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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 infant discomfort. How can parents help alleviate their baby’s pain. What non-medicinal methods are effective for infant pain relief. When should medication be considered for infant pain management.

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Recognizing Pain in Infants: Signs and Symptoms

Infants, despite their inability to verbalize discomfort, do experience pain. Healthcare professionals and parents must be vigilant in recognizing the signs of infant distress. But how can we identify pain in babies who can’t tell us what they’re feeling?

Infants communicate their pain through a combination of behavioral and physiological cues:

  • Crying: Increased pitch and duration
  • Facial expressions: Furrowed brow, squeezed eyes, quivering chin
  • Muscle tension: Clenched fists, rigid body, or flailing limbs
  • Irritability and restlessness
  • Changes in feeding patterns
  • Disrupted sleep
  • Alterations in vital signs: heart rate, breathing rate, blood pressure

It’s important to note that each infant may respond differently to pain, and their reactions may vary over time. Observing these signs in combination typically indicates discomfort in a baby.

Common Causes of Infant Pain: From Medical Procedures to Everyday Discomforts

Understanding the sources of infant pain is crucial for effective management. What are the most common reasons babies experience discomfort?

  • Post-surgical pain from incisions or tissue manipulation
  • Medical procedures such as IV insertions or blood draws
  • Infections causing generalized achiness
  • Prolonged immobility leading to muscle soreness
  • Discomfort from medical tubes or devices
  • Skin irritations or abrasions

Recognizing these potential pain sources allows caregivers and medical professionals to anticipate and address infant discomfort proactively.

The Role of Parents in Infant Pain Management

Parents play a crucial role in managing their baby’s pain. How can parents contribute to their infant’s comfort?

  1. Be present and engaged during medical procedures
  2. Communicate with healthcare staff about perceived pain levels
  3. Implement routine calming activities before and after stressful events
  4. Provide gentle touch, such as patting or massaging
  5. Use soothing voices and familiar sounds
  6. Hold and rock the baby when appropriate

Parental involvement not only provides comfort but also helps healthcare providers tailor pain management strategies to each individual infant’s needs.

Non-Medicinal Pain Relief Techniques for Infants

Before resorting to medication, several non-pharmacological methods can be employed to alleviate infant pain. What are some effective drug-free pain relief strategies for babies?

  • Environmental modifications: Reducing light, noise, and activity levels
  • Pacifier use: Promoting non-nutritive sucking
  • Sugar water administration: Utilizing 24% sucrose solution
  • Distraction techniques: Employing soothing music, stories, or songs
  • Kangaroo care: Practicing skin-to-skin contact
  • Positioning: Ensuring proper containment and warmth

These methods can be particularly effective for minor discomforts and can complement medicinal approaches for more severe pain.

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

Healthcare institutions are increasingly recognizing the importance of comprehensive pain management for infants. The Children’s Comfort Promise™ exemplifies this commitment. But what does this promise entail?

The Children’s Comfort Promise™ is a pledge to:

  • Recognize infants’ right to optimal pain relief
  • Take a team approach to pain and anxiety management
  • Utilize both medicinal and non-medicinal therapies
  • Encourage collaboration between staff and families
  • Assess pain promptly and treat it effectively

This holistic approach ensures that infant pain is addressed comprehensively, considering both physical and emotional aspects of discomfort.

Assessing Pain in Infants: Tools and Techniques

Accurate pain assessment is crucial for effective management. How do healthcare professionals measure pain in infants who can’t verbalize their discomfort?

Pain assessment in infants involves observing various behavioral and physiological indicators:

  • Sleep patterns
  • Irritability levels
  • Restlessness
  • Appetite changes
  • Movement patterns
  • Vital signs fluctuations

Healthcare providers may use specialized pain scales designed for infants, which combine these observations to quantify pain levels. These tools help in determining the need for intervention and evaluating the effectiveness of pain relief measures.

When to Consider Medication for Infant Pain Relief

While non-pharmacological methods are often effective, there are situations where medication may be necessary. When should parents and healthcare providers consider using pain medication for infants?

Medication may be appropriate in cases of:

  • Severe post-surgical pain
  • Persistent discomfort unrelieved by non-medicinal methods
  • Acute pain from medical procedures
  • Chronic conditions causing ongoing discomfort

The decision to use medication should always be made in consultation with healthcare professionals, considering the infant’s overall health status, the nature and severity of pain, and potential side effects of the medication.

Types of Pain Medications for Infants

When medication is deemed necessary, what types of pain relievers are commonly used for infants?

  • Acetaminophen (Tylenol): For mild to moderate pain and fever
  • Ibuprofen: For infants over 6 months, to relieve pain and reduce inflammation
  • Opioids: For severe pain, typically in hospital settings
  • Topical anesthetics: For localized pain relief during minor procedures

Dosage and administration of these medications must be carefully calculated based on the infant’s weight and age, always under medical supervision.

Long-Term Effects of Untreated Pain in Infants

Addressing infant pain is not just about immediate comfort; it also has long-term implications. What are the potential consequences of inadequately managed pain in babies?

Research suggests that untreated pain in infancy may lead to:

  • Altered pain sensitivity in later life
  • Increased risk of chronic pain conditions
  • Developmental delays
  • Behavioral and emotional issues
  • Changes in stress response systems

These potential long-term effects underscore the importance of effective pain management strategies for infants, emphasizing the need for a proactive approach to infant comfort.

Neuroplasticity and Pain Memory in Infants

The concept of neuroplasticity plays a significant role in understanding the long-term effects of infant pain. How does early pain experience shape an infant’s developing nervous system?

Infant brains are highly plastic, meaning they’re particularly susceptible to environmental influences. Pain experiences during this critical period can:

  • Alter pain processing pathways
  • Affect emotional regulation centers
  • Influence stress response mechanisms
  • Impact cognitive development

This neuroplasticity highlights the importance of minimizing unnecessary pain experiences and effectively managing unavoidable discomfort in infants.

Cultural Perspectives on Infant Pain Management

Pain perception and management can vary across cultures. How do different cultural backgrounds influence approaches to infant pain relief?

Cultural factors that may impact infant pain management include:

  • Beliefs about the nature of pain and suffering
  • Traditional remedies and practices
  • Attitudes towards medical interventions
  • Family roles in caregiving
  • Communication styles with healthcare providers

Healthcare professionals must be culturally sensitive when developing pain management plans, respecting diverse perspectives while ensuring evidence-based care.

Integrating Cultural Practices with Modern Pain Management

How can healthcare systems effectively incorporate cultural practices into infant pain management protocols?

Strategies for cultural integration include:

  • Providing cultural competency training for healthcare staff
  • Offering interpreters and translated materials
  • Incorporating traditional healing practices when safe and appropriate
  • Engaging family members in pain assessment and management
  • Developing culturally tailored education programs for parents

By bridging cultural practices with modern medical approaches, healthcare providers can offer more comprehensive and acceptable pain management strategies for infants from diverse backgrounds.

Technological Advancements in Infant Pain Assessment and Management

As technology continues to evolve, new tools are emerging to enhance infant pain assessment and management. What innovative technologies are being developed to address infant discomfort?

Recent technological advancements include:

  • AI-powered cry analysis systems to detect pain-related vocalizations
  • Wearable devices that monitor physiological indicators of pain
  • Virtual reality distraction techniques adapted for infants
  • Smart pacifiers that deliver precise doses of pain-relieving solutions
  • Advanced imaging techniques to visualize pain responses in the infant brain

These technologies promise more objective pain assessment and targeted interventions, potentially revolutionizing infant pain management in clinical settings.

Ethical Considerations in Infant Pain Research

While technological advancements offer exciting possibilities, they also raise ethical questions. What are the key ethical considerations in conducting pain research on infants?

Researchers and clinicians must navigate several ethical challenges:

  • Obtaining informed consent from parents or guardians
  • Balancing the potential benefits of research with risks to vulnerable subjects
  • Ensuring equitable access to new pain management technologies
  • Protecting infant privacy in data collection and analysis
  • Addressing potential long-term consequences of experimental interventions

Ethical frameworks for infant pain research must prioritize the well-being of the infant while advancing our understanding of pain mechanisms and management strategies.

The Future of Infant Pain Management: Trends and Predictions

As our understanding of infant pain continues to evolve, what trends are likely to shape the future of pain management for babies?

Emerging trends in infant pain management include:

  • Personalized pain management plans based on genetic and epigenetic factors
  • Integration of artificial intelligence in pain assessment and treatment decision-making
  • Development of novel, infant-specific analgesic formulations
  • Increased focus on family-centered care models
  • Expansion of telemedicine for remote pain management support

These trends suggest a future where infant pain management becomes increasingly precise, holistic, and accessible, potentially leading to better outcomes for infants and their families.

Challenges in Implementing Advanced Pain Management Strategies

While the future of infant pain management looks promising, what obstacles might hinder the widespread adoption of these advanced strategies?

Potential challenges include:

  • High costs associated with new technologies and treatments
  • Resistance to change in established medical practices
  • Lack of specialized training for healthcare providers
  • Regulatory hurdles in approving new pain management approaches
  • Ethical concerns surrounding certain advanced interventions

Addressing these challenges will require collaborative efforts from researchers, healthcare providers, policymakers, and patient advocates to ensure that advancements in infant pain management are effectively translated into clinical practice.

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.