Newborns often experience acute pain due to necessary medical procedures such as vitamin K injections, blood sampling, and vaccinations. Infants in neonatal intensive care may undergo up to 17 painful procedures daily, and untreated pain during this critical period can lead to immediate and long-term adverse outcomes, including disruptions in pain processing, neurodevelopment, and physiological stability.
Despite available evidence-based pain management strategies, their implementation remains inconsistent in clinical practice. To address this, the Canadian Paediatric Society (CPS) has updated its position statement, providing comprehensive recommendations for a multidimensional approach to managing pain in newborns.
Understanding Acute Pain in Newborns
Newborns face numerous painful interventions, from routine blood draws to immunizations. Without adequate pain relief, these experiences can have lasting impacts. The CPS emphasizes the importance of consistent pain management practices in healthcare facilities and has identified key areas to focus on:
• Establishing organization-wide pain management frameworks.
• Training care providers in pain prevention and assessment techniques.
• Implementing strategies to minimize painful procedures.
• Actively engaging parents in decision-making and pain care.
Nonpharmacologic Interventions for Infant Pain
The CPS highlights several evidence-based nonpharmacologic methods that are safe and effective for reducing pain in newborns:
• Direct breastfeeding: Breastfeeding during painful procedures provides comfort and natural analgesic effects.
• Skin-to-skin care: Holding the infant on the parent’s chest, with maximum skin contact, promotes warmth and security.
• Non-nutritive sucking: Using a pacifier helps to calm and distract the infant during procedures.
• Facilitated tucking: Positioning the infant in a side-lying, flexed position offers a sense of containment and comfort.
• Sweet-tasting solutions: Oral sucrose solutions (e.g., 24% sucrose) can effectively reduce pain when given before procedures.
Pharmacologic Pain Management
Pharmacologic interventions are reserved for more invasive or surgical procedures. CPS recommendations include:
• Topical anesthetics: Used cautiously for procedures like lumbar punctures or circumcision.
• Acetaminophen: An effective adjuvant for post-operative pain but not recommended for routine procedural pain.
• Opioids: Administered for major surgical or invasive procedures under close monitoring.
• Sedative agents: Used sparingly and only as an adjuvant, with midazolam avoided in infants younger than 34 weeks.
Prevention and Pain Assessment Strategies
Prevention
• Avoid routine blood sampling whenever possible.
• Cluster blood draws to minimize repeated procedures.
• Perform procedures only when absolutely necessary, ensuring a clear justification.
Assessment
• Train healthcare providers to use validated pain assessment tools appropriate for the newborn’s gestational age.
• Regularly reassess pain, particularly before and after procedures, and document all findings.
The Role of Parents in Pain Management
Parents play a vital role in managing newborn pain. The CPS recommends:
• Including parents in the decision-making process.
• Encouraging maternal or parent-led interventions such as breastfeeding or skin-to-skin contact during painful procedures.
• Having at least two care providers present during procedures, one of whom can focus solely on supporting the parent and infant.
Key Recommendations for Specific Procedures
Needle-Related Procedures
• Use breastfeeding and skin-to-skin care as first-line interventions.
• Sweet-tasting solutions and non-nutritive sucking can serve as second-line measures.
• Avoid routine use of topical anesthetics for heel lance procedures.
Surgical and Major Invasive Procedures
• Use validated pain tools to guide opioid administration.
• Combine opioids with regional anesthesia for effective pain relief.
• Administer acetaminophen as an adjunct for post-operative pain.
Empowering Families in Neonatal Pain Care
The CPS underscores the importance of family involvement in neonatal pain care. Healthcare providers should empower parents with knowledge and resources, enabling them to advocate for their baby’s comfort. Through counseling and collaboration, families become active participants in their infant’s care.
Conclusion
Minimizing and managing acute pain in newborns requires a coordinated effort that blends nonpharmacologic and pharmacologic interventions, regular pain assessments, and active parent involvement. By following the CPS’s updated recommendations, healthcare providers can ensure that infants experience less pain during critical early life interventions, improving their immediate well-being and long-term outcomes.