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Pain and Your Infant: Medical Procedures, Circumcision and Teething

What is pain?

Pain is an uncomfortable sensation, or feeling.  It can be constant (always there) or intermittent (coming and going).  Pain can be dull and aching, sharp, or throbbing.  It can be both physical and mental, and every infant experiences it differently.

What causes pain?

Babies feel pain when their brains send out special signals to their bodies.  Usually, they are sick or injured when their brains send these signals.  Feeling pain is a signal that something is wrong.  There are many causes of pain in babies.  There are the typical ones, like colic, circumcision, teething, and vaccine (immunization) shots.  Some babies may have health problems and may experience pain as part of their disease process or painful treatments.

Do newborns experience pain?  How does pain affect babies?

Everyone can feel pain, including infants.  Even premature babies can feel pain. Newborns experience pain and should receive reliefPain affects babies' nervous systems [1] in many ways, even changing the structure and physiology of the nervous system.  Pain can cause medical complications, and 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. 

What are signs that my baby is in pain?

Because little babies can't tell you anything about how they feel, doctors and nurses are using new tools to help define pain in the babies they care for.  Talking to your child's doctors and nurses about pain is important.  The more they know about your infant's pain, the more they can help.  Infants give certain behavioral signals when they are hurting:

Measuring pain in babies is difficult.  Changes in vital signs (heart rate, breathing rate, and blood pressure), the amount of oxygen in the blood, and the baby's facial expression and behavior are most widely used to rate infants' pain.  The doctors and nurses caring for your baby should take regular measurements of your baby's pain, and record the results in the medical chart.  If your baby is in pain, the pain needs to be treated.

How can parents help infants in pain?

Will my baby become addicted to pain medication?

If your baby is in the hospital for a longer time, you may worry about them becoming addicted to the pain medicine.  Don't worry: your baby will not become addicted. If your baby needs pain medications and sedatives for a long time, physical dependence may occur.  Physical dependence is not the same as addiction—addiction is a psychological problem.  Because of this physical dependence, medication doses will be decreased slowly to prevent possible withdrawal symptoms that can occur if the medicine is stopped suddenly. Nurses and doctors will watch your baby carefully for signs of medication withdrawal. Comfort measures such as holding, rocking, and giving a pacifier can be helpful when doses of pain and sedation medications are being decreased.

What about when infants have to have shots or other medical procedures?

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.  Medical procedures can cause your baby emotional distress as well as varying degrees of pain. 

As all parents know, children receive a series of vaccine shots in infancy.  One study found that using easy behavioral interventions helps babies feel less pain and stress with these shots [4]. The University of Michigan researchers simply had parents distract and engage their infants with sucking (breastfeeding, finger or pacifier), rubbing, rocking, singing, or getting them to look at an interesting object while the staff person got the shot ready.  If possible, the parent continued the distraction while the staff person gave the shot.  EMLA and giving glucose (a sugar solution) together were found to alleviate immunization pain in a study of three-month-old infants [5] Another study found that when parents held their babies, let them suck and gave them a sweet solution during a series or four injections, the babies cried less than without holding and sucking.  Both parents and nurses found this strategy easy to use [6].   For venipuncture (blood draw), a study found that glucose on a pacifier was more effective at reducing infants’ pain than EMLA cream [7].    Breastfeeding, or a pacifier dipped in sugar water is also helpful in decreasing the amount of time spent crying after medical procedures [8]. A review of 17 different studies on giving sucrose with or without sucking on a bottle or pacifier concluded that sucrose is safe and effective for reducing pain from minor medical procedures; however, the dose, use in preemies, and repeated use need more study [9].

So the bottom line of all these studies is:  during shots, blood draws, and other minor medical procedures:

For more information on infants and medical procedures, including more serious procedures, such as surgery:

Should my baby boy have any anesthesia during his circumcision?
Yes!  Newborns who are circumcised without an anesthetic experience true pain.  We can tell they have pain because they have the signs:  increased blood pressure, increased heart rate, decreased oxygen in the blood, and a surge of stress hormones.  Circumcision is surgery on a very sensitive part of the body.  Research suggests that boys who were circumcised without any anesthetic experience more trauma (pain and fear) with each of their many routine childhood vaccines.  Fortunately, many local pain-killers are now used for circumcision.  Ask your doctor about EMLA cream, dorsal penile nerve block (DPNB), and the subcutaneous ring block.  A review of the research concludes that DPNB is the most effective treatment for preventing circumcision pain [10].   In addition, while letting your baby suck on sugar water on a pacifier or your fingertip is not enough pain control on its own, combined with effective treatment, it can help comfort him and may enhance pain control.  Acetaminophen (Tylenol) can help dull the pain, but is not enough by itself for surgical pain.  The American Academy of Pediatrics' (AAP) 1999 policy statement says that pain treatment is safe and effective and should always be provided during infant circumcision.  In addition, the AAP states that the benefits of circumcision are not great enough to recommend circumcision as a routine procedure. 

What is teething?

Teething is when your baby’s gums get inflamed and sensitive as new teeth grow, pushing their way against and through the gums.  When your baby is teething, they will probably drool a lot, be fussy, and have red, swollen gums.  Although there is actually no scientific evidence to support the connection between teething and low-grade fever or mild diarrhea, most parents and many health practitioners believe in this connection.  Babies may get a rash on their faces because of all the drool.

How can I help my baby with teething pain?

Here are some ways to help your baby be more comfortable:

Not all teething treatments work or are safe.  Here are some to avoid:

For more information on teething:

Are there any books about infants and pain?

Where can I find other resources related to pain and babies?

Related topics on YourChild:

Citations

Written and compiled by Kyla Boyse, R.N.  Reviewed by faculty and staff at the University of Michigan

Updated February 2007

U-M Health System Related Sites:
Department of Psychiatry
U-M Pediatrics

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