Open Access Highly Accessed Research article

Breastfeeding and pain relief in full-term neonates during immunization injections: a clinical randomized trial

Maryam Modarres1, Azam Jazayeri2, Parvin Rahnama3* and Ali Montazeri4*

Author Affiliations

1 PhD student of Medical Education, Lecturer of Midwifery Education, Midwifery, Nursing & Midwifery Care Research Center, Tehran University of Medical Sciences (TUMS), Tehran, Iran

2 Faculty of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran

3 Department of Midwifery, Shahed University, Tehran, Iran

4 Mental Health Research Group, Health Metrics Research Center, Iranian Institute for Health Sciences Research, ACECR, Tehran, Iran

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BMC Anesthesiology 2013, 13:22  doi:10.1186/1471-2253-13-22

Published: 13 September 2013



The aim of this study was to examine the effect of breastfeeding on pain relief in full-term neonates during injection of hepatitis B vaccine.


This was a randomized clinical trial. A sample of full-term neonates was randomly allocated into two groups: the experimental group and the control group. Neonates in the experimental group were breastfed two minutes before, during, and after the hepatitis B immunization and the control group were held in mothers’ arms but not fed. Pain was assessed using the Douleur Aiguë du Nouveau-né (DAN) scale measuring facial expressions, limb movements and vocal expressions. The assessments were carried out after hepatitis B immunization.


One hundred thirty healthy full-term neonates were studied (65 in the experimental group and 65 in the control group). Gestational age, birth weight, Apgar score and gender did not differ between the two groups. The mean total pain score as measured by the DAN scale was 3.52 (SD = 1.37) for the experimental group and it was 6.78 (SD = 1.69) for the controls indicating a significant lower pain score for the experimental group (P<0.001). Also, there were significant differences for the three measures of DAN scale that are facial expressions, limb movements and vocal expression, between the two study groups (P<0.001).


The findings confirm that breastfeeding reduces pain and is effective way for pain relief during hepatitis B vaccine injection.

Trial registration