Managing pain in newborns: A complete guide to infant's comfort and care

Effective management of neonatal pain is crucial, not only for their immediate comfort but also for their future development. (Image: Canva)

Neonates or newborns do feel pain as much as adults do, but their ability to express it is limited. Hence, effective management of neonatal pain is crucial, not only for their immediate comfort but also for their future development. Proper neonatal pain management reduces short-term distress and prevents long-term adverse neurodevelopmental effects.

Understanding Neonatal Pain

Dr. Mamatha R, MBBS, MD, fellowship in neonatology, explains that although a newborn's nervous system is fully developed and capable of perceiving pain, their responses differ from those of older children and adults. Newborns often react to pain with more subtle signs because they cannot express discomfort verbally. Instead, their pain responses may include changes in facial expressions, crying, and increased physiological indicators like a higher heart rate or increased oxygen consumption. In contrast, older children and adults can show more noticeable indicators, such as changes in facial expressions and vocalisations. Physiological responses like increased heart rate and altered breathing patterns are common in both age groups, but the way pain is expressed becomes more complex and recognisable as children grow older.

Comforting techniques

Kangaroo care: Skin-to-skin contact between parents and newborns has been shown to ease pain. It offers warmth, comfort, security and reduces the experience of pain during minor procedures, says Mamatha R.

Breastfeeding and oral sucrose: Breastfeeding not only provides nutrition to the newborn, it also provides comfort. Sucrose solution has a pain-relieving capacity. Its sweet taste triggers the release of endogenous opioids, particularly for short and painful procedures.

Swaddling and facilitated tucking: Both methods of swaddling and tucking have similarities. Swaddling is wrapping a baby in a firm blanket or in arms, where the baby's arms and legs are flexed and held close to the body. Tucking focusses more on positioning and involves gently tucking the arms and legs close to the body, which makes the baby feel secure and comfortable.

Medical techniques

Medical techniques are an important pillar of neonatal pain management, particularly for serious or procedural pain, where adequate control cannot be achieved with non-medical measures alone. These interventions involve medications applied cautiously to ensure safety and efficacy. The choice of medicines should be based on careful consideration of the age, weight, and medical condition of the neonate. Monitoring should be done continuously to establish if the intervention works or has any side effects.

The combination of the different medical and non-medical interventions greatly improves pain relief and hence becomes an all-rounded approach to neonatal pain management.

Integrative approaches

Multimodal pain management: Combinations of various methods, both medical and non-medical, may have an enhanced pain-relieving effect. For instance, using topical anaesthetics along with breastfeeding.

Control of the environment: Minimising the light and noise can likely decrease the amount of stress and pain experienced by neonates.

Parental involvement: Involvement of parents and educating them to participate in managing the pain of the newborn improves the comfort of the newborn. It is easier for parents to give emotional support and apply other interventions that are not related to medications.