Longer-lasting pain: How to treat and manage in infants and toddlers

By SickKids staff

Download PDF Print

Find out how to treat and manage longer-lasting pain in infants.

Key points

Ongoing pain during infancy, if not managed properly, can affect how infants react to pain later in life and how their brains develop.
The 3P approach to pain management is a mix of psychological, physical and pharmacological methods to treat and manage pain.
Psychological approaches include keeping a calm environment and talking to your infant to distract them.
Physical approaches include skin-to-skin contact and facilitated tucking.
Pharmacological approaches include numbing creams, sugar water and medications.

Introduction

Treatment

Psychological strategies

Creating a calm environment

Creating a calm environment positively affects the way infants react and recover from painful experiences. Babies understand body language, so it is important to manage your stress when you are with your baby during painful procedures.

Take a few calm deep breaths down into your belly. This slows down your breathing and heart rate, which if you are holding your infant in your arms, will slow down their heart rate and breathing and make them feel less distressed.

Distraction

Gently speak to your infant while they are in your arms. The sound of your voice will help distract them from any distress.

Physical strategies

Skin-to-skin contact

Skin-to-skin contact is also known as "kangaroo care". When you know your infant is about to undergo a painful procedure, ask to hold them for a few minutes. Ideally, hold your child clothed only in a diaper so that they are against your bare chest facing you. Start this at least 15 minutes before the painful procedure, but even two minutes of contact beforehand can help. You can wear a blanket or shirt for privacy and warmth. Mothers or fathers can offer skin-to-skin support.

Facilitated tucking

If you cannot do skin-to-skin contact, try giving your infant a "hand cuddle" (also known as "facilitated tucking"). This involves placing your hands on your infant while they are lying down to help them tuck their arms and legs into their body.

Breastfeeding

Breastfeed your infant during a painful procedure when they are old enough to co-ordinate sucking, swallowing and breathing. You can also put a dab of breast milk on a pacifier. Sucking with a regular rhythm on the pacifier helps to calm your infant.

Pharmacological strategies (medications)

Pain medicines can also minimize your child's pain. In general, when an infant is in the hospital, doctors and nurses will decide what medications to give them for acute procedures and surgeries.

If you are giving any pain medicines at home, always talk to a health-care professional first. They can advise you if the pain medicine is safe and effective for your child's type of pain.

Numbing creams

Numbing creams can be helpful for painful needle-related procedures such as vaccinations. Apply the cream to the area where the needle will be injected 30 to 60 minutes before the procedure, depending on the cream.

Sucrose or sugar water

Giving your infant two to three drops (0.1 mL) of sucrose (sugar water) about two minutes before a painful procedure can also reduce their pain.

Using a syringe or dropper, place the sugar water, one drop at a time, onto the front of your baby's tongue. You can also dip your baby's pacifier into the sugar water.

Only use sugar water when your baby is experiencing acute pain, not when they have general irritability.

Over-the-counter medications

It may also be helpful to give your infant acetaminophen or ibuprofen after a painful procedure as this can reduce the pain that persists. Speak to a health-care professional first if your infant is less than six months old.

Opioid medications

Opioids are among the strongest pain relievers and are often used after surgery or other major painful procedures. If your infant is in moderate to severe pain, their health-care team may prescribe opioids such as morphine, oxycodone or hydromorphone, generally for short-term use.

Opioids have risks and side effects, which can be serious. Always talk to your child's health-care provider for advice on taking, storing and disposing of opioids safely.

Resources

References

Last updated: January 25th 2019