Date of Award


Degree Name

Doctor of Philosophy



First Advisor

Dr. C. Richard Spates

Second Advisor

Dr. Wayne Fuqua

Third Advisor

Dr. Michael Bahr

Fourth Advisor

Dr. Helen Prat


In this study four different pre-immunization interventions were compared with respect to their effects on modifying arousal level before an immunization and their effects on the level and duration of distress after the immunization. In addition, the study evaluated whether the infants’ pre-inoculation behavioral state affected their response to a painful stimulus. Data consisting of facial expression, presence or absence of cry, cry duration, and behavioral state were collected prior to, during, and after the inoculation. Forty-two subjects were randomly assigned to one of four soothing conditions. These included: rocking, swaddling, sucking on a pacifier, and a control group.

An analysis of variance across dependent measures revealed that there were no significant differences between groups during the baseline phase. Repeated measures ANOVA on each dependent variable with phases as the within factor were then conducted. Facial characteristics measured by the Neonatal Facial Coding System (NFCS) were not significantly different across groups, but were significant during the post-immunization phase. This further validated facial features as an index of pain. As expected, there was a significant difference between the presence or absence of cry during the baseline, experimental phase, and post-immunization phase. Duration of cry was not significant between groups but was significant during both the experimental phase and post immunization phase. Only 10 subjects failed to soothe within the 2 minute post-immunization phase (swaddle group = 4 , rocking group = 2, pacifier group = 1, control group = 3).

Infant State was not significantly different across groups but again was significant during the post-immunization phase. A Kruskal-Wallis one-way analysis of variance on state during the post-immunization phase indicated no significant differences between groups. One-way analysis of variance revealed that infants in an "active awake" state exhibited significantly more facial characteristics associated with pain. The results are discussed in light of past research.

Access Setting

Dissertation-Open Access