In the 16th century, babies were considered sub-human, prehuman and a lower animal in human form. Only recently has procedural pain in newborns been acknowledged. Pain in babies had been the subject of debate within the medical profession for centuries, as many doctors believed that babies’ brains were not developed enough to feel pain.
Now, that there’s evidence that the brains of babies indeed process pain, this has changed the way doctors treat newborns, especially those who are premature or need extra medical attention in the neonatal intensive care unit. Currently, many studies on the use of pharmacological as well as non pharmacological interventions for alleviation of this pain have been conducted. The prevention of pain is important, not only because it is an ethical expectation, but also because repeated painful exposures have the potential for deleterious consequences for the baby.1
What Causes Pain In Babies?
Pain is defined as an unpleasant sensory and emotional experience associated with actual or potential tissue damage. The experience of pain is always subjective. Hence, verbalization is the gold standard for assessment of pain. Since neonates (a newborn child) cannot verbalize their pain, the recognition and management of pain in newborn babies is still sub-optimal in neonatal intensive care units. Studies have documented that babies born at less than 32 weeks of gestation are exposed to 10–15 painful procedures each day, during the first few weeks of life, and in almost 80% of the cases, no treatment for pain relief is offered. [Stevens B, McGrath P, Gibbins S, et al. Procedural pain in newborns at risk for neurology impairment. Pain. 2003; 105(1–2):27-35]
Babies may experience pain because they are sick or injured in some way or from painful procedures, both diagnostic and therapeutic. Caregivers can attempt to minimize pain, whether it is a result of some form of injury or of a procedure.23
How Do Painful Procedures Affect Newborns ?
Procedures are invasive medical treatments. They may be mildly invasive, such as stitches, shots and blood draws or they may be more invasive, as in surgery. Neonates often experience painful procedures during routine care, such as needle insertions, suctioning, gavage-tube placement and tape removal, as well as stressful disruptions, including diaper changes, chest physical therapy, physical examinations, nursing evaluations and exposure to environmental stimuli. Medical procedures can cause your baby emotional distress as well as varying degrees of pain. Pain in neonates is known to cause adverse short and long-term effects. A host of physiological, biochemical and behavioral responses have been noted during painful episodes such as:
A State Of Passivity
When exposed to prolonged pain, neonates enter a state of passivity with few body movements. They have an expressionless face, decreased heart rate, respiratory variability and decreased oxygen consumption, all suggestive of a marked conservation of energy.
Increases The Response Elicited
Prolonged or repeated pain also increases the response evoked by future painful stimuli (hyperalgesia) and non-painful stimuli (allodynia). The consequences include permanent changes in the pain sensitivity which may last till adolescence, resulting in permanent neuro-anatomical, behavioral, emotional and learning disabilities.4
Changes The Structure And Physiology Of The Nervous System
Everyone can feel pain, including infants. Even premature babies can feel pain. Pain affects babies’ nervous systems in many ways, even changing the structure and physiology of the nervous system.
Can Cause Medical Complications
Pain in infants can cause problems with sleep, feeding and self-regulation. It can also make kids hypersensitive or insensitive to pain later in life or lead to chronic pain and other problems later on.5
Here are various measures you must take while putting your infant under any medical procedure:
- Hold your baby, if you can, during the procedure and/or afterward.
- Breastfeed or give sugar water in a bottle or on a pacifier during and/or afterward.
- Use other forms of distraction, such as sucking, rubbing, rocking, singing, shaking a rattle, showing a toy, etc. before, during and afterward.
These measures have been shown to be useful in preterm and term neonates in reducing pain.
Pain is a universal language that can be understood by its vocal sounds, facial expressions, body movements, respiration, color and even its crashing metabolism. Just like adults, babies speak the language too. We should listen seriously and react appropriately.
Pain also makes a deep impression; babies are probably more impressionable than older children and adults. Protecting them from the impact of pain would prevent personal suffering at the beginning of life and the need for psycho therapeutic treatments later.
|↑1||Babies don’t feel pain: A century of denial in medicine, The Second International Symposium on Circumcision, San Francisco, California|
|↑2||Pain and Your Infant: Medical Procedures, Circumcision and Teething, University of Michigan Health System|
|↑3||Babies feel pain ‘like adults’, University of Oxford|
|↑4||American Academy of Pediatrics Committee on Fetus and Newborn, Section on Surgery, and Section on Anesthesiology and Pain Medicine. Prevention and management of pain in the neonate: an update. Pediatrics 2006; 118; 2231-2241|
|↑5||Mitchell A, Boss, BJ. Adverse effects of pain on the nervous systems of newborns and young children: a review of the literature. Journal of Neuroscience Nursing 34 (2002):228-236|