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NICU Infants, Pain Management

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We are committed to pain management for all patients.

The health care team at Children’s Hospital of The King’s Daughters believes that all patients deserve to have the best possible level of pain relief that we can safely provide. We strive to promptly recognize pain and treat it effectively using a team approach. In addition to the NICU physicians (neonatologists) and nurses our team consists of a Pain Care Coordinator and Child Life Specialists.

You are an important part of the team. You can help your baby deal with new and difficult situations.

We will use medicines and non-medicine methods to help reduce your infant’s pain. There are many types of medicines that we can give for pain. The type of pain, how long it will last and the reason your infant has pain will determine which type of pain medicine is the best choice for him/her.

These are some answers to questions parents frequently ask.

Do infants have pain?

Yes, everyone can feel pain, including premature infants. Even though infants cannot tell us what hurts, there are pain clues we can recognize and their pain can be treated. We want to do all we can to make your baby comfortable.

What might cause a baby to have pain?

Like other people, each infant will respond in his/her own way to pain. Things that cause pain for one infant may not affect another infant the same way.

These are some examples of reasons a NICU baby might have pain:

  • procedures that require needle sticks, such as starting an IV (intravenous line for fluids) or drawing blood for lab tests
  • soreness after surgery: incision pain or stretching or pushing on tissues or organs
  • an illness that cause the nerves to sense tissue damage or swelling
  • discomfort from tubes
  • skin rashes or sores

How do we know an infant is in pain?

Your baby’s nurse will use a special tool to measure pain. It is called the NIPS Pain Scale. The nurse will look at your baby’s facial expression, cry, breathing patterns, arm and leg movements and how awake, sleepy or fussy your baby is to measure your baby’s pain. Your baby’s nurse will use this pain scale to measure your baby’s pain each time she checks your baby’s vital signs during the day. Changes in vital signs, such as heart rate, breathing rate and blood pressure can also be clues for recognizing pain.

Infants act differently when they are in pain than when they are comfortable. There are several clues that you and the health care team can look for. You may see some of these signs even when your baby is not in pain, but combinations of these clues usually indicate an infant has pain.

  • Crying: An infant in pain may cry louder and longer than usual. The pitch of crying may be different for pain. Sick or premature babies may not have enough energy to cry when they are in pain. We will look for other clues for these quiet babies.
  • Making faces such as:
    • Grimacing
    • Quivering chin
    • Wrinkling brow
    • Squeezing eyes shut
    • Deep lines around the infant’s nose
  • Position and movement
    • Can be tense and stiff when in pain with the arms and legs either pulled in close or tightly stretched out; you may see flailing movements with the baby pulling arms and legs in and out or squirming
    • Premature or very ill babies may have floppy muscle tone, appear frail and seem to be asleep
  • Change in other behaviors
    • Irritable, restless, fussier and unable to stay asleep. Some infants may seem withdrawn and sleep more than usual.
    • Refusing to eat
    • Unable to be calmed by usual comfort measures

How can I help my baby when he/she has pain?

Your role is important. Your close bond with your baby will help you work closely with the health care team to make decisions about pain management. These are some ways you can help your baby cope with pain:

  • Visit often. This will help you recognize behavior changes. If you are not able to visit, ask others who know your baby to visit.
  • Talk to the nurse or neonatologist if you think your baby’s pain is not well controlled. Let them know if you think pain medicine is making your baby too sleepy.
  • Distract your baby with music, a story or singing a song during stressful procedures.
  • Calm your baby after he/she has a stressful procedure. We will work together to find the best methods for your baby.
    • Gently pat or massage your baby
    • Talk in a soothing voice
    • Hold your baby with as much skin to skin contact as possible. Talk to your nurse about Kangaroo Care. Skin to skin contact during breastfeeding along with the sucking action can be very comforting to babies.
  • Try these other non-medicine methods reduce your baby’s stress:
    • Offer a pacifier during painful events
    • Less noise and activity at the bedside
    • Rocking or other slow, steady rhythmic motion
    • Swaddle your baby in a blanket. Some babies find a snug blanket more comfortable than being able to move their arms and legs.

Ways the health care team will manage your baby’s pain:

In addition to the methods above we can use oral sucrose (sugar) and medicine to help your baby when he/she is in pain. Your neonatologist and nurse will talk to you about the pain medications which are best for your baby’s pain control plan.


Disclaimer: This information is not intended to substitute or replace the professional medical advice you receive from your child's physician. The content provided on this page is for informational purposes only, and was not designed to diagnose or treat a health problem or disease. Please consult your child's physician with any questions or concerns you may have regarding a medical condition.

Reviewed: 11/2008

(757) 668-7000