Also noted

Comment 

There has been increased attention to decreasing pain during immunizations, primarily through distraction techniques or application of topical anesthetics before vaccination. This study examines whether the pain response to administration of the diphtheria, polio, and tetanus toxoids and acellular pertussis and Haemophilus influenzae type b vaccine and the pneumococcal conjugate vaccine is affected by the order in which they are given. With the validated Modified Behavioral Pain Scale, videotaped recordings of the procedure (to assess crying), and parental ratings of pain on a visual analog scale, they found that children had less pain (on all 3 measures) when the diphtheria, polio, and tetanus toxoids and acellular pertussis and diphtheria, polio, and tetanus toxoids and acellular pertussis and H influenzae type b was given before the pneumococcal conjugate vaccine. Reducing pain through this simple intervention will benefit the child and may increase adherence with the vaccination schedule.