I think this whole thing needs to be looked at seriously, in relation to
autism - the use of aceaminophen and ibuprofen pre and post vaccination.



Published online August 31, 2007
PEDIATRICS Vol. 120 No. 3 September 2007, pp. e637-e643

Routine Immunization Practices: Use of Topical Anesthetics and Oral Analgesics
Anna Taddio, PhDa,b, Jennifer Manley, BAa,b, Leah Potash, BAa, Moshe Ipp,
MD, FRCPCc, Michael Sgro, MD, FRCPCd and Vibhuti Shah, MD, FRCPCe

a Department of Pharmacy, Program in Child Health Evaluative Sciences
c Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario,
b Faculty of Pharmaceutical Sciences, University of Toronto, Toronto,
Ontario, Canada
d Department of Pediatrics, St Michael's Hospital, Toronto, Ontario, Canada
e Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada

BACKGROUND. Immunization pain is a global public health issue. Despite an
abundance of data that demonstrate the efficacy of local anesthetics for
decreasing immunization pain, their adoption in practice has not been
determined. Our objective was to evaluate analgesic use during childhood

PATIENTS AND METHODS. We used a cluster-sampling survey of pediatricians in
the greater Toronto area (who administer immunizations) and multiparous
women. By using a self-administered survey, pediatricians reported
frequency of analgesic use in their practice for 2 phases of immunization:
injection (needle puncture and vaccine administration) and postinjection
(hours to days postvaccination). By using an interviewer-administered
face-to-face survey, mothers reported analgesic practices for their children.

RESULTS. Of 195 eligible pediatricians, 140 (72%) responded. During the
injection phase, 58% rarely or never used analgesics compared with 11% for
the postinjection phase. During injection, the local anesthetics
lidocaine-prilocaine and tetracaine were used at least sometimes in 12% and
2% of the practices, respectively, whereas acetaminophen and ibuprofen were
used in 81% and 46%, respectively. Postinjection, acetaminophen and
ibuprofen were used in 89% and 56% of practices. Of 257 eligible mothers,
200 (78%) participated. During injection, analgesics were used in 25% of
immunizations (acetaminophen [87%], ibuprofen [7%], and
lidocaine-prilocaine [6%]). Postinjection, analgesics were used in 33% of
immunizations (acetaminophen [86%] and ibuprofen [14%]).

CONCLUSIONS. A minority of pediatricians and mothers use topical local
anesthetics during childhood immunization despite evidence to support their
use. Oral analgesics are used more commonly, but this practice is not
consistent with scientific evidence. Knowledge-translation strategies are
needed to increase the use of local anesthesia.