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Pain relief for infants. Pain Management Strategies for Infants: Recognizing and Alleviating Discomfort in Babies

by alexxlab

How do infants experience pain. What are the signs of pain in babies. How can parents and healthcare providers effectively manage infant pain. What non-medicinal methods can help alleviate discomfort in infants. When are pain medications necessary for babies.

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Understanding Pain in Infants: Myths and Realities

For many years, it was believed that infants didn’t experience pain in the same way adults do. However, modern research has debunked this myth. Infants do indeed feel pain, and their experiences can have lasting impacts on their development and well-being. Do infants have a fully developed pain response system? While their nervous systems are still developing, babies are capable of experiencing pain from birth, and possibly even before.

The challenge lies in recognizing and addressing infant pain, as they cannot verbalize their discomfort. This makes it crucial for parents and healthcare providers to be attuned to the subtle signs that indicate an infant is in distress.

Common Causes of Pain in Infants

Infants may experience pain for various reasons, some of which might surprise new parents. Are medical procedures the only source of pain for babies? No, pain can arise from multiple sources:

  • Post-surgical discomfort from incisions or tissue manipulation
  • Routine medical procedures like vaccinations or blood draws
  • Infections causing generalized aches or localized pain
  • Prolonged immobility leading to muscle soreness
  • Discomfort from medical devices such as feeding tubes or IVs
  • Skin irritations or pressure sores

Understanding these potential sources of pain can help caregivers be more proactive in addressing their infant’s needs and seeking appropriate medical attention when necessary.

Recognizing Pain Signals in Infants

Since infants cannot verbalize their pain, it’s essential to be observant of behavioral and physiological changes that may indicate discomfort. How can parents and healthcare providers identify pain in babies? Look for these key indicators:

  • Crying patterns: Increased intensity, pitch, or duration of crying
  • Facial expressions: Furrowed brow, squeezed eyes, quivering chin
  • Body language: Muscle tension, clenched fists, or rigid posture
  • Changes in behavior: Irritability, restlessness, or withdrawal
  • Alterations in sleep patterns: Difficulty falling asleep or staying asleep
  • Feeding changes: Refusal to eat or changes in appetite
  • Physiological signs: Elevated heart rate, rapid breathing, or increased blood pressure

It’s important to note that these signs may vary depending on the infant’s overall health status and energy levels. Premature or very ill babies might exhibit more subtle signs of pain, making careful observation even more critical.

The Role of Parents in Pain Management

Parents play a crucial role in managing their infant’s pain. Their intimate knowledge of their baby’s normal behavior and patterns makes them invaluable allies in the healthcare team’s efforts to assess and address pain. How can parents contribute to their baby’s pain management?

  1. Be present: Your familiar presence can be comforting to your baby during stressful or painful experiences.
  2. Communicate with healthcare providers: Share your observations about your baby’s behavior and any changes you notice.
  3. Advocate for your baby: If you believe your infant’s pain is not being adequately controlled, don’t hesitate to speak up.
  4. Participate in comfort measures: Engage in soothing activities like gentle touching, rocking, or talking in a calming voice.
  5. Learn pain management techniques: Work with healthcare professionals to learn specific methods for comforting your baby during painful procedures or recovery periods.

By actively participating in their infant’s care, parents can help ensure that pain is promptly recognized and effectively managed, promoting better outcomes and reducing stress for both baby and family.

Non-Medicinal Pain Relief Strategies for Infants

While medications have their place in pain management, there are numerous non-pharmacological approaches that can be highly effective in soothing infants and reducing their discomfort. These methods can be used alone for minor pain or in conjunction with medications for more severe pain. What are some effective non-medicinal pain relief strategies for babies?

  • Environmental modifications: Reducing light, noise, and activity around the infant can help create a calming atmosphere.
  • Sucking: Offering a pacifier can provide comfort and distraction during painful procedures.
  • Sweeteners: Small amounts of sugar water (24% sucrose solution) given before, during, and after procedures can help reduce pain perception.
  • Distraction techniques: Soothing voices, gentle music, or simple stories can help shift the infant’s focus away from pain.
  • Physical comfort measures: Holding, rocking, or providing gentle, rhythmic movement can be very soothing.
  • Positioning: Swaddling or positioning the infant in a way that provides containment and warmth can offer comfort.
  • Skin-to-skin contact: Also known as “kangaroo care,” this method involves placing the infant directly on a parent’s chest, which can be highly comforting and pain-relieving.

These non-medicinal approaches not only help manage pain but also promote bonding between infants and caregivers, contributing to overall well-being and development.

Medical Approaches to Infant Pain Management

When non-pharmacological methods are insufficient to manage an infant’s pain, medical interventions may be necessary. Healthcare providers carefully weigh the benefits and risks of pain medications for infants, considering factors such as the severity of pain, the infant’s age and health status, and potential side effects. Are there safe pain medications for infants?

Yes, there are several pain relief options that can be used safely in infants when properly administered:

  • Acetaminophen (Paracetamol): Often used for mild to moderate pain and fever reduction.
  • Ibuprofen: Can be used in infants over 6 months for pain and inflammation.
  • Topical anesthetics: For localized pain, such as during minor procedures.
  • Opioids: Reserved for severe pain, such as post-surgical discomfort, and used under close medical supervision.

The dosage and administration of these medications are carefully calculated based on the infant’s weight and specific needs. It’s crucial that parents never administer pain medications to infants without consulting a healthcare provider first.

Pain Assessment Tools for Infants

To ensure effective pain management, healthcare providers use specialized tools to assess pain levels in infants. These tools typically involve scoring systems based on observable behaviors and physiological indicators. What are some commonly used pain assessment tools for babies?

  • FLACC Scale (Face, Legs, Activity, Cry, Consolability)
  • NIPS (Neonatal Infant Pain Scale)
  • PIPP (Premature Infant Pain Profile)
  • CRIES (Crying, Requires oxygen, Increased vital signs, Expression, Sleeplessness)

These assessment tools help healthcare providers objectively measure an infant’s pain level and determine the most appropriate pain management strategy.

Long-Term Impacts of Unmanaged Infant Pain

The importance of effective pain management in infants extends beyond immediate comfort. Research has shown that untreated or poorly managed pain in infancy can have lasting effects on a child’s development and future pain responses. What are the potential long-term consequences of unmanaged infant pain?

  • Altered pain perception: Infants who experience repeated untreated pain may develop heightened sensitivity to pain later in life.
  • Developmental delays: Chronic pain can interfere with normal developmental processes, potentially leading to cognitive or behavioral issues.
  • Stress response alterations: Early pain experiences may affect how the body responds to stress throughout life.
  • Emotional and behavioral challenges: Unmanaged pain in infancy has been associated with increased risk of anxiety and depression in later childhood and adolescence.
  • Impact on bonding: Pain can interfere with the crucial early bonding process between infants and caregivers.

These potential long-term effects underscore the importance of proactive and effective pain management strategies for infants, not just for their immediate comfort but for their overall long-term health and well-being.

Integrating Pain Management into Routine Infant Care

Effective pain management should be an integral part of routine infant care, not just during obvious painful procedures or illnesses. How can pain management be incorporated into everyday care practices for infants?

  1. Regular pain assessments: Incorporate pain evaluation into routine health check-ups and daily care routines.
  2. Preventive measures: Use comfort techniques proactively, especially before potentially uncomfortable procedures.
  3. Education for caregivers: Provide parents and other caregivers with information on recognizing and managing infant pain.
  4. Minimizing painful procedures: When possible, combine necessary procedures to reduce the frequency of painful experiences.
  5. Promoting a pain-aware culture: Encourage healthcare providers and institutions to prioritize pain management as a key component of infant care.

By making pain management a routine consideration in infant care, we can ensure that babies receive the most comprehensive and compassionate care possible, setting the stage for healthier development and more positive healthcare experiences throughout their lives.

The Role of Technology in Infant Pain Management

Advancements in technology are opening new avenues for assessing and managing infant pain more effectively. How is technology being used to improve pain management in infants?

  • Advanced monitoring systems: Devices that can track subtle physiological changes indicative of pain.
  • Virtual reality: While not directly applicable to infants, VR technologies are being explored for use with older children and may inform future approaches for younger patients.
  • Mobile apps: Tools that help parents and healthcare providers track pain indicators and management strategies over time.
  • Non-invasive pain assessment tools: Technologies that can measure pain through skin conductance or brain activity without causing additional discomfort.

These technological advancements hold promise for more precise pain assessment and management in infants, potentially leading to more personalized and effective care strategies.

Ethical Considerations in Infant Pain Management

The management of pain in infants raises several ethical considerations that healthcare providers and parents must navigate. What are some of the key ethical issues surrounding infant pain management?

  • Balancing pain relief with potential side effects of medications
  • Ensuring informed consent from parents for pain management strategies
  • Addressing disparities in pain management across different populations
  • Considering the long-term impacts of pain experiences on infant development
  • Weighing the risks and benefits of painful but necessary medical procedures

Navigating these ethical considerations requires open communication between healthcare providers and families, as well as ongoing research to inform best practices in infant pain management.

Cultural Perspectives on Infant Pain

Cultural beliefs and practices can significantly influence how infant pain is perceived and managed. Different cultures may have varying thresholds for what constitutes concerning pain in infants and different approaches to addressing it. How do cultural factors impact infant pain management?

  • Pain expression: Some cultures may encourage stoicism, potentially leading to underreporting of infant pain.
  • Treatment preferences: Cultural beliefs may influence preferences for traditional remedies over Western medical approaches.
  • Family involvement: The role of family members in pain management may vary across cultures.
  • Spiritual beliefs: Some cultures may attribute pain to spiritual causes, affecting treatment approaches.

Healthcare providers must be culturally sensitive and work to understand and respect diverse perspectives on infant pain while ensuring that all infants receive appropriate pain management.

Future Directions in Infant Pain Research and Management

The field of infant pain management continues to evolve as new research emerges and our understanding of infant pain deepens. What are some of the promising areas of research and development in infant pain management?

  • Genetic factors: Exploring how genetic variations may influence pain sensitivity and response to pain management strategies in infants.
  • Neuroimaging studies: Using advanced brain imaging techniques to better understand how infants process pain at a neurological level.
  • Novel pain relief methods: Investigating new non-pharmacological approaches, such as specific sound frequencies or light therapies, for pain management.
  • Long-term follow-up studies: Conducting research to better understand the long-term impacts of early pain experiences and management strategies.
  • Personalized medicine approaches: Developing more tailored pain management protocols based on individual infant characteristics and responses.

These areas of research hold the potential to significantly advance our ability to assess and manage infant pain more effectively, potentially leading to improved outcomes and reduced long-term impacts of early pain experiences.

As our understanding of infant pain continues to grow, so too does our responsibility to ensure that all infants receive compassionate, effective pain management. By staying informed about the latest research and best practices, healthcare providers and parents can work together to provide the best possible care for our youngest and most vulnerable patients, setting the stage for healthier development and more positive healthcare experiences throughout their lives.

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.