by Anne Eglash MD, IBCLC, FABM
The Academy of Breastfeeding Medicine recently updated its’ clinical protocol entitled Non-pharmacologic Management of Procedure-Related Pain in the Breastfeeding Infant, Revised 2016
This protocol reviews the literature on pain control for infants undergoing office procedures such as circumcision, blood draw, immunizations, and urinary catheter placement. Based on strong evidence, the protocol emphasizes that breastfeeding should be the first choice to soothe young infants during immunizations or heel sticks. If direct breastfeeding is not possible, human milk given via syringe, bottle or dropper + pacifier also has a soothing effect on procedural pain.
When direct breastfeeding is not possible, and human milk is not available, the next option would be using a sucrose solution. Skin-to-skin contact in conjunction with sucrose solution plus a pacifier may be more effective for soothing than sucrose solution by itself.
According to ABM’s protocol, what do you think are true statements about pain control for infants? (more than 1 answer)
- Sucrose by syringe without a pacifier, finger, or skin-to-skin can reduce pain in young infants during office procedures.
- Sucrose solution via naso-gastric feeding (through a feeding tube from the nose into the stomach) is effective to reduce pain in hospitalized infants undergoing a minor procedure.
- Sucrose solution via pacifier or finger is nearly as soothing as direct breastfeeding for minor procedures.
- Sucrose solution should be given 2 minutes before the procedure starts.
- A glucose solution is not as effective as a sucrose solution.
- Skin-to-skin by itself between the infant and parent or caregiver adds comfort to an infant undergoing a procedure.
See the Answer
(Regarding #2 and #5- Sucrose solution via nasogastric feeding is not effective to reduce pain. Glucose solution is as effective as sucrose)Milk Mob Comment by Anne Eglash MD, IBCLC, FABM
According to the 2016 American Academy of Pediatric policy statement Prevention and Management of Procedural Pain in the Neonate: An Update research indicates that experiencing pain as an infant can increase the infant’s sensitivity to future pain. I have observed that the 9 month and 12 month old infants in my office who are up-to-date with immunizations express much more fear and anxiety during their well-child exams as compared to those infants who have never been immunized.
After reading this protocol, I realize that we could be more proactive in my office in reducing pain from immunizations, heel sticks, and venous draws for infants and children. Perhaps this is because the procedures are relatively quick, we assume that young infants won’t remember pain, and parents accept that infants will experience pain in the office. In addition, I have had several mothers fear nursing their infants during a procedure, concerned that this may set up an association between breastfeeding and pain. The good news is that we can reassure parents that breastfeeding during a procedure appears to be the most effective strategy to reduce infant pain. This could also be added to the list of reasons why families ought to decide to breastfeed!