The Effect of Methods 5 S: Swaddling, Side/Stomach Position,

Sushing, Swingging, Sucking with Pain Responce on Baby after HB-0

Immunization

Syatriawati*, Juni Mariati Simarmata, Anita Purba, Abdi Lestari Sitepu, Samuel Ginting, Arfah May

Sarah

*Faculty of Nursing and Physiotherapy, Institut Kesehatan Medistra Lubuk Pakam, Indonesia

Keywords: Baby, 5’S Method, Pain.

Abstract: Immunization is a source of acute pain in infants that can cause trauma, non-pharmacological techniques that

can be done is by giving of 5'S method (swaddling, side/stomach position, sushing, swinging, and sucking)

which are effective and easy to do and the purpose of this study was to find out whether there is an effect of

5'S method (swaddling, side /stomach position, sushing, swinging and sucking) on pain response in infants

after Hb-0 immunization at Grandmed Hospital Lubuk Pakam 2019, the method and design of this study was

Quasy Experiment with one group pretest and posttest design. the population in this study were infants aged

0-7 days who received Hb-0 immunization, amounting to 40 people with purposive sampling technique

according to inclusion criteria and pain measurement uses the NIPS (Neonatal Infant Pain Scale) pain scale

the data analysis was performed by Paired Sample t-test with a confidence level of 0.05%, the results of the

study were lower pain in the treatment group with p = 0.0000 <0.05 (<ɑ), the conclusion of this study is that

there was an effect of the 5'S method (swaddling, side / stomach position, sushing, swinging, and sucking) on

pain response in infants after Hb-0 immunization.

1 INTRODUCTION

Degenerative phase for growth and development and

is very susceptible to contracting infections during

infection because the baby's immune system has not

been formed and functions optimally (Trimawati,

2016). Efforts that can be made to prevent this are by

immunization. Immunization is an attempt to provide

immunity to infants and children by introducing

vaccines into the body to prevent certain diseases.

Howeverin carrying out immunization

procedures often cause pain in infants, especially

when doing injection procedures during

immunization, so immunization is often referred to as

one source of acute pain in infants. Pain experienced

by infants during immunization is caused by low

levels of endorphine in infants which causes the

infant's defense mechanism to pain is very

limited.Therefore, nurses need to consider how to

minimize the discomfort and painfelt by the baby

because improper handling will have an impact that

is not good for the baby, both in the short term and

the impact in the long term.

Treatment that can be taken to manage pain non-

pharmacologically to reduce pain during

immunization are using the intervention method 5'S.

5'S action is one of the efforts that can be done to

provide comfort to the baby the new findings state

that newborns up to 3 months of age are not fully

ready in the world, so babies who cry can be

conditioned as in the mother's womb. Dr.Karp

teaches techniques to "re-condition as in the womb"

so that the baby is calm and comfortable, with the 5's

method which includes swaddling, side/stomach

position (left tilted position/stomach), shushing sound

(giving sshhhh sound), swinging (swinging

movements), sucking (sucking / giving ASI). The

technique is done because in the first 3 months after

birth, babies miss the comfortable sensations they

experience while in the mother's womb.The table

below shows high interest of mothers immunizing

Hepatitis HB O against their infants teaching

techniques to "re-condition as in the womb" so that

the baby is calm and comfortable, with method 5's

which includes swaddling, side / stomach position

444

Syatriawati, ., Simarmata, J., Purba, A., Sitepu, A., Ginting, S. and Sarah, A.

The Effect of Methods 5 S: Swaddling, Side/Stomach Position, Sushing, Swingging, Sucking with Pain Responce on Baby after HB-0 Immunization.

DOI: 10.5220/0009837804440451

In Proceedings of the International Conference on Health Informatics and Medical Application Technology (ICHIMAT 2019), pages 444-451

ISBN: 978-989-758-460-2

stomach), shushing sound (giving sound), swinging

(moveswinging), sucking (suck/given ASI), as soon

as the vaccine is given, the baby is wrapped snuggly

in a blanket, then placed on her side or stomach and

gently “shushed” and rocked a bit. If that doesn’t do

the trick, she’s given a pacifier.

Figure 1: Immunization on Baby

Technique is done because the first 3 months after

birth, babies miss the comfortable sensations they

experience while in the mother's womb. Based on the

results of research conducted by Dr. Harrington in

Norfolk, Virginia, United States (2012) Stated that

most infants who get the intervention of the 5's

method stop crying with 45 seconds, while those who

receive a sugar solution still cry within 2 minutes after

invasive vaccination. This is cause babies need

comfort. Based on research conducted by Shu, Lee, et

al in China (2014) Stated that babies who get medical

treatment will cry because they have not been able to

control pain. However, when applying the 5'S

method, Lee found it surprising because the baby who

initially cried quietly quietly and the oxygen

saturation which initially decreased returned to

normal and the baby's Heart Rate which initially

increased slowly returned to normal.

Table 1: HB Vaccine coverage

Based on the results of a survey conducted by the

Ministry of Health (2018) it was found that there was

still a high incidence of hepatitis sufferers. In 2013

the largest region affected by hepatitis was North

Sulawesi province, but in 2018 the biggest area

affected by hepatitis was Papua Province, but both

regions were still in the same percentage at 0.7%.

This research was carried out based on the number of

provinces in Indonesia. due to the high incidence of

hepatitis, the government is calling for this problem

to be taken seriously, and it is hoped that this problem

can be overcome by administering immunizations

that begin at birth in the world. It’s no secret that

vaccine jabs create distress, for infants and parents

alike. The usual routine in pediatricians’ offices is to

get the shots done quickly and then pass the baby into

mom’s arms for some comfort. Some physical

comfort and a soothing voice may make routine

vaccinations a little easier on babies without resorting

to painkillers like acetaminophen, a new study

suggests. Overall, the researchers found, the 5-S

groups showed fewer signs of pain — less grimacing

and frowning. And their crying faded sooner.

Provision of the 5's method of intervention is

effective in reducing the pain response in infants

when taking blood.

Based on the new study, the result is less pain and

a lot less crying, said Dr. John W. Harrington, of

Eastern Virginia Medical School and Children’s

Hospital of the King’s Daughters in Norfolk, who led

the study.Crying is part of normal infant behavior

and plays an important role in the mutual regulation

between infant and parent. However, up to 20% of

infants cry excessively. Wessel’s definition of infant

excessive crying is often used: crying for at least

three hours per day for at least three days per week,

and at least for three weeks in a row. In clinical

practice, this definition is not very useful as parents

may also perceive less frequent crying as a problem.

Crying is therefore considered excessive when

parents experience it as such.

Crying problems are burdening to infants and

parents and are associated among others with

impaired infant sleep, parental exhaustion and

depression, and shaken baby syndrome. For some

families, the excessive crying is so unbearable that

infants are hospitalized to alleviate parental stress and

family disturbance. Only in 5% of excessively crying

infants, however, a medical cause for the crying can

be found. Effects of behavioral methods to reduce

infant cry and fuss problems in infants younger than

six months have rarely been reported and do not take

into account the immaturity of newborn babies. New

solutions that reduce infant crying are therefore

warranted.

The Effect of Methods 5 S: Swaddling, Side/Stomach Position, Sushing, Swingging, Sucking with Pain Responce on Baby after HB-0

Immunization

445

2 RESEARCH METHODS

Type of research was quantitative research. This

study used a Quasy Experiment research design with

a one group pretestpost test design, because this study

is directed to find out how the 5'S method

(Swaddling, Side / Stomach Position, Swinging,

Sushing and Sucking) on the pain response in infants

after immunization HB-0. Design of Research.

Information:

A1 : Group before 5’S method

X : Group treatment 5’S method

A2 : Group after 5’S method

Figure 2: Treatment 5’S method swingging

The location of this research at Grandmed Lubuk

Pakam Hospital.There are some reason researcher

doing this research:

• The number of babies receiving Hb-0

immunization at Grandmed Lubuk Pakam

Hospital.

• No research has been conducted on the effect of

the 5'S method on pain responses in infants after

• Hb-0 immunization at Grandmed Lubuk Pakam

Hospital.

• The location of the study is close to the residence

of the researcher, so that researchers will more

easily conduct research.

Based on preliminary studies conducted by

researchers note that there are 270 babies who get

Hb-0 immunization for 3 last month (January,

February, March) 2019 at the Grandmed Lubuk

Pakam Hospital.

Population was a large number of subjects or

possesses certain characteristics, the subject can be

humans, animal experiments, data from laboratories,

hospitals, etc, and the characteristics of the subject

itself are determined according to theplace and

purpose of the study (Sastroasmoro, 2017). The

population in this study based on the results of a

preliminary study of the study is 270 babies who

received Hb-0 immunization in the last 3 months 3

(January, February, March) in 2019.

Based on the survey, there were estimated to be

40 babies who get Hb-0 immunizations every month.

Sample is a portion of population selected in a

particular way, technique of sampling in this research

was done by purposive sampling technique that is

how to choose a sample among population

accordance with the specific sample inclusion

criteria (Sastroasmoro, 2017). To determine the

number of samples in this research used calculations

through the Lameshow formula (Firdaus, 2015)

sample size obtained from the formula above was 40

people. Inclusion Criteria, 1) Baby 0 – 7 day, 2) The

baby’s parents allowed if the baby be a sample for

research, 3) Baby with normal weight (2500-4000

gram), 4) Baby with stable condition (didn’t fever,

normally breath). Ekslusion Criteria, 1) Babies

mounted on a ventilator, 2) Babies mounted on a

ventilator who have cyanosis, 3) Babies with immune

system disorders, 4) Babieswho have congenital

heart abnormalities. Infants’ CR was assessed with

an experimental task that consisted of two conditions

each composed of three phases. Each phase lasted

two minutes. During the baseline phase of the parent

condition, the parent sat on a chair with the infant on

his lap.

Method Collecting the Data, Primary data in this

research were obtained from the results of direct

observation sheets about the pain response

experienced by infants after getting Hb-0

immunization at Grandmed Lubuk Pakam Hospital,

Secondary data of this research were obtained the

data Medical Record at Grandmed Lubuk Pakam

Hospital. Data measurement method is a method

used to measure variables so that the characteristics

of these variables are found, on the dependent

variable the effect of the 5'S method (Swaddling,

Side / Stomach position, Sushing, Swinging, and

Sucking) is measured when the baby is immunized

Hb-0 and the measurement results will be included

in the observation period of the NIPS (Neonatal

Infant Pain Scale) pain measurement scale and an

assessment is given based on the baby's response in

accordance with the NIPS pain scale. The greater the

score obtained, the greater the perceived pain

response.

ICHIMAT 2019 - International Conference on Health Informatics and Medical Application Technology

446

While the smaller the score obtained, the smaller the

perceived pain response.If the score is 0 then the pain

is not felt if the score is 1-3 then the pain is felt a little

(mildpain) if the score is 4-6 then the pain is felt and

disturbs comfort (moderate pain) whereas if the score

is obtained 7-8 then the pain is felt and very disturbing

(severe pain). In this resrach the data analysis was

carried out in stages, namely: 1) Univariate Analysis,

The analysis is used to obtain a description of the

frequency distribution or the magnitude of the

proportions based on the variables studied, namely

the independent variable (5'S method) and the

dependent variable (infant pain response during

immunization)

Table 2: Showed the Percentage of each baby age

who is doing Hb-0 Immunization

Usia Responden Frekuensi Percentage

(Days) (People ) (%)

0 7 17.5

1 12 30

2 6 15

3 5 12.5

4 4 10

5 3 7.5

6 2 5

7 1 2.5

Total 40 100

We care about your child’s comfort. You are an

important member of your child’s healthcare team.

You know your child best. We want to partner with

you to help control your child’s pain. If you have

questions or concerns, please speak up and let your

child’s nurse know. While we may not be able to

make your child pain free, this is what we can do.

Assess your child’s pain. This is the first step to

understand and treat pain.oWeuse pain scalesbased

on the child’s age, ability to communicate and

preference. We work with you and your child to

decide which one works best. The pain scale you

choose is used the whole time your child is in the

hospital. unlessyourchild’scondition changes.Work

with you and your child to come up with a goal for

pain control. Learn what has worked before to control

your child’s pain and put that information in your

child’s plan of care. Use medicine and non-drug

methods to control your child’s pain. Teach you about

other methods you can use to control your child’s

pain. Often a combination of medicine and comfort

methods will give the best pain relief.

In this study data were obtained from the

observation sheet on the NIPS pain scale for pain

response. The measurement results are compared to

test the research hypothesis. The statistical test in this

study uses paired sample t-test with a significant

value <0.05, if the results of the study p value <0.05,

then the null hypothesis is rejected, meaning that the

alternative hypothesis is accepted, which means that

there is an effect of the 5'S method on the pain

response in infants when immunizing the

Distribution of Respondents Based on Age

Characteristic in Infants Receiving Hb-0

Immunizations.

If you think medicine is needed, please let your

child’s nurse know. In the hospital a doctormust order

pain medicine before a nurse can give it to a patient.

Your child’s nurse works with you to decide what is

needed. In clinic your child’s doctor or nurse talks

with you aboutthepain medicine plan. You can start

using some simple methods if your child seems

uncomfortable or in pain. These methods are often

able to provide comfort and distraction that may

decrease your child’s pain. At the hospital we have

options to provide pain control without medicine.

The nurse, nursing assistant or child life therapist can

work with you to choosethe best tools for your child.

They can give youtipsabout how to use the tools

that are chosen.We also have another Health Fact for

You titled Non-drug Pain Control for Kidsthat gives

tipsbased on your child’s age. These methods can be

used with or without medicine. Pain control research

teaches us that the best pain control happens when we

combine medicines that work in different ways, and

non-drug methods of pain control. We suggest you

try these non-drug methods with your child when you

feel they may be helpful. Neonatal Infant Pain Scale

(NIPS)At the American Family Children’s Hospital

(AFCH) the NIPS is used in children less than one

year of age. Children at this age are not able to tell us

if they are in pain. This scale uses body language to

help us to understand if a child is in pain. A child is

evaluated and either scored a 0 or 1 in each category

based on their behavior. A total score is calculated.

Most of the time a score greater than 3 tells us a child

is likely to be experiencing pain or discomfort. If you

notice this, you could try some of the comfort

methods listed, Repositioning, Singing or soft music,

Gentle stroking, Rocking with the child in a rocking

chair, Swaddling, Pacifier, Holding a comfort item or

blanket

The Effect of Methods 5 S: Swaddling, Side/Stomach Position, Sushing, Swingging, Sucking with Pain Responce on Baby after HB-0

Immunization

447

Table 3: Scale Pain Neonatal Infant Pain Scale

(NIPS)

NO Parameter Condition Skor

Eks

ression Rileks 0

of Face Cr

Crying Not Crying 0

Loud cr

Breathin

Rileks 0

Pattern

Changes

Breathin

Pattern

Arm Restrained 0

Rileks 0

Fleksi 1

Ekstensi 2

Restraine

Rileks 0

Fleksi 1

Ekstensi 2

Aroused Sleep

State

Wake up 0

Talktative 1

Information:

Skor 0 : No Pain

Skor 1 – 3 : Mild Pain

Skor 4 – 6 : Moderate Pain

Skor 7 – 8 : Severe Pain

This study, Harrington said, was designed to test

whether the measures work — not how effectively

they can be done in everyday practice. Harrington had

pediatric residents on hand to do the 5 S’s, which is a

luxury not available in the real world.But ideally,

parents can be taught over the course of their routine

well-child visits to perform at least some of the 5 S’s,

according to Harrington. That way, parents will learn

some extra tools for soothing their baby anytime, and

not just after a needle stick.

3 RESULTS AND DISCUSSION

Swaddling recreates the snug packaging inside the

womb and is the cornerstone of calming. It decreases

startling and increases sleep. And, wrapped babies

respond faster to the other 4 S’s and stay soothed

longer because their arms can’t wriggle around. Table

4 found that Pretest Swaddling Pain Scale is Mild

pain (1-3) of 8 people (20%), Moderate pain scale (4-

6) of 9 people (22.5%), severe pain ((7-8) ) as many

as 23 people (57.5%) and the Posttest Swaddling pain

Scale ie no pain (0) as many as 6 people (15%), Mild

pain scale (1-3) as many as 28 people (70%) and

Moderate pain scale (4-6) as many as 6 people (15%).

Table 4: Pain Scale Pretest and Post swaddling

Pain Scale Pre test Pos test

o Pain

(

)

8 6

Middle Pain (1-3)

9 28

Moderate Pain (4-6)

23 6

Total

40 40

Table 5 getting that Pretest Side/Stomach Position

no pain (0) as many as 8 people (20%), Mild pain (1-

3) as many as 12 people (30%), Moderate pain scale

(4-6) as many as 18people (45%) and severe pain (7-

8) as many as 2 people (5%) and scale of mild pain

and scale pain Posttest Side/Stomach Position

namely no pain (0) as many as 21 people (52,5%),

Mild pain (1-3) as many as 18 people (45%), and

Moderate pain (4-6) as many as 1 people (2,5). The

back is the only safe position for sleeping, but it’s the

worst position for calming fussiness. This S can be

activated by holding a baby on her side, on her

stomach or over your shoulder. You’ll see your baby

mellow in no time.

Table 5: Pain Scale Pretest and Pos tside/Stomach

Position

Pain Scale Pre test Post test

o Pain

(

)

8 21

Middle Pain (1-3) 12 18

Moderate Pain (4-6) 18 1

Severe Pain (7-8) 2 -

Total 40 40

Table 6 getting that Pret est Shushing and

Swingging namely no pain (0) as many as 5 people

(12,5%), Mild pain (1-3) as many as 8 people 20%),

Mild pain (4-6) as many as 21 people (52,5%), and scale

severe pain

as many as 6 people (15%)and scale pain

Post Test Swingging and Shushing no pain (0) as

many as 13 people (32,5%), Mild pain (1-3) as many

as 23 people (57,5%), and scale mild pain (4-6) as

many as 4 people (10%)

Table 6: Scale Pain Pretest and Post sushing and

Swinging

Pain Scale Pre test Post test

o Pain

(

)

5 13

Middle Pain (1-3)

8 23

Moderate Pain (4-6)

21 4

Severe Pain (7-8)

Total

40 40

ICHIMAT 2019 - International Conference on Health Informatics and Medical Application Technology

448

Table 7 found that the Pre Test sucking was no pain

of 3 people (7.5%), Mild pain (1-3) of 5 people

(12.5%), Moderate pain (4-6) of 7 people (17.5%)and

severe pain (7-8) as many as 25 people (62.5%) and Pain

Test Post Sucking Scale no pain (0) as many as 7 people

(17.5), Mild pain (1- 3) as many as 25 people (62.5),

Moderate pain (4-6) as many as 7 people

(17.5%) and

severe pain (7-8) as many as 10 people (2.5%)

Swaddling, Side/Stomach Position, Sushing,

Swinging and Sucking Against pain. Pain Response

in Infants After Hb-0 Immunization at Grandmed

Lubuk Pakam Hospital 2019.That the significant

value of pre-test and post-test Sucking = 0,000 (ɑ

<0.05) which means that there was an influence

before and after the Sucking treatment. Based on the

results of data analysis using paired sample t test

obtained p value (0.005) <ɑ (0.05), which means that

the Alternative Hypothesis was accepted, which

means there was an effect of Method 5'S (Swaddling,

Side/Stomach).

Table 7: Scale Pain Pretest and postsucking

Pain Scale Pretest Posttes

o Pain (0) 3 7

Middle Pain (1-3) 5 25

Moderate Pain (4-6) 7 7

Severe Pain (7-8) 25 1

Total 40 40

It’s no secret that vaccine jabs create distress, for

infants and parents alike. The usual routine in

pediatricians’ offices is to get the shots done quickly

and then pass the baby into mom’s arms for some

comfort. But in the new study, researchers tested the

so-called “5 S’s” approach — a method of soothing a

fussy baby popularized by pediatrician Dr. Harvey

Karp in the book “The Happiest Baby on the Block

4 CONCLUSIONS

Based Overall, our study concluded that the

physical intervention of the 5 S’s (swaddling,

side/stomach position, shushing, swinging, and

sucking) provided

decreased pain scores on a validated pain scale

and decreased crying time among 2- and 4-month-old

infants immediately after routine vaccinations. The

use of 5 S’s did not differ from the use of 5 S’s and

sucrose. This simple physical intervention will

require additional studies to see whether it is

reproducible for other painful procedures and

whether parents can be taught to perform the 5 S’s

reliably.Parental and mechanical soothing using

swaddling, sound, and movement promptly induced a

CR in infants. This has important clinical

implications for soothing fussy and crying infants.

Future studies should investigate the effects of

parental versus mechanical soothing in the home

setting.

Based on the study, the 5S's physical intervention

are effective toward pain and length of crying after

immunization injection. By providing effective 5S's

physical intervention education and training to

parents will contribute to decrease pain after

immunizations injection.

There are Effect of 5’S Method (Swaddling,

Side/Stomach Position, Swinging, Sushin and

sucking) on pain response in infants after Hb-0 at

Grandmed Lubuk Pakam Hospital 2019 with p

value<0,00

ACKNOWLEDGEMENTS

Physical intervention of the 5 S’s (swaddling,

side/stomach position, shushing, swinging, and

sucking) provided decreased pain scores on a

validated pain scale and decreased crying time among

2- and 4-month-old infants during routine

vaccinations. The use of 5S’s did not differ from 5S’s

and sucrose.

We thank the nursing staff at General Academic

Pediatrics at Children’s Hospital of the King’s

Daughters and our patients for allowing us to perform

this study during normal working hours.

Researcher are grateful to all participants and staff

who have been helping and can be used as input and

source of information in overcoming pain in infant

after Hb 0 immunization at Grandmed Lubuk Pakam

Hospital.

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