I appreciate the thoughtful review of our report of pain reduction for infant immunization injections1 by Ms Hammer and Drs Schechter and Backer. These readers point out that the needles used for injection in our study do not conform to current immunization recommendations. However, it should be noted that, as stated in our "Results" section, our study was conducted from June 1, 2000, to April 10, 2001. This study period predated the publication of the cited Advisory Committee on Immunization Practices/American Academy of Family Physicians and the American Academy of Pediatrics recommendations in 2002 and 2003, respectively. In 2002, we changed our standard intramuscular injection procedure to use the recommended 25-gauge, 1-in needles.