The Effect of Foot Reflexology on Acute Pain in Infants: A Randomized Controlled Τrial 
Tuba Koc., RN, MSc, Research Assistant, • Duygu Gozen, RN, PhD, Msc, Αssociate Professor


Aim: This study was a randomized controlled trial designed to evaluate the effect of foot reflexology applied on infants on acute pain that may arise after vaccine injection.

Methods: The sample consisted of 1- to 12-month-old infants registered in a family health center in Istanbul, Turkey, for healthcare follow-up. A total of 60 infants who met the criteria of the sample group were included in the study; 30 infants constituted the reflexology group and the other 30 constituted the control group.

Although questionnaire forms were used to determine the descriptive characteristics of infant-mother pairs, the Face, Legs, Activity, Cry, Consolability (FLACC) Pain Assessment Scale was used to evaluate pain level.

Infants in the reflexology group received reflexology treatment for an average of 20–30 minutes before vaccination, depending on the physical size of the infant’s foot. Pain, heart rate, oxygen saturation levels, and crying periods of infants in the reflexology and control groups were evaluated before and after vaccination.

Results: The FLACC pain score was observed to be statistically similar between groups. After reflexology was applied to infants in the reflexology group before vaccination, it was determined that the pain score was reduced to .50 ± 1.14. In the examination performed after vaccination, FLACC pain score was found to be 5.47 ± 2.11 in the reflexology group and 9.63 ± .85 in the control group.
A statistically significant difference was observed between the mean FLACC pain scores of infants in the reflexology and control groups (p = .000). The infants in the reflexology group also had lower heart rates, higher oxygen saturation, and shorter crying periods than the infants in the control group
(p <.001).

Linking Evidence to Actions: Reflexology before vaccine reduced the pain level experienced after vaccination. Future research needs to explore different interventional practices.


Pain is an experience that affects people adversely in all age groups, including physical, mental, and social aspects of pain. Previous pain experiences of infants affect their perception of pain.

Physiological indicators of pain in infants include an increase in heart rate, blood pressure, rate of breathing, and a decrease in oxygen level. Behavioral indicators of pain, such as crying, changes in body movements, and facial expressions also are observed in infants. Because infants cannot express verbally their emotions regarding pain, it is important for nurses to assess behaviors of infants through objective data to assess the pain effectively. When an infant’s pain is assessed correctly, the pain can be relieved by using personalized pharmacological and nonpharmacological methods

The belief that newborns did not feel pain changed as a result of the studies conducted in the 1980s’ and research has supported that newborns feel pain.

Since then, numerous diagnosis and treatment studies have been conducted regarding pain management in infants. In addition to the medical treatment, the importance of complementary and alternative treatments (CAT) has increased for pain treatment (Khorshid & Yapucu, 2005).

There are many CAT methods. Reflexology is among these CATs. Reflexology is a reliable, noninvasive treatment method… Reflexology enables endorphin and encephalin release by stimulating the pituitary gland through the pressure and massage performed on reflex points on hands and feet. It resolves problems in organs and body parts that correspond to these points, reduces pain, and relieves discomfort (Wang, Tsai, Lee, Chang & Yang, 2008; Wilhelm, 2009).

Published in: Worldviews on Evidence-Based Nursing, 2015; 12:5, 289–296.

Keywords: reflexology, infant, acute pain,