Pain in Infants

By Yolanda Smith, B.Pharm.Reviewed by Dr. Liji Thomas, MD

Pain is an uncomfortable sensation that may be described as dull, aching, sharp, throbbing or piercing. It may be constant or intermittent. Every individual may experience pain occasionally, including young children and infants. There are different types of pain, and each infant may display different signs of being in pain.

There are many possible causes of pain in infants, including:

• Illness such as in infections, or colic
• Surgical procedures such as circumcision
• Teething
• Immunizations
• Physical injury

Signs

It can sometimes be difficult to understand when an infant is in pain as they are unable to communicate in words. However, they will usually behave differently when they are in pain. Common signs include:

• Difficulty in sleeping and settling down
• Difficulty in feeding
• Intense crying
• Lack of energy
• Pained facial expressions
• Tense or stiff body movements
• Irritability

Measuring the intensity of pain and monitoring the progress of pain management is a challenging task in infants. In most cases, several factors are considered including the heart rate, the breathing rate, the blood pressure, the blood oxygenation level, the facial expression and the behavior.

There are various scales that are used to rate the pain intensity for infants. These include the FLACC (face, legs, activity, cry, consolability) Scale and the Riley Infant Pain Scale.

Management

All infants, including newborn babies, may experience pain. In such a case, they may require pain relief because untreated pain can affect the structure and function of the nervous system. This has the potential to lead to abnormal sensitivity to pain later in life with its associated problems.

Parents should be encouraged to hold and console an infant in pain. Direct skin contact is thought to help comfort the infant and is a good technique. Breastfeeding is often the best pain reliever for infants. It not only helps to comfort the baby but increases skin-to-skin contact simultaneously. In addition, sucking produces distraction from pain, while it leads to the presence of sweet milk in the mouth.

It can also help to distract the infant from the pain if the mother talks to, rocks, plays with, or sings to the baby.

When infants begin to experience teething, the gums may become red, swollen and sensitive. This can also cause the baby to drool. Some babies develop a rash on the face around their mouths as a result of constant wetting by saliva. Sucking on a pacifier coated with sugar solution can help to comfort and distract your baby from the pain during this time. Putting honey on a pacifier is not recommended, as raw honey is a rare but identified cause of botulism in infants.

Medications such as acetaminophen (paracetamol) and ibuprofen may be recommended to relieve pain for infants. It is important that the dose of these medications is calculated according to the body weight of the infant. This will help ensure that they receive adequate pain relief with a low risk of adverse effects.

Many parents with a child who experiences chronic pain may worry about the long-term effects of ongoing pain relief medication, and the possibility of addiction to the drugs. In some cases, physical dependence may occur. This, however, is distinct from addiction, which is a psychological issue. Physical dependence refers to the adaptation of the body as it grows accustomed to regular dosing of the drug. This can be reversed if the drug is slowly withdrawn over an extended period of time.

Prevention

In some cases, such as when an infant is going to have a medical procedure or be immunized, we may anticipate feelings of pain in infants.

Some research has shown that implementing behavioral interventions can help to reduce the pain and stress that infants feel at these times. This may include techniques such as distraction, comfort, movement or sound during the procedure. Some research also suggests that administering shots while the baby breastfeeds can help to prevent distress.

References

1. https://www.michiganmedicine.org/
2. http://pediatrics.aappublications.org/content/108/3/793
3. https://www.childrensmn.org/
4. http://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/neonatal_pain_assessment/
5. http://pmj.bmj.com/content/79/934/438.full

Further Reading

• All Pain Content
• Using a Pain Diary
• How Do We Sense Pain?
• Role of Dopamine in Pain
• Common Causes of Stomach Ache