In nursing school we were told that infants didn't really need pain relief for needlesticks, IV starts, circumcisions, and other painful procedures; they just needed a pacifier dipped in a heavy sucrose solution. The sucrose solution elicited a sort of euphoria which blocked the pain, and possibly amnesia about the event so they didn't grow to feel rejected and abandoned in a hostile environment.
What a load of crap, we all thought. None of us believed it. I don't think the nursing instructors even believed it. There's not even a good physiological explanation for it. Yet it's a thoroughly established practice.
An interesting article from Peaceful Parenting highlighted a Lancet published study which showed that oral sucrose doesn't block pain in infants. Rather, it occasionally changes their facial expressions, which alters the caregiver's impression of their pain. Spinal cord pathways and brain activity related to pain reception did not change whether infants were given sterile water or sucrose solution prior to a painful procedure. Other infantile reflexes related to discomfort were not significantly different, either.
It's nice to see non-evidence-based practices being knocked down. However, I think it might be a long time before busy obstetrical and neonatal clinicians take this study (or, in general, the effects of pain on infant bonding, feeding, and neurological development) very seriously.
Do you know of similar studies about breastfeeding blocking/diminishing pain - yay or nay? I've always understood that we should encourage mothers to breastfeed through painful procedures, but based on similar theories (the sucking and sweet taste are calming/pain relieving).
ReplyDeleteI certainly wouldn't mind seeing babies leaving the nursery having NOT consumed 5-10 ml of sugar water during a procedure...
Thank you! As a scientist, I never could see how sugar water would block pain. Hell, if that was the case, why is there other pain killers on the market instead of a big ol candy ring?
ReplyDeleteI am sure the breastfeeding thing does not eliminate pain either. My pediatrician recommended breastfeeding through proceedures, and I politely declined, but offered the breast afterwards to sooth and pacify. Who wants them to corrilate pain with breastfeeding?
I can remember giving my little brother and sister bottles of sugar water all the time, not just when someone thought they were in pain - why do they tell you to do that?
ReplyDeleteThank you for sharing this.
ReplyDeleteJust discovered your blog and added it to my list of daily reads. I enjoy it. Thank you.
ReplyDeleteI'm sure the nursing doesn't block or remove the pain, however I can believe that it soothes the infant and makes the pain more tolerable, if that makes any sense at all. I mean, if you think of yourself, having a comforting presence during something traumatic makes it a little easier to handle.
ReplyDeleteAs far as correlating breastfeeding with pain, I think there are too many other instances where there is only pleasure related to it for there to be any real correlation to pain. Of course, this is only my own hypothesis at work and no real scientific evidence behind it LOL
I agree with Naji, I doubt very much nursing during needlepricks, IVs and other painful procedures suddenly makes a baby immune to pain, however the comfort nursing provides usually apparent.
ReplyDeleteI know my daughter handles pain much better when she's allowed to nurse through painful experiences, anyway, and I'd assume most babies probably cope similarly.
One of the worst experiences ever was when she was about three months old and I took her to the ER for a low grade fever (what a mistake that was!) and the nurses wouldn't allow me to nurse her while they put in an IV. The nurse said, and I quote "This is way too painful to allow her to nurse during. She'll CHOKE!"
My daughter was too distressed to nurse afterward and wouldn't calm down for another 15 minutes. Which of course is great for an infant suffering from a low grade fever.
This excerpt from one of my blog posts sums up what I make of this phenomenon:
ReplyDelete"When a baby is hungry, he will cry in response to the pain in his belly. When he is put to the breast, the infant must calm himself and stop crying in order to nurse effectively and resolve his problem. The pain is his belly is not gone, his hunger is not satisfied- but the correct answer has been offered and he must have faith that sucking at the breast is the solution to make the pain go away. I feel that there is something sacred here, in this gift, in this order. To give a sucrose pacifier to an infant being circumcised is an abuse in his trust that sucking will resolve his pain. Yes it may work, but it works by deceit. To take that most precious maternal association- and exploit in order to silence him- is a lie and betrayal of both mother and baby in the highest order."
The "sucrose soother" is an archaic method of quieting a fussing baby....I remember watching as a student 30 yrs ago as they gave one to a little baby boy just as he was circumcised. Cruel for sure....you would think things would change....both with the sucrose soother AND circumcision. Btw, there have been studies that show circumcised males have a lower pain threshold when older....
ReplyDeleteAs a NICU nurse, I agree that it's often frustrating to us that we do not get more orders for pain medications for our infants undergoing painful procedures. However, none of us believe that the sucrose pacifier "takes away the pain." It simply is a way to help the infant cope with the painful procedure. The best nurses use other devices like swaddling and cuddling post-procedure if appropriate to help the infant self-soothe and recover from the procedure.
ReplyDeleteCertainly it's not appropriate to give an infant an IV medication that can possibly cause apnea for an IV stick. If we give oral medication, it will not affect the infant until well after the procedure is over. Also, correct me if I'm wrong, but a competent physician will give an infant lidocaine locally at the least for a circumcision.
This comment has been removed by the author.
ReplyDeleteSarah - that's a pretty deep point, and something I hadn't thought of. The baby only shuts up when you let it suckle because it's expecting satisfaction or relief, not because it's actually experiencing these things.
ReplyDeleteAs an extra to "Cartoon Character's" post about circumsized men feeling more pain later in life, there are also reports that premature babies also experience more pain later in life. I am sure no one would disagree with the fact that most preemie's deal with quite a few painfull procedures and events at a young age that probably go unmedicated. (speaking as a 29-week preemie who now at 28 suffers from a few chronic pain disorders.)
ReplyDelete~Stacey
Here is the link: http://www.dailymail.co.uk/health/article-1275978/Premature-babies-feel-pain-later-life.html