
• Explain procedure to the mother
• Prepare the infant for the procedure .
• Take sucrose solution with the help of dropper .
• Made the mother to hold the infant before immunization injection .
• 2 ml of solution was poured with the help of dropper into the child’s mouth before the
immunization injection .
• After giving sucrose solution , after 2 minutes immunization injection was given and
assessed the pain perception .
AFTER CARE
• Wipe baby’s mouth.
• Correct baby’s clothing.
• Replace all articles.
• Clean articles.
• Wash hands.
• Document procedure.
CONCLUSION
The administration of oral sucrose solution can reduce pain perception among
infants undergoing immunization injection. Sucrose is a non pharmacological pain
intervention. It is cheap method and easy to use, has no side effects and is well accepted
by infants.

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EFFECTIVENESS OF ORAL SUCROSE SOLUTION ON

CERTIFIED THAT THIS IS THE BONAFIED WORK OF

Reg. No: 301616102

SIGNATURE: COLLEGE SEAL

Dr.P.MUTHULAKSHMI.M.SC (N)., M.Phil., Ph.D.,

A DISSERTATION SUBMITTED TO THE TAMILNADU

APPROVED BY THE DISSERTATION COMMITTEE ON OCT 2017

RESEARCH GUIDE: ____________________________

SUBJECT GUIDE : ________________________________

MEDICAL GUIDE : __________________________________

A DISSERTATION SUBMITTED TO THE TAMILNADU

I am highly obliged to my beloved father Mr. K.P. Mohanan, my mother

I express my deep sense of gratitude to Dr. L. P. Thangavelu, MS., F.R.C.S.,

It is my long felt desire to express my profound gratitude and exclusive thanks

I express my sincere thanks to Dr. T. Ashwin., M.S, Laproscopic Surgeon,

I profusely thank Dr. Ashok Kumar., M.D , Consultant Pediatrician, Ashwin

I express my special thanks to my dearest sister Ms. Binu Thomas and my

I extend thanks to Librarian and Assistant Librarian PPG institute of health

I express my heartiest thanks to the Mothers of the samples who have

No research dissertation can be completed without the unrelenting support of all

Above all I owe my success to GOD.

CHAPTER CONTENT PAGE NO

S.NO CONTENT PAGE NO

1. Distribution of Demographic variables in experimental and 32

2. Data on assessment of level of pain perception of infants during 46

3. Data on the effectiveness of sucrose solution among experimental 48

4. Data on the association between the level of post test pain 50

Data on the association between the level of post test pain

S.NO CONTENTS PAGE.NO

1. Conceptual Frame Work Based on Modified 23

2. The Schematic Representation of the Research Design. 25

3. The Schematic Representation of Variables. 25

4. The Overall View of Research Methodology 30

5. Distribution of Demographic variables according to 38

6. Distribution of Demographic variables according to 39

7. Distribution of Demographic variables according to 40

9. Distribution of Demographic variables according to the 42

10. Distribution of infants according to the Types of 43

Comparison of pain level in experimental and control 49

2. Letter seeking permission for conducting the study

3. Letter seeking permission from experts for content validity of

4. Format for the content validity

5. List of experts for content validity

“ To live is to suffer , to survive is to find some meaning in the suffering.”

- Friedrich Nietzsche ,1875.

Infancy is a period of rapid growth and development. At no other time in life

are physical changes and developmental achievements so dramatic as during infancy. In

speak or speechless very young offspring of a human.

infectious. But the development and administration of immunization is the greatest

impact on disease prevention and reduction of human suffering. To provide this

control and prevention, before the age of 2yrs. (Marilyn J, 2009).

The government of India has introduced a new vaccine in the national

immunization programme. Pentavalent vaccine provides protection to a child from 5-

already part of routine immunization in India.

Immunization is one of the most important preventive measures in children’s

term debilitating effects on survivors. (David Wilson, 2009).

Immunizations are the important part of health promotion and disease