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Pain relief for infants. Pain Management for Infants: Recognizing and Treating 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 soothe a baby in discomfort. When should pain medication be considered for infants.

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Understanding Pain in Infants: More Than Just Tears

Contrary to outdated beliefs, infants do experience pain, even if they cannot verbalize it. The developing nervous system of babies is fully capable of sensing discomfort, and it’s crucial for caregivers and healthcare providers to recognize and address it promptly. Pain in infants can stem from various sources, including post-surgical soreness, medical procedures, infections, and prolonged immobility.

Recognizing pain in infants requires keen observation and understanding of their non-verbal cues. Healthcare teams employ a multifaceted approach to pain assessment, considering factors such as sleep patterns, irritability levels, appetite changes, and vital signs. This holistic evaluation helps in determining the presence and intensity of pain in babies who cannot communicate their discomfort through words.

Common Causes of Pain in Infants

  • Surgical incisions and post-operative swelling
  • Medical procedures (e.g., IV insertions, blood draws)
  • Infections causing generalized achiness
  • Prolonged immobility leading to muscle soreness
  • Discomfort from medical tubes and devices
  • Skin irritations or pressure sores

Decoding Baby’s Pain Signals: Behavioral Indicators

Infants communicate their pain through a variety of behavioral changes. While these signs may not always indicate pain, a combination of several indicators often suggests discomfort. Understanding these cues is essential for timely intervention and relief.

Key Behavioral Indicators of Pain in Infants

  1. Crying: Increased pitch and duration of crying, or unusual silence in very sick babies
  2. Facial expressions: Furrowed brow, squeezed eyes, quivering chin
  3. Muscle tension: Clenched fists, rigid body, or flailing limbs
  4. Irritability and restlessness
  5. Changes in feeding patterns
  6. Disrupted sleep cycles
  7. Altered movement patterns based on health status and energy levels

Can an infant’s pain response vary. Indeed, each baby may react differently to pain, and their responses can be inconsistent over time. Factors such as the baby’s overall health, energy levels, and the nature of the pain can influence how they express discomfort.

The Crucial Role of Parents in Pain Management

Parents play an indispensable role in managing their infant’s pain. As the primary caregivers who know their baby best, parents are uniquely positioned to detect subtle changes in behavior that might indicate discomfort. Collaboration between parents and healthcare professionals is key to effective pain management in infants.

How Parents Can Assist in Pain Management

  • Maintain a consistent presence or arrange for familiar visitors
  • Communicate observations about pain levels to healthcare staff
  • Provide comfort through gentle touch, holding, and soothing voices
  • Participate in decision-making regarding pain management strategies
  • Implement routine calming activities before and after stressful events

How can parents effectively communicate their observations to healthcare providers. It’s crucial to be specific about changes in behavior, sleep patterns, or feeding habits. Describing the duration and intensity of crying episodes, noting changes in facial expressions, and reporting any unusual responses to touch or movement can provide valuable insights to the medical team.

Non-Medicinal Approaches to Infant Pain Relief

Pain management in infants often begins with non-pharmacological methods. These techniques can be highly effective in reducing discomfort and are often preferred as first-line interventions due to their safety and lack of side effects. Healthcare providers and parents can work together to implement these strategies, tailoring them to the individual needs of each baby.

Effective Non-Medicinal Pain Relief Techniques

  1. Environmental modifications: Reducing light, noise, and activity levels
  2. Pacifier use: Encouraging non-nutritive sucking
  3. Sugar water administration: Using 24% sucrose solution during procedures
  4. Distraction techniques: Employing soothing voices, music, or storytelling
  5. Physical comfort measures: Holding, rocking, or providing gentle motion
  6. Positioning techniques: Ensuring proper containment and warmth
  7. Skin-to-skin contact: Implementing Kangaroo Care when appropriate

How does sugar water help in pain management for infants. Sucrose solution (24%) has been shown to have analgesic effects in infants when administered before, during, and after painful procedures. It works by triggering the release of endogenous opioids, providing a natural pain-relieving effect. However, its use should be carefully monitored and administered under healthcare provider guidance.

The Children’s Comfort Promise™: A Holistic Approach to Pain Management

Healthcare institutions are increasingly recognizing the importance of comprehensive pain management strategies for infants. The Children’s Comfort Promise™ exemplifies this commitment, emphasizing a proactive and multidisciplinary approach to preventing and treating pain in young patients.

Key Principles of the Children’s Comfort Promise™

  • Acknowledging infants’ right to optimal pain relief
  • Employing a team-based approach to pain and anxiety management
  • Integrating both pharmacological and non-pharmacological therapies
  • Fostering collaboration between staff and families
  • Prioritizing prompt pain assessment and effective treatment

How does the Children’s Comfort Promise™ impact day-to-day care. This initiative encourages healthcare providers to consistently implement pain prevention and management strategies in all aspects of infant care. It promotes regular pain assessments, tailored interventions, and ongoing communication with families to ensure that pain relief remains a top priority throughout the treatment process.

Pharmacological Interventions: When and How to Use Pain Medication

While non-medicinal approaches are often the first line of defense against infant pain, there are situations where pharmacological interventions become necessary. The decision to use pain medication in infants requires careful consideration of the pain severity, underlying medical conditions, and potential side effects.

Considerations for Pain Medication Use in Infants

  1. Assessment of pain intensity and duration
  2. Evaluation of the infant’s overall health status
  3. Consideration of potential drug interactions with other treatments
  4. Weighing the benefits against possible side effects
  5. Determining the most appropriate medication and dosage
  6. Monitoring the infant’s response to medication

What types of pain medications are commonly used for infants. The choice of pain medication depends on various factors, but may include acetaminophen for mild to moderate pain, ibuprofen for infants over 6 months old, and in more severe cases, opioid medications under strict medical supervision. Topical anesthetics may also be used for localized pain relief during certain procedures.

Long-Term Implications: The Importance of Effective Pain Management in Infancy

The way pain is managed in infancy can have lasting effects on a child’s development and future pain responses. Research suggests that untreated or poorly managed pain in early life may lead to altered pain sensitivity and increased risk of chronic pain conditions later in life. This underscores the critical importance of effective pain management strategies from the earliest stages of life.

Potential Long-Term Effects of Inadequate Pain Management in Infants

  • Altered pain thresholds and sensitivity
  • Increased risk of developing chronic pain conditions
  • Potential impact on cognitive and emotional development
  • Changes in stress response systems
  • Possible influence on future healthcare-seeking behaviors

How can healthcare providers balance immediate pain relief with long-term considerations. It’s crucial to adopt a comprehensive approach that addresses both acute pain management and potential long-term implications. This involves using the least invasive pain relief methods when possible, carefully titrating medication doses, and implementing strategies to minimize the overall pain experience during medical procedures and treatments.

Advancing Infant Pain Management: Current Research and Future Directions

The field of infant pain management is continuously evolving, with ongoing research aimed at improving our understanding of pain perception in babies and developing more effective treatment strategies. Recent advancements in neuroimaging and biomarker analysis are providing new insights into how infants experience and process pain, paving the way for more targeted interventions.

Emerging Areas of Research in Infant Pain Management

  1. Neuroimaging studies to better understand pain processing in the infant brain
  2. Development of more sensitive pain assessment tools for non-verbal patients
  3. Investigation of long-term outcomes associated with early life pain experiences
  4. Exploration of novel non-pharmacological pain relief techniques
  5. Refinement of pain medication protocols for neonates and infants
  6. Study of genetic factors influencing individual pain responses

What promising new approaches are on the horizon for infant pain management. Researchers are exploring innovative techniques such as music therapy, virtual reality distraction for older infants, and the use of probiotics to modulate pain responses. Additionally, there’s growing interest in personalized pain management strategies based on genetic profiles and individual pain sensitivity assessments.

As our understanding of infant pain continues to grow, so too does our ability to provide compassionate and effective care. By combining cutting-edge research with time-tested comfort measures and a family-centered approach, healthcare providers can ensure that even the youngest patients receive the pain relief they need and deserve. The ongoing commitment to improving pain management in infants not only enhances immediate care but also contributes to healthier developmental outcomes and a more positive relationship with healthcare throughout life.

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.