What parents need to know about pain in newborns

Just because newborn babies can’t tell you they feel pain doesn’t mean they don’t feel pain. They do. And parents can help.

We tend to think that newborns are too little to really experience pain, and that if they do experience it, they soon forget it. However, research has shown that, indeed, babies do experience pain — and that repeated painful experiences in the newborn period can lead to both short- and long-term problems with development, emotions, and responses to stress.

This is particularly a problem for babies who need many medical procedures after they are born, such as premature babies, babies with certain birth defects, and those who have birth complications or get sick shortly after birth. But even perfectly healthy babies may have some painful procedures, such as heel sticks for newborn screening tests, immunizations, or circumcisions.

That’s why the American Academy of Pediatrics (AAP) created a policy statement on the prevention and management of procedural pain in newborns: to lessen the pain newborns experience. While the policy statement is written for health care providers, it’s important for the parents of newborns to be aware of it too.

We certainly need to avoid doing painful procedures in the first place. The policy statement does say that we should be very thoughtful and careful when it comes to choosing to do painful things to babies. But some of the painful things we do are either necessary or very helpful to the health of babies now and in the future.

Luckily, there are things health care providers — and parents — can do.

It turns out that even something as simple as holding a baby during a procedure can make a difference. Swaddling the baby, or just holding him or her in a bent position with the arms tight against the body, has been shown to lessen pain. So has breastfeeding during the procedure — or giving expressed breast milk. It also can help to simply look at and gently talk to the baby, while stroking the face or back. If a child is very sick or the procedure is complicated, it may not be practical to hold, nurse, or stroke and talk to a baby during a procedure, but it certainly could be done during a heel stick or immunization.

Another simple way to help is by giving babies sucrose, or sugar. It’s not fully clear how sucrose helps, but it does (glucose, which is similar to sucrose, can work too). It may be that the sweet taste activates natural pain-killing chemicals in the body. It’s best to give it about 2 minutes before the procedure, and the effects last about 4 minutes; for longer procedures such as circumcision, a few doses may be needed. If you talk to and massage the baby along with giving the sucrose, the effects may be even stronger.

For more painful procedures, there are medications (such as opioids, like morphine) that can be used. These medications have side effects, and must be used very carefully, but the AAP urges doctors to always think about using them.

So, parents, if you are told that your baby is going to have a procedure, ask questions. Ask if the procedure is necessary. If it is, ask what can be done to prevent or lessen pain. Ask if you can hold, or caress and talk to, your baby. Ask about using sucrose or glucose. Ask if there are other medications that might help.

Hopefully you won’t need to; hopefully, your doctor or nurse will suggest something before you even have a chance to say anything. But if they don’t, do what your baby can’t do: speak up.