1. 1 Pharmacological Physical Based on evidence from Clinical Therapeutics 2009 (supplement issue) Psychological The 4 P’s of Pain Management Procedural EVIDENCE-BASED CLINICAL PRACTICE GUIDELINES FOR IMMUNIZATION PAIN MANAGEMENT IN CHILDREN

2. 2 Step 1: Pharmacological (Pain Medicine) Step 2: Physical (Body Position & Activity) Step 3: Psychological (Thoughts & Behaviors) Step 4: Procedural (Injection Techniques) 4 P’S OF PAIN MANAGEMENT

3. 3 SickKids Parent and Clinician fact sheets http://www.sickkids.ca/Learning/Stories/Knowledge-Translation/anna- taddio.html Video http://www.aboutkidshealth.ca/En/HealthAZ/TestsAndTreatments/Giving Medication/Pages/Pain-Free-Injections.aspx YouTube: http://www.youtube.com/watch?v=jxnDc2PxGUchttp://www.youtube.com/watch?v=jxnDc2PxGUc TOOLS AND RESOURCES

4. 4 SAMPLE FACT SHEET FOR PARENTS 4

5. 5 Baby Rourke Record http://www.rourkebabyrecord.ca/pdf/RBR2011Nat_Eng_High.pdf Immunization Competencies Education Program http://www.advancingpractice.com/p-68-immunization-competencies- education-program.aspx Toronto Public Health http://www.toronto.ca/health/immunization_children/howtoreducepain.htm TOOLS AND RESOURCES

6. 6 FEASIBILITY OF IMPLEMENTATION 6 Paediatrics & Child Health 2011

7. 7 STEP 1: PHARMACOLOGICAL

8. 8

9. 9 STEP 2: PHYSICAL

10. 10 STEP 2: PHYSICAL

11. 11 STEP 2: PHYSICAL 11

12. 12 STEP 3: PSYCHOLOGICAL

13. 13 STEP 3: PSYCHOLOGICAL

14. 14 STEP 4: PROCEDURAL 14

15. 15 STEP 4: PROCEDURAL 15