Sunday, March 18, 2012

Do Babies Feel Pain?

Kyla Boyse, R.N.
What is pain?
Pain is an uncomfortable sensation or feeling. It can be constant (always there) or intermittent (coming and going). Pain can be dull and aching, sharp, or throbbing. It can be both physical and mental, and every infant experiences it differently.
What causes pain?
Babies feel pain when their brains send out special signals to their bodies. Usually, they are sick or injured when their brains send these signals. Feeling pain is a signal that something is wrong. There are many causes of pain in babies. There are the typical ones like colic, circumcision, teething, and vaccine (immunization) shots. Some babies may have health problems and may experience pain as part of their disease process or painful treatments.
Do newborns experience pain? How does pain affect babies?
Everyone can feel pain, including infants. Even premature babies can feel pain. Newborns experience pain and should receive relief. Pain affects babies' nervous systems in many ways, even changing the structure and physiology of the nervous system. Pain can cause medical complications and problems with sleep, feeding, and self-regulation. It can also make kids hypersensitive or insensitive to pain later in life, or lead to chronic pain and other problems later on.
What are signs that my baby is in pain?
Because little babies can't tell you anything about how they feel, doctors and nurses are using new tools to help define pain in the babies they care for. Talking to your child's doctors and nurses about pain is important. The more they know about your infant's pain, the more they can help. Infants give certain behavioral signals when they are hurting:
• Crying — Your baby's cry may be more insistent, higher pitched, and may last longer than usual. If your baby is very ill or premature, they may not have the energy to cry, so they may be quiet even though they are in pain.
• Making faces — Your baby may grimace, open their mouth, wrinkle their brow, have deep lines around his nose, and squeeze his eyes shut.
• Body posture and movement — Your baby's body may be tense or stiff, with the arms and legs either pulled in or all stretched out. Your baby may be squirmy and move their arms and legs in and out. If they are premature or very frail or ill, they may be quiet or floppy with low muscle tone, and may even withdraw and seem to be sleeping.
• Irritability — Your baby may be fussy, restless and off their usual schedule, refusing to eat or sleep. Your baby may not be calmed by comforting or feeding.
Measuring pain in babies is difficult. Changes in vital signs (heart rate, breathing rate, and blood pressure), the amount of oxygen in the blood, and the baby's facial expression and behavior are most widely used to rate infants' pain. The doctors and nurses caring for your baby should take regular measurements of your baby's pain, and record the results in the medical chart. If your baby is in pain, the pain needs to be treated.
• There are different pain rating scales used for infants, such as the FLACC Scale (FLACC stands for face, legs, activity, cry, consolability), and the Riley Infant Pain Scale. These pain rating systems look at the baby’s behavior to determine the level of pain.
How can parents help infants in pain?
• Hold your child — with as much skin-to-skin contact as possible.
• Distract your baby with movement, sucking, music, toys, talking, rocking or singing.
• Breastfeed — it may just be the perfect pain reliever for simple procedures, according to a recent review of research studies. Nursing your baby involves holding, skin-to-skin contact, sucking, and a sweet taste. These are all proven ways to reduce the pain a baby feels, combined in one convenient package.
• As an alternative to breastfeeding, give your baby a sugar solution (but never honey—it can cause botulism in babies under one year old) on a pacifier.
• Your doctor can tell you about proper dosing of acetaminophen (Tylenol) or ibuprofen (Advil or Motrin) for your baby, or other medicines to help relieve pain.
Will my baby become addicted to pain medication?
If your baby is in the hospital for a longer time, you may worry about them becoming addicted to the pain medicine. Don't worry: your baby will not become addicted. If your baby needs pain medications and sedatives for a long time, physical dependence may occur. Physical dependence is not the same as addiction — addiction is a psychological problem. Because of this physical dependence, medication doses will be decreased slowly to prevent possible withdrawal symptoms that can occur if the medicine is stopped suddenly. Nurses and doctors will watch your baby carefully for signs of medication withdrawal. Comfort measures such as holding, rocking, and giving a pacifier can be helpful when doses of pain and sedation medications are being decreased.
What about when infants have to have shots or other medical procedures?
Procedures are invasive medical treatments. They may be mildly invasive, such as stitches, shots, and blood draws, or they may be more invasive, as in surgery. Medical procedures can cause your baby emotional distress as well as varying degrees of pain.
As all parents know, children receive a series of vaccine shots in infancy. One study found that using easy behavioral interventions helps babies feel less pain and stress with these shots. The University of Michigan researchers simply had parents distract and engage their infants with sucking (breastfeeding, finger or pacifier), rubbing, rocking, singing, or getting them to look at an interesting object while the staff person got the shot ready. If possible, the parent continued the distraction while the staff person gave the shot.
EMLA and giving glucose (a sugar solution) together were found to alleviate immunization pain in a study of three-month-old infants. Another study found that when parents held their babies, let them suck and gave them a sweet solution during a series or four injections, the babies cried less than without holding and sucking. Both parents and nurses found this strategy easy to use.
For venipuncture (blood draw), a study found that glucose on a pacifier was more effective at reducing infants’ pain than EMLA cream. Breastfeeding, or a pacifier dipped in sugar water is also helpful in decreasing the amount of time spent crying after medical procedures. A review of 17 different studies on giving sucrose with or without sucking on a bottle or pacifier concluded that sucrose is safe and effective for reducing pain from minor medical procedures; however, the dose, use in preemies, and repeated use need more study.
So the bottom line of all these studies is: during shots, blood draws, and other minor medical procedures:
• Hold your baby, if you can, during the procedure and/or afterward.
• Breastfeed or give sugar water in a bottle or on a pacifier during and/or afterward.
• Use other forms of distraction, such as sucking, rubbing, rocking, singing, shaking a rattle, showing a toy, etc. before, during and afterward.
• Ask your doctor about applying EMLA cream before scheduled shots and blood draws.

Written by Kyla Boyse, R.N. 
Reviewed by faculty and staff at the University of Michigan (Updated February 2007)
Content provided by the University of Michigan Health System, Pain and Your Infant: Medical Procedures, Circumcision and Teething

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