Effect of needle length on incidence of local reactions to routine immunisation in infants aged 4 months: randomised controlled trial

Diggle and Deeks implicitly suggest that infants should be
routinely immunised with 25 mm long needles inserted into
the skin up to the hub.1

Use of 25 mm long needles might be detrimental to infants,
as I have personally not rarely seen: in lean infants, deep
insertion of 25 mm long needles can very painfully puncture
the periosteum and make the actual injection very difficult
or even impossible without slightly withdrawing the needle
into more extensible tissues, another potentially painful
movement.

Further, bone punctures can lead to osteomyelitis in
infants.2 Such a rare event might have gone undetected in
Diggle and Deeks' small study.

Diggle and Deeks'suggestions are too reductionnist. They
might well protect parents from perceiving local redness and
swelling in their immunised infants. They might as well put
infants at risk of having more painful immunisations or,
even worse although probably very rare, of developing bone
infections.

References

1 Diggle L., Deeks J. Effect of needle length on incidence
of local reactions to routine immunisation in infants aged 4
months: randomised controlled trial. BMJ 2000;321:931-3

2 Goldberg I, Shauer L, Klier I, Seelenfreund M. Neonatal
osteomyelitis of the calcaneus following a heel pad
puncture. Clin Orth