No Hurting Allowed

No Hurting Allowed

When I trained as a newborn intensive care physician, we were taught that newborn babies do not feel pain in the same way that older humans do. It was the early 1970s and it was quite routine for newborn patients to undergo surgery with minimal or no pain mitigation.

As a trainee, this unproven concept was difficult to accept. We witnessed our patients in the Neonatal Intensive Care Unit (NICU) daily, on multiple occasions, reacting vigorously to regular procedures such as venipuncture and I.V. placement. When we expressed skepticism, we were informed that the reactions we were observing were based upon the “fact” that babies disliked having their arms and legs restrained for a procedure.

We were told that it had nothing to do with pain perception.

Together with our nursing colleagues, we developed an unofficial means of testing what we were taught. We recorded the relationship between the onset of crying and the application of the preparatory restraint vs. the initiation of the IV procedure.

We found that 83% of our patients did not begin to cry until the needle was inserted.

  Swaddled infant asleep on a white sheet

 

More recently, it has been clearly demonstrated that the components of the nervous system that respond to pain, the nociceptive pathways, are present and functioning even in extremely premature infants. The cautious introduction of pharmaceutical pain management into infant care is based, not on ignorance or indifference, but on the lack of pharmacologic data regarding drug metabolization, appropriate dosage, and the unknown side effects, especially to the developing brain.

Today there is accumulating research data indicating that this caution was justified. However, there is also accumulating evidence that experience of pain in early childhood adversely affects the behavioral response to pain in later life.

Fortunately, pediatric nursing staff have time-tested, non-pharmacologic measures to mitigate painful experiences for their patients. The most basic technique is swaddling, a common method of infant restraint.

Another non-pharmacologic practice includes suckling during the procedure.

Since I completed my training, more than 100 randomized, controlled studies have been performed on the pain moderating effects of suckling formula, breast milk, sucrose, glucose, or other sweet tasting solutions. More than 90% of these studies have demonstrated efficacy in reducing the behavioral response to pain.

 

Newborn infant asleep in hospital

 

Extrapolating from the newborn, it seems reasonable to assume that exposure to pain later in childhood is also likely to have a negative impact on behavioral response as kids grow up. Common sense, non-toxic methods of reducing procedural pain in children are a welcome addition to pediatric pain mitigation practices.

 

Mhairi MacDonald, MD

Emeritus Professor of Pediatrics

 

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