In children, teens and adults, chronic (long-term) pain:
- lasts longer than expected (more than three months)
- can be continuous (never goes away) or recurring (comes and goes)
- persists even after regular healing times for injuries and illness have passed
The definition of chronic pain may not be appropriate for infants, especially those who may be less than three months old but have experienced pain for a large portion of their young lives.
Experts are still debating an exact definition of chronic pain in infants. Some experts believe that chronic pain (as defined in older children and adults) may not be possible for infants, as they do not experience the nervous system changes we see in older people with chronic pain. As a result, the term "longer-lasting pain" is used for infants instead.
How does longer-lasting pain develop in infancy?
Most health-care professionals working with hospitalized infants agree that infants can experience:
- long-lasting pain from certain diseases and conditions (such as staphylococcal-scalded skin syndrome)
- continuous pain from repeated invasive medical procedures
| The pain from one short painful procedure (acute pain) is different from ongoing pain (from certain diseases and conditions) or repetitive pain from many painful procedures in the hospital. |
Infants in the hospital who have several painful procedures a day (like heel lances, lumbar punctures, arterial line insertions) for many days in a row need more attention than healthy infants who, for instance, have pain from routine vaccinations.
Generally speaking, infants who have severe, persistent pain are either in hospital or in a highly medically-supported environment at home.
Assessing pain at home
Because your infant cannot speak yet, they can only tell you if they are in pain – and how much pain – through their behaviour.
Typically, infants who are suspected to have longer-lasting pain tend to display two patterns of behaviour:
- hyper-reactive (reacting very strongly to painful stimulation)
- hypo-reactive (reacting very little to painful stimulation)
Hyper-reactive behaviours
Infants who are hyper-reactive tend to:
- cry when handled before the painful procedure
- flail their arms and legs a lot
- lose their breath for a short time
- tightly shut their eyes or have a bulging brow
- stretch their mouth wide open
Hypo-reactive behaviours
Infants who are hypo-reactive tend to:
- go limp
- offer no reaction to the painful procedure
- show less interest in interacting with caregivers
- have a blank face
Because of these different responses, it is important to observe changes in your infant's behaviours for clues that they might be experiencing pain.
Assessing pain in medical settings
When your infant is in the hospital, your child's health-care team uses a range of tools to determine how much pain your child is feeling during an acute painful event (such as a heel lance).
The most common tools measure typical behaviours of a child in acute pain, such as:
- crying
- facial expressions
- body movements
They also measure physiological signs (signs inside the body) such as your infant's:
- heart rate
- oxygen saturation (how much oxygen is in their blood)
- breathing rate
Because there is no widely accepted definition of longer-lasting pain in infants, there is no single standard tool for measuring it. Indeed, physiological signs may not be helpful for assessing longer-lasting pain. However, in the NICU setting, the COMFORTneo scale and the EDIN scale both offer promising assessments, as they focus on patterns of behaviour over time, rather than immediate reactions to something painful.
Websites
Comforting your baby in intensive care (in-depth PDF)
http://familynursing.ucsf.edu/sites/familynursing.ucsf.edu/files/wysiwyg/Comfy%20PDF%20ENGLISH%20Dec%2017.pdf
Videos
It Doesn't Have to Hurt: The Power of a Parent's Touch
https://www.youtube.com/watch?v=OlAItP-06hM
Dr. Marsha Campbell Yeo: What's the power of a parent's touch?
https://www.youtube.com/watch?v=XXzkAUV9ICE&t=132s
Reduce your infant's pain during newborn blood tests
https://www.youtube.com/watch?v=L43y0H6XEH4&list=PLlZczt8t4Ac8cW3pbuRKJAEs3SoC5y8MB
Content developed by Rebecca Pillai Riddell, PhD, CPsych, OUCH Lab, York University, Toronto, in collaboration with:
Lorraine Bird, MScN, CNS, Fiona Campbell, BSc, MD, FRCA, Danielle Ruskin, PhD, CPsych, Bonnie Stevens, RN, PhD, FAAN, FCAHS
Hospital for Sick Children
References
Debillion, T., Zupan, V., Ravault, N., Magny, J.F., Dehan, M. Development and initial validation of the EDIN scale, a new tool for assessing prolonged pain in preterm infants. Arch. Dis Child. Fetal 2001, 85, F36–F41.
DiLorenzo, M., Pillai Riddell, R., & Holsti, L. (2016). Beyond acute pain: understanding chronic pain in infancy. Children, 3(4), 26.
Pillai Riddell, R.R., Stevens, B.J., McKeever, P. et al. Chronic pain in hospitalized infants: health professionals' perspectives. J Pain. 2009;10:1217–1225.
Van Dijk, M., Roofthooft, D.W., Anand, K.J., Guldemond, F., de Graaf, J., Simons, S., de Jager, Y., van Goudoever, J.B., Tibboel, D. Taking up the challenge of measuring prolonged pain in (premature) neonates: The COMFORTneo scale seems promising. Clin. J. Pain 2009, 25, 607–616.
Van Ganzewinkel, C.J., Anand, K.J., Kramer, B.W., Andriessen, P. Chronic pain in the newborn: Toward a definition. Clin. J. Pain 2014, 30, 970–977.