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Pain Relief for Infants: Understanding and Managing Baby Discomfort

by alexxlab

How do infants experience pain. What are the signs of discomfort in babies. How can parents and healthcare providers alleviate infant pain. What non-medicinal methods are effective for soothing babies. When should pain medication be considered for infants.

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The Reality of Infant Pain: Debunking Common Myths

For many years, it was believed that infants didn’t experience pain in the same way adults do. However, modern research has conclusively shown that this is far from the truth. Babies not only feel pain but may actually be more sensitive to it than older children and adults. This heightened sensitivity is due to their developing nervous systems and inability to contextualize the pain experience.

Why is understanding infant pain crucial? Unmanaged pain in infants can have long-lasting effects on their neurological development, pain perception, and even future health outcomes. Recognizing and addressing infant pain is not just about immediate comfort—it’s an investment in their long-term well-being.

Common Misconceptions About Infant Pain

  • Infants don’t remember pain, so it doesn’t matter
  • Babies cry all the time, so it’s hard to tell if they’re in pain
  • Giving pain relief to infants is dangerous
  • Infants will become addicted to pain medication

These myths have been debunked by extensive research. In reality, infants do have pain memory, which can affect their future pain responses. While babies do cry for various reasons, pain-induced crying has distinct characteristics. When administered correctly, pain relief for infants is safe and essential for their well-being.

Identifying Pain in Infants: Reading the Non-Verbal Cues

One of the biggest challenges in managing infant pain is the inability of babies to verbalize their discomfort. Healthcare professionals and parents must rely on a combination of behavioral and physiological indicators to assess an infant’s pain level. Understanding these cues is crucial for timely and effective pain management.

Behavioral Indicators of Pain in Infants

  1. Crying patterns: Increased pitch and duration of crying
  2. Facial expressions: Furrowed brow, squeezed eyes, quivering chin
  3. Body movements: Tensed muscles, pulled-in arms, raised legs
  4. Sleep disturbances: Difficulty falling asleep or staying asleep
  5. Appetite changes: Refusal to eat or decreased feeding

Is there a difference in pain expression between full-term and premature infants? Indeed, premature or very ill infants may exhibit more subtle signs of pain due to their limited energy reserves. They might become very quiet or ‘floppy’ instead of displaying the more typical tension and movement associated with pain in full-term babies.

Physiological Signs of Infant Pain

  • Increased heart rate
  • Elevated blood pressure
  • Faster breathing rate
  • Changes in oxygen saturation levels
  • Sweating or clamminess

Healthcare providers often use a combination of these behavioral and physiological indicators, along with standardized pain assessment tools, to evaluate an infant’s pain level accurately. This comprehensive approach ensures that even the subtlest signs of discomfort are not overlooked.

Common Causes of Pain in Infants: From Everyday Discomforts to Medical Procedures

Understanding the potential sources of pain in infants is crucial for effective management and prevention. While some causes are obvious, others may be less apparent but equally distressing for the baby. Let’s explore the various factors that can lead to infant pain.

Medical Procedures and Interventions

  • Post-surgical pain from incisions
  • Discomfort from IV insertions or blood draws
  • Pain associated with vaccinations
  • Diagnostic procedures (e.g., lumbar punctures)

How can healthcare providers minimize procedural pain in infants? Employing techniques such as using the smallest needle gauge possible, applying topical anesthetics before needle procedures, and utilizing distraction methods can significantly reduce procedural pain. Additionally, clustering necessary procedures can minimize the frequency of painful experiences.

Everyday Sources of Discomfort

  1. Teething pain
  2. Colic or gastrointestinal discomfort
  3. Ear infections
  4. Skin irritations or diaper rash
  5. Minor injuries from exploring their environment

Parents and caregivers should be aware that these common issues can cause significant discomfort for infants. Recognizing and addressing these sources of pain promptly can greatly improve a baby’s quality of life and overall well-being.

The Role of Parents in Pain Management: Empowering Caregivers

Parents play a crucial role in managing their infant’s pain. As the people who know their baby best, they are often the first to notice subtle changes in behavior that might indicate discomfort. Empowering parents with knowledge and strategies for pain management is essential for comprehensive infant care.

Key Ways Parents Can Help Manage Infant Pain

  • Being present during medical procedures
  • Communicating with healthcare providers about pain observations
  • Implementing non-pharmacological comfort measures
  • Advocating for appropriate pain management
  • Maintaining a calm and reassuring presence

How can parents effectively communicate their observations to healthcare providers? It’s important for parents to be specific about changes in their baby’s behavior, sleep patterns, feeding habits, and general demeanor. Keeping a log of these observations can be incredibly helpful in discussions with medical professionals.

The Importance of Parental Presence

Research has shown that the presence of a parent during painful procedures can significantly reduce an infant’s distress. This is attributed to the comfort and security that a familiar presence provides. Parents can offer physical comfort through holding, skin-to-skin contact, or gentle touch, which can help regulate the baby’s physiological responses to pain.

Moreover, parents are often best suited to interpret their baby’s unique pain cues. They can alert healthcare providers to changes that might not be immediately apparent to others, ensuring more timely and effective pain management interventions.

Non-Pharmacological Pain Relief Strategies: Gentle Approaches to Comfort

While medication has its place in pain management, non-pharmacological strategies play a crucial role in alleviating infant discomfort. These methods are often preferred as first-line interventions due to their safety profile and ability to be implemented readily by both healthcare providers and parents.

Environmental Modifications

  • Reducing ambient light and noise
  • Maintaining a comfortable room temperature
  • Minimizing unnecessary handling or stimulation

Creating a calm, soothing environment can significantly reduce stress and discomfort for infants. This is particularly important in hospital settings where overstimulation is common.

Physical Comfort Measures

  1. Swaddling
  2. Kangaroo care (skin-to-skin contact)
  3. Gentle massage or touch
  4. Rocking or swaying motions
  5. Positioning techniques for comfort

These physical interventions can help regulate an infant’s physiological state, promoting relaxation and pain relief. Kangaroo care, in particular, has been shown to have numerous benefits beyond pain management, including improved temperature regulation and bonding.

Sensory Interventions

  • Non-nutritive sucking (pacifier use)
  • Sucrose solution administration
  • Breastfeeding during minor procedures
  • Music therapy or white noise

How does sucrose solution work for pain relief in infants? Sucrose (sugar water) is believed to trigger the release of endogenous opioids, providing a natural analgesic effect. When administered 2 minutes before a painful procedure, it can significantly reduce pain responses in infants.

Pharmacological Approaches to Infant Pain Management: When Medicine Is Necessary

While non-pharmacological methods are often the first line of defense against infant pain, there are situations where medication becomes necessary. Understanding the appropriate use of pain relief medications in infants is crucial for both healthcare providers and parents.

Types of Pain Medications for Infants

  • Acetaminophen (Paracetamol)
  • Ibuprofen (for infants over 6 months)
  • Topical anesthetics (for minor procedures)
  • Opioids (for severe pain, typically post-surgery)

When should pain medication be considered for infants? Pain medication is typically considered when non-pharmacological methods are insufficient, for moderate to severe pain, or for anticipated painful procedures. The decision to use medication should always be made in consultation with a healthcare provider, taking into account the infant’s age, weight, and overall health status.

Considerations for Medication Use in Infants

  1. Accurate dosing based on weight
  2. Monitoring for side effects
  3. Assessing the risk-benefit ratio
  4. Considering potential drug interactions
  5. Duration of treatment

It’s crucial to note that infants metabolize drugs differently than adults, and their developing organs may be more sensitive to medication effects. Therefore, careful consideration and close monitoring are essential when administering pain relief medications to infants.

Long-Term Impact of Unmanaged Infant Pain: Why Early Intervention Matters

The importance of effectively managing infant pain extends far beyond immediate comfort. Research has shown that unmanaged pain in early life can have significant long-term consequences on an individual’s health and well-being. Understanding these potential impacts underscores the critical nature of comprehensive pain management strategies for infants.

Neurological and Developmental Effects

  • Altered pain perception in later life
  • Increased risk of chronic pain conditions
  • Potential impacts on cognitive development
  • Changes in stress response systems

How does early pain experience affect an infant’s developing brain? Studies have shown that repeated or prolonged pain experiences can lead to structural and functional changes in the brain. These alterations can affect how the brain processes pain signals in the future, potentially leading to increased pain sensitivity or chronic pain conditions later in life.

Psychological and Behavioral Impacts

  1. Increased risk of anxiety and depression
  2. Potential for post-traumatic stress symptoms
  3. Alterations in social-emotional development
  4. Impact on future healthcare-seeking behaviors

Infants who experience poorly managed pain may develop negative associations with healthcare settings, leading to anxiety or avoidance of medical care in the future. This underscores the importance of positive, pain-minimized healthcare experiences in early life.

Physiological Effects

  • Potential impact on immune system function
  • Alterations in hormonal responses
  • Changes in pain threshold and tolerance

Research suggests that early pain experiences can influence the development of the body’s stress response systems, potentially affecting how an individual responds to stressors throughout their life. This highlights the interconnected nature of pain management and overall health outcomes.

Given these potential long-term impacts, it’s clear that effective pain management in infancy is not just about immediate comfort—it’s an investment in the child’s future health and well-being. Healthcare providers and parents must work together to ensure that infant pain is recognized, respected, and appropriately managed to promote optimal development and long-term health outcomes.

Advances in Infant Pain Research: New Horizons in Understanding and Treatment

The field of infant pain research has seen significant advancements in recent years, leading to improved understanding and more effective management strategies. These developments are paving the way for more nuanced and targeted approaches to infant pain relief.

Neuroimaging Studies

  • Functional MRI insights into infant pain processing
  • EEG studies on pain-related brain activity
  • Near-infrared spectroscopy for assessing cortical responses to pain

These imaging techniques have provided unprecedented insights into how the infant brain processes pain stimuli, allowing researchers to better understand the neurological basis of infant pain experiences and develop more targeted interventions.

Genetic Factors in Pain Sensitivity

Emerging research is exploring the role of genetics in individual pain sensitivity and response to analgesics. This field of study, known as pharmacogenomics, holds promise for personalized pain management strategies tailored to an infant’s genetic profile.

Novel Pain Assessment Tools

  1. Automated facial recognition systems for pain detection
  2. Wearable devices for continuous physiological monitoring
  3. Machine learning algorithms for pain prediction

These technological advancements are enhancing our ability to detect and quantify infant pain more accurately and objectively, potentially leading to earlier and more effective interventions.

Innovative Non-Pharmacological Interventions

  • Virtual reality distraction techniques
  • Targeted vibrational therapy
  • Refined sucrose formulations for enhanced pain relief

Researchers are continually exploring new and improved non-pharmacological methods for pain relief, aiming to provide effective alternatives or complements to traditional pain management approaches.

How might these research advances change infant pain management in the future? As our understanding of infant pain deepens, we can expect to see more personalized, targeted, and effective pain management strategies. This could lead to improved outcomes, reduced reliance on medications, and better long-term health prospects for infants who undergo painful procedures or experience chronic pain conditions.

The ongoing research in this field underscores the importance of continued investment in understanding and addressing infant pain. As new discoveries emerge, healthcare providers and parents will have access to an expanding toolkit of strategies to ensure that infants receive the most appropriate and effective pain management possible.

Pain in Infants (Babies)

Article Translations: (Spanish) (Hmong) (Somali)

Our commitment to pain management

We believe infants have a right to the best level of pain relief that can be safely provided. The Children’s Comfort Promise™ states we will do everything possible to prevent and treat pain, so we take a team approach to pain and anxiety management, using medicine and non-medicine therapies. Our goal is to have staff and families work together to assess pain promptly and treat it effectively.

Do infants have pain?

Even though infants are still developing and cannot tell us about their pain, they do feel pain, and their pain can be treated. The health care team will do all they can to relieve pain and make your baby comfortable.

Why do infants have pain?

Pain can have many causes, including:

  • soreness after surgery caused by:
    • the incision (an opening made in surgery)
    • stretching or swelling of tissue or organs
  • procedures such as starting an IV or drawing blood for a lab test
  • nerves that sense tissue damage or swelling
  • an achy feeling that can be caused by an infection
  • sore muscles from being in bed for a long time
  • discomfort from tubes
  • skin abrasions or sores

How do we know an infant is in pain?

Infants cannot tell us about their pain in words, like older children, but they do give us clues by certain behaviors. We can measure pain by observing things like sleep, irritability, restlessness, appetite, movement, and vital signs (heart rate, breathing rate, blood pressure) to help decide if your baby is having pain.

How do infants act when in pain?

Infants will act differently when they are in pain than when they are comfortable. Each infant will respond individually and may be inconsistent in how they react from time to time. Infants use a combination of behaviors to signal pain. These signs may occur when the infant is not in pain, but combinations are usually present in an infant with pain. Look for the clues listed below. 

  • Crying: Your baby may cry robustly. Crying is often increased in pitch and length of time. Babies who are very sick or premature and have less energy may be silent even though they are uncomfortable.
  • Facial expression: Babies may have a furrowed or deeply wrinkled brow with eyes squeezed shut. Sometimes their chin quivers. Even babies on breathing machines may do this.
  • Muscle tension: Babies will tense up their muscles, pulling the arms in and the legs up or sometimes stretching everything out (this is called flailing). They may also clench their fists or keep their body rigid. Babies who are very sick may lose muscle tension and become floppy.
  • Babies in pain are also often irritable, restless, may refuse to eat and might be unable to sleep.
  • Movement will depend on your baby’s health status and energy level. Some babies will squirm and vigorously bend arms and legs. Babies that are frail may be very quiet and not move.
  • Sleep/wake patterns: Babies in pain are often fussier and sleep less. Some babies may withdraw and seem to be asleep all the time.

What can parents do?

Parents have a very important role. Because you know your baby best, you can work closely with Children’s staff (such as doctors, nurses, or child life specialists) to make decisions about managing pain. You are the best person to help your baby deal with new or difficult situations. To help your baby cope with pain, you can:

  • Be present, or ask others who know your baby to visit.
  • Tell the staff if you think the pain is not being controlled, or if your baby is ready to have pain medicine decreased because he or she is too sleepy or more active.

Use routine calming activities before and after a stressful event: gently patting or massaging your baby, holding, rocking, or talking in a soothing voice.

What can be done to reduce pain?

Non-medicine methods

Pain is both a physical and emotional state. Infants feel pain in their body, and they may also have thoughts and memories about pain. Because infants do not yet have language, it is hard for us to know exactly what they think of it. We will partner with you to try  and reduce both the feelings and the worry about pain. Here are some things that can help reduce pain for your baby:

  • Change the infant’s environment. Less light, noise, and activity at the bedside will often help calm your baby.
  • Sucking on a pacifier can help an infant cope with procedures and other painful events.
  • Sugar water (24 % sucrose) is often used before, during, and after needle and other procedures to help with pain. (See the education sheet for Sucrose 24%)
  • Distractions like using a soothing voice, music, stories, or songs can take an infant’s attention away from the pain or the procedure.
  • Holding your baby; rhythmic motion, rocking or other slow, steady movement can help.
  • Positioning infants so that they are more contained and warmer can be very comforting.
  • Doing Kangaroo Care or skin-to-skin contact can be very soothing and relieve pain.
  • Rubbing or gentle massage helps relax the muscles and the nerves that send pain messages to the brain, so the brain does not sense as much pain.

We will help you to learn how to use any or all of these techniques with your baby. Please check with your child’s nurse or provider to learn more.

Medicines 

There are many types of pain medicines we can use. Which type is best for your baby will depend on many things, including the type of pain, how long it will last, and the reason your child has pain. Some medicines are described below.

Numbing cream, such as 4% lidocaine, can be put on the skin to numb it before a needle procedure such as an IV start, lab draw, or injection. It has to be on for at least 30 minutes to work best and help reduce discomfort with needles. It is not usually used on babies less than 37 weeks of gestation. (See the education sheet, ” Anesthetic (Numbing) cream.”)

Non-steroidal anti-inflammatory drugs (NSAIDs) reduce pain and inflammation. They can be bought over the counter and help manage mild to moderate pain. To reduce stomachache, they should be taken with food or formula when possible. Ibuprofen (Pediaprofen®, Motrin®, Advil®, or another brand) is an example of an NSAID.

Acetaminophen (Tylenol® or another brand) is another over-the-counter medicine that helps treat mild to moderate pain. It has fewer side effects than NSAIDs but does not reduce inflammation.

Opioids are strong medicines used to treat moderate to severe pain, often used after surgery. They may be given by IV or taken by mouth. Opioids can have side effects of itching, nausea, and constipation. Infants will often become sleepy and their breathing can slow down. Sometimes NSAIDs or acetaminophen and opioids are used together. To prevent constipation, your baby may need more fluids than usual, or a stool softener.

After your baby goes home, follow your doctor’ instructions about giving pain medicines. Give the medicine as soon as the pain starts. Severe pain is harder to take away. Be sure to give medicine at bedtime to help your baby sleep comfortably. Some medicines need to be given around the clock. Your doctor will tell you the schedule for this if it is needed.

Be sure to call the doctor if the medicine does not seem to help the pain, or if the pain becomes worse. If you call the doctor about pain you might be asked if your baby has a fever, how severe the pain is based on how your baby is acting, and what the wound or surgical site looks like (if there is one).

Questions?

This sheet is not specific to your child but provides general information. If you have any questions or concerns, please talk to the doctor or the staff working with your child. Your doctor or nurse can also access other pain experts in the hospital. Good pain management is a team effort.

Last Reviewed 6/2020

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Pain management in babies | Pregnancy Birth and Baby

Pain management in babies | Pregnancy Birth and Baby

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If you have given your child too much ibuprofen or paracetamol, call the Poisons Information Centre (13 11 26) immediately or take them to your nearest hospital emergency department.

Key Facts

  • Your baby can’t tell you when they are in pain, so it’s a good idea be aware of the signs.
  • In the first year of life, your baby will have vaccinations and may undergo procedures like blood tests that cause minor pain and distress, but they are very important since they help keep your baby well.
  • There are many ways to help reduce your baby’s pain including talking or singing to your baby, breastfeeding, swaddling and taking your baby to a dark, quiet room.
  • Medicines like paracetamol and ibuprofen can be used for temporary relief of pain and discomfort.
  • Any baby or young child who is unwell or in moderate to severe pain should see a doctor to find the source of the pain.

How do I know if my baby is in pain?

It can be difficult to know if a baby is in pain since they can’t directly communicate how they are feeling, but there are signs that can help you recognise when they are in pain. For example, if a baby is in pain:

  • they may cry or whimper and be unable to settle
  • they may be tense, with clenched fists and may keep their arms and legs close to their chest
  • they may be fidgety, agitated or have an disturbed wake / sleep schedule
  • they may be pale, flushed or sweaty
  • they may shut their eyes tightly, furrowing their eyebrows or have larger than normal pupils

As a parent, you know your child best — if you notice your baby sounds, looks or behaves in an unusual way and you are worried they may be in pain, seek medical advice.

A doctor or baby health clinic can check for other signs that your baby might be unwell, such as an unusual heart rate or blood pressure.

Pain during procedures

In the first year of life, your baby will undergo several medical procedures. These cause minor pain and distress, but they are very important since they help keep your baby well.

In the first 3 days of your newborn’s life, a small amount of blood will be taken from their heel. This newborn screening test (or ‘heel prick test’) is done to check for rare but serious conditions. You will also be offered a number of vaccinations, which help prevent some serious contagious diseases.

If your baby is born prematurely, or with a medical problem, they may also require blood tests, feeding tubes, intravenous (IV) lines, surgery or other medical procedures. While these procedures may cause your child some pain in the short-term, the aim is to ensure their long-term health and wellbeing.

How can I help my baby in pain?

You are one of the greatest sources of comfort to your baby, and just being close to them may have a calming effect.

Some good pain reducing techniques include:

  • talking or singing to your baby
  • taking your baby to a dark, quiet space
  • swaddling your baby
  • breastfeeding or offering your baby a dummy
  • nappy changing

Other pain reducing techniques involve touching or holding your baby in a certain way. Useful techniques include:

  • tactile soothing (stroking your baby’s head and back softly)
  • ‘kangaroo care’ (skin-to-skin contact between you and your child, where you are both covered by a blanket)
  • holding your baby with both hands (to provide a feeling of security)
  • letting your baby hold your finger

If your newborn undergoes a painful procedure, their doctor or nurse may suggest you breastfeed or hold your baby skin-to-skin if possible, or give them a sugar (sucrose) solution. These techniques are proven to have a calming and pain relieving effect on infants.

Video provided by Sharing Knowledge About Immunisation (SKAI)

When can I give my child medicine for pain-relief?

You can give your child medicines such as paracetamol and ibuprofen for short-term relief of symptoms such as pain or fever. While they won’t make the cause of the pain go away, they will make your baby feel and sleep better

  • Paracetamol may be given from 1 month of age, every 4 to 6 hours in the correct dosage (based on age and weight), but no more than 4 times in 24 hours.
  • Ibuprofen may be given from 3 months of age, every 6 to 8 hours in the correct dosage (based on age and weight), but no more than 3 times in 24 hours. If your child has a bleeding disorder, do not give them ibuprofen.
  • Never give your child aspirin, unless specifically instructed by your doctor.

It’s important to make sure that you give your child the correct dose of pain medicines for the shortest period possible. Read the instructions on the pack carefully, as the amount your baby needs will be specific to your baby’s age and weight, and the strength of the formulation you buy. Giving your child too much medicine or giving it too frequently could be harmful.

Where can I get help?

Any baby or young child who is unwell or in moderate to severe pain should see a doctor to determine the source of the pain.

Do not give your baby or child paracetamol or ibuprofen for more than 48 hours without seeing a doctor.

Ask your pharmacist if you are unsure of the correct dose of medicine for your baby.

Speak to a maternal child health nurse

Call Pregnancy, Birth and Baby to speak to a maternal child health nurse on 1800 882 436 or video call. Available 7am to midnight (AET), 7 days a week.

Sources:

Royal Children\u2019s Hospital
(Neonatal Pain Assessment),
Government of South Australia
(Post-natal care),
Miracle Babies foundation
(Miracle Babies foundation),
Royal Children\u2019s Hospital
(Sucrose (oral) for procedural pain management in infants),
Royal Children’s Hospital Melbourne
(Pain relief for children – paracetamol and ibuprofen)

Learn more here about the development and quality assurance of healthdirect content.

Last reviewed: November 2022

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Related pages

  • Helping kids with medical procedures and hospital stays
  • Breastfeeding your baby
  • Immunisation and vaccinations for your child
  • What is kangaroo care?

Need more information?

Pain management (acute) – children – Better Health Channel

If you think your child is in pain, always see your doctor for diagnosis and treatment.