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What do we know about the experience of pain in the baby?

Many procedures and conditions experienced in the NICU involve some pain for the baby. Yet, there are many different opinions on how much the newborn experiences pain, how to tell whether a baby is experiencing pain, and what should be done to relieve pain.

Do babies experience pain?

For adults and older children, we know that there are two parts to a painful experience.

  • The sensory experience. This happens when the pain nerves are stimulated by some harmful event, such as a finger prick or cut.
  • The emotional experience. This is what the sensory event seems or feels like to the individual person. Many things affect this. They include what we remember from past experiences and have learned from our family and friends, how well we are feeling otherwise at the time, and whether it is a brief, one-time event or will last for an unknown amount of time.

For babies, we know that:

  • The sensory experience is well developed as early as 24 weeks of gestation. Babies do feel pain.
  • The emotional experience is not well understood. There are questions about what the sensory event means to the newborn, whether the baby remembers it, and whether it has any effect on the baby after the pain has gone.

How will I know if my baby is experiencing pain?

Unfortunately, there is no one behavior or set of behaviors or physiological signs (heart rate, breathing rate, blood pressure, oxygen levels), that we know for sure mean that a baby is in pain.

  • If there is some obvious painful event, and the baby responds with a change in either behavioral or physiological signs, it seems fairly safe to assume the baby is in pain.
  • However, if there is no obvious event, it is not always easy to tell if a baby is experiencing pain.

A baby may show the following signs that we interpret as indicating pain:

  • crying, grimacing
  • trouble sleeping
  • an increase in motor activity, jerky movements, or stiffness
  • flushing — turning red
  • high breathing and heart rates, or drops in oxygen levels.

Or, a baby may instead show:

  • falling asleep or becoming drowsy
  • a decrease in motor activity, or floppiness
  • turning pale, or no color change
  • decreased breathing rate or slowing of the heart rate.

Babies may show these same behaviors when they are upset or agitated but there is no reason to suspect pain, such as when they are being diapered or are having trouble breathing.

There are now several tools designed to help determine when a baby is in pain. They usually rate how irritable the baby appears (crying, whimpering, grimacing), change in activity level, change in sleep patterns, change from usual ways of responding, and stability of physiological signs (heart rate, breathing, oxygen levels). Becoming familiar with the pain tools help you as a parent to understand your baby’s responses when there is reason to suspect pain.

How can we relieve pain and discomfort for the baby?

There are a number of drugs that can be used for relieving the sensory experience of pain in babies. However, all drugs have disadvantages as well as benefits.

Sometimes, the physician or nurse may decide that using a drug to reduce pain is more harmful to the baby than the experience of pain. For example, drugs used for pain may cause the blood pressure to fall, impair the baby’s ability to breathe, or hide a fever.

There are a number of other ways to help relieve the sensory experience of pain and help the baby cope with the experience of pain or discomfort.

  • Giving rhythmical, repetitive stimulation may block out painful sensations. For example, rocking and music often are soothing.
  • Firm touch may block painful sensations. (Light finger-tip touching usually is arousing, not soothing.) Gentle but firm pressure with the hand, or swaddling the baby tightly, provide a constant touch sensation that may block pain.
  • Distraction can reduce the baby’s attention to painful sensations. Sucking on a pacifier can provide distraction.
  • Use of sucrose(sugar) on a pacifier

Responding quickly to signs of pain or discomfort gives the baby some control. A pacifier also gives some control — the baby can stop and start sucking or adjust the strength of sucking.

Do all babies respond the same to soothing efforts?

No, babies will react in different ways to these attempts to soothe them. For example, for some babies being touched or rocked is not soothing, and for others, sounds or music also may not be calming. It always is important to carefully watch how the baby responds when trying any of the suggested ways to relieve pain or discomfort. Try something else if what you are doing seems to be more stressful than helpful.

When we experience pain or discomfort, each of us tries to deal with it or adapt to it in ways that work for us. Therefore, rather than trying to identify a set of specific behaviors or signs that mean your baby is in pain, it is more helpful to learn how each individual baby tries to cope with being upset or uncomfortable, and what works best to help him or her feel more comfortable.