Assessing and Relieving Your Baby's Pain

This can be difficult because some of the behaviours displayed when babies are in pain are also displayed when they are hungry or need their nappy changed.

Signs that your baby is in pain include:

• increased blood sugar levels due to the release of hormones caused by increased stress levels
• fast breathing and heart rates or drops in oxygen levels
• facial grimace
• high pitched, shrill cry
• kicking of legs or rigidity to arms and legs
• limp and floppy arms and legs
• vomiting
• color changes, mottled colouring
• trouble sleeping
• jerky movements or stiffness
• flushing (turning red).

or your baby may:

• fall asleep or become drowsy
• show a decrease in activity or an increase in floppiness
• turn pale
• breathe slowly or his or her heart rate may drop.

If you feel that your baby is in pain, please let your nurse or doctor know.
If your baby is clinically well and it is appropriate in connection with the clinical procedure, a breastfeed or nuzzle on the breast may be offered.

Medicines

Medicines that can be used for relieving pain in babies on the Neonatal Unit are outlined below. The staff on the unit will let you know what pain relief your baby is having.

• Morphine is the most frequently used pain medication for babies requiring intensive care. Parents often voice concerns about their babies receiving morphine. They worry about possible drug withdrawal when the morphine is stopped. There is no cause for concern. Morphine is usually only prescribed when babies are ventilated and requiring intensive care, or following surgery. The dose is gradually reduced and is eventually stopped.
• Paracetamol is used for mild pain or fever. It can be given orally as liquid paracetamol or via the rectum in suppository form, which is especially useful if your baby is not yet feeding. Paracetamol can either be given regularly, every six hours, or only when your baby appears to need it. Your baby can be offered the breast or expressed breast milk prior to or during a procedure if appropriate.
• Sucrose is a sugar solution. A tiny amount is placed on the front of the baby’s tongue immediately before a procedure. This activates the brain into thinking it has had a pain reliever and soothes the baby. If your baby has a dummy, the effect of sucrose is enhanced by the action of sucking. Sucrose is often given to babies before a painful procedure. The pain relieving effects of sucrose do not last very long and usually wear off after a few minutes.
• Expressed breast milk can be given to relieve your baby’s pain.

As well as using drugs to relieve pain, there are a number of other ways to help your baby cope with the experience of pain or discomfort.

• Appropriate handling – many ill and premature infants do not respond well to excessive handling. Firm but gentle pressure with the hand may block painful sensations. Giving rhythmica, repetitive stimulation, such as rocking and music, may be soothing. Holding your baby skin-to-skin may also help.
  Rather than waking a baby up from a deep sleep, we try to carry out potentially painful procedures when nappy changes or other cares are due.
• Swaddling – research has shown that this can effectively reduce pain, especially in babies who are premature or have a low birth weight. Swaddling your baby involves wrapping in a soft blanket, keeping the arms and legs tucked in, to provide security and containment.
• Sucking – the use of a dummy, or soother, to suck on when encountering a painful procedure has also been shown to reduce many of the behavioural responses to painful stimuli
• Talking to your baby – this may act as a distraction.

Babies are individuals and react in different ways to attempts at soothing, so that some babies will not be soothed by rocking but will be by the sound of a voice or music. You need to watch how your own baby responds to comfort measures.

Try something else if what you are doing does not seem to work. If you have any concerns at all please speak to the nurse looking after your baby.

To find out how to give us feedback on your visit or healthcare experience, please visit www.esneft.nhs.uk and search for ‘PALS’, or speak to a member of staff on the ward or department you are in.