For years, doctors and scientists believed infants' brains were not developed enough for them to feel pain, but science has since shown that is not true.
Now, the American Academy of Pediatrics is urging health care providers to take steps to minimize the pain infants feel during medical procedures in their first hours, days and weeks.
And parents, they believe, can play a vital role in comforting their children through non-pharmacologic measures doctors may have overlooked in the past, like simply holding their babies close.
On Monday, the group released a statement aimed at improving the prevention and management of pain experienced by newborns during routine medical procedures.
"I've been working in neonatology since the late '80s and when I started, I was told babies don't feel pain, and if they do, they certainly won't remember it," Erin Keels, director of the neonatal nurse practitioner program at Nationwide Children's Hospital and and an author on the statement, told The Huffington Post. "We have come a long way in the science to show that bio-physiologically they are able to feel a sense of pain, and there are short- and long-term effects to that."
Newborns typically undergo a heel prick to test their blood for certain disorders, for example, as well as a vitamin K injection -- both of which are small but important procedures that can cause some degree of pain.
The type and volume of painful procedures generally increases for babies who are in the NICU, Keels said.
“"When I started, I was told babies don't feel pain, and if they do, they certainly won't remember it."”
Keels emphasized, however, that those procedures are essential and life-sustaining, and the new statement is not a call to eliminate them. Rather, it provides health care providers with tools they can use to minimize pain during necessary procedures -- and reminds them of the significant value of non-pharmacologic relief options.
Keels added that she hopes the statement also encourages medical providers to be judicious about what procedures they use when creating treatment plans for any newborns who require more hands-on medical care.
"We want to avoid as many painful procedures as possible," she said. "That sounds pretty intuitive, but [health providers] need to be really thoughtful and stop and say, 'Do I really need to do this now? Can I postpone it? Can I change the way I do this? Can I do something differently that might be less painful?'"
The new statement, last updated in 2006, reflects recent research suggesting that in addition to more serious drugs like morphine, which may be necessary at times, there is good evidence showing how non-pharmacologic options can help minimize babies' feelings of pain in their first month of life and should be used more often.
The authors referenced studies that have shown how seemingly simple measures such as swaddling, providing skin-to-skin care and giving a baby something to suck on for comfort during a potentially painful intervention are effective. They also referred to one review that found that breastfeeding babies while they undergo a heel stick had shorter crying times and smaller increases in their heart beat.
“Mothers and fathers should absolutely feel empowered to ask to be with their babies during even the most routine procedures when the circumstances allow.”
Of course, the challenge for health care providers who work with new babies is how to assess pain levels in patients who cannot speak. Experts have developed many tools to help determine pain levels in new, vulnerable babies, but none are perfect, Keels said. For now, she urged providers to pick the tool they like best, and ensure that they and their teams all use it consistently so they are "speaking the same language" when it comes to understanding babies' pain.
And parents, Keels added, should feel reassured that while they may not be able to keep their babies from undergoing certain procedures that are necessary for their broader health and wellbeing, they can play "a huge role" in soothing them. Mothers and fathers should absolutely feel empowered to ask to be with their babies during even the most routine procedures when the circumstances allow, Keels said.
"They should not be shy about asking their care providers, 'How's my baby doing? What's my baby's level of pain? How can I help you to care for my baby?'" she said
"Our responsibility on the provider side," Keels added, "is to be open to that."
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