Issues in Neonatal Pain

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It is a great pleasure to introduce this week’s guess bloggers: Dr. Marsha Campbell-Yeo (@drmcampbellyeo) and Dr Denise Harrison (@dharrisonCHEO), will also be co-leading this week’s ENB twitter chat on Wednesday the 7th of October between 8-9pm UK time focusing on ‘Issue in Neonatal pain’. Participating in the twitter chat requires a Twitter account; if you do not already have one you can create an account at www.twitter.com. Once you have an account contributing is straightforward – follow the discussion by searching links to #ebnjc or @EBNursingBMJ, or better still, create and send us a tweet (tweets are text messages limited to 140 characters) to @EBNursingBMJ. Add #ebnjc (the EBN chat hash tag) at the end of your tweet, this allows everyone taking part to view your tweets.

Be Sweet to Babies – Reduce pain during needles

Today’s guest blog is from Dr Denise Harrison (@dharrisonCHEO). Who is an associate professor and Chair in Nursing Care of Children, Youth and Families at the Children’s Hospital of Eastern Ontario (CHEO), CHEO Research Institute & University of Ottawa. She leads the Be Sweet to Babies team, which focusses on pain treatment in sick and healthy newborn infants and young children. The Be Sweet to Babies team conducts research to find effective pain treatments and methods to assess pain, and to explore best ways to translate knowledge into practice.

High quality evidence shows that three are simple, effective and cost effective ways to reduce babies’ pain during their newborn screening blood tests, other blood tests and injections.

  1. Mothers can breastfeed before and during the procedures;
  2. Mothers, fathers or other family members or friends can hold the baby skin-to-skin;
  3. Or, if these strategies are not able to be used, the babies can be given very small amounts of sugar water – just a few drops before and during blood tests or needles.

The evidence supporting these three strategies has been around for many years, and guidelines produced by national and international organizations recommend using these treatments (http://pediatrics.aappublications.org/content/early/2014/01/28/peds.2013-2744.full.pdf). For example, groups such as Ottawa Public Health and CHEO, in partnership with parents of young children, have co-produced educational brochures targeted at parents of babies and children about ways to reduce pain during early childhood vaccination (http://ottawa.ca/en/residents/public-health/disease-and-medical-conditions/reducing-pain-during-vaccination). Yet, too many babies still have blood tests, vaccinations and other painful procedures with no pain treatment. This is shown over and over again by published studies of practices in neonatal units (http://www.nainr.com/article/S1527-3369(15)00089-6/abstract), pediatric hospitals,1 and in community settings where vaccinations take place.2 In addition, YouTube is full of videos showing crying babies having blood tests and injections with no pain treatment (http://www.biomedcentral.com/1471-2431/14/134) and most news reports about the importance of early childhood vaccinations show crying babies and screaming toddlers being held down during their vaccinations (https://mobile.twitter.com/OttawaSunMike/status/567169619824504832/photo/1).

Education about how to effectively reduce pain in babies, in the form of guidelines and publications, including systematic reviews is available for health care providers in the various settings where babies have painful needles. However, as the uptake of evidence is low, our Be Sweet to Babies team, in partnership with parents of babies and young children, felt we needed to include parents of babies in our educational plans. Studies tell us that parents want to know more about how to help comfort their babies during painful procedures,3 so we wanted to help parents know about the pain reducing effects of breastfeeding, skin-to-skin care and sugar water (sucrose or glucose) and how to use these treatments. We therefore produced a brief YouTube video which shows newborn babies having their blood tests while these three strategies are being used (http://tinyurl.com/BSweet2newborns). The video clearly shows the profound calming and pain reducing effects of breastfeeding or holding their baby skin-to-skin during the blood test, as well as the effectiveness of sugar water, for when parents cannot be present. Voice-over clearly explains in user-friendly language how parents can help their babies by working with nurses and doctors to use these strategies. The video has also been posted onto YouTube in French (http://tinyurl.com/BSweet2newborns-French), Spanish (http://tinyurl.com/BSweet2newborns-Spanish), Portuguese (http://tinyurl.com/BSweet2newborns-Portuguese), Arabic (http://tinyurl.com/BSweet2newborns-Arabic), Mandarin (http://tinyurl.com/BSweet2newborns-Mandarin), German (http://tinyurl.com/BSweet2newborns-German) and Inuktitut (unlisted link: https://youtu.be/9TulDO77uag). Our goal is that the BSweet2Babies video, in all the languages will help empower parents of healthy and sick and premature babies to advocate for their babies, and to partner with the health care team members to support their babies during painful blood tests and other procedures, such as vaccinations.

Breastfeeding and sugar water also reduce pain in older babies, up to about one year of age. Our Be Sweet to Babies team therefore produced another video; “Secret to a calm and peaceful immunization” which clearly shows the calming effects of a mother breastfeeding her 2-month old baby boy Lucas, and sucrose, when given to Sam, aged 6 months (http://tinyurl.com/BSweet2Babies).

Effectively treating pain during painful procedures is important to all, and especially important to babies and their parents. Breastfeeding or skin-to-skin by the mother or father, or small amounts of sugar water are all easy to use in any settings. Health care of babies is best delivered in partnership between all health care providers and families, and reducing pain during painful procedures is a perfect example of the important role we all need to play to ensure babies get the best care possible. Treating pain right from the beginning is important, and has the potential to reduce development of needle fears and subsequent fear of medical care. So, let’s work together so that no baby suffers unnecessarily during painful procedures, put our knowledge into practice and …Be Sweet to Babies.

Dr Denise Harrison (RN, PhD), Associate Professor and Chair in Nursing Care of Children, Youth and Families, Children’s Hospital of Eastern Ontario (CHEO) Research Institute & University of Ottawa.

Email: dharrison@cheo.on.ca

Facebook: https://www.facebook.com/besweet.tobabies

Twitter: @dharrisonCHEO

  1. Stevens B, Abbott L, Yamada J, et al. Epidemiology and Management of Painful Procedures in Hospitalized Children Across Canada. C Can Med Assoc J. 2011;183(7):E403-E410.
  2. Harrison D, Elia S, Royle J, Manias E. Pain management strategies used during early childhood immunisation in Victoria. J Paediatr Child Health. 2013;49 :313-318. doi:10.1111/jpc.12161.
  3. Johnston C, Barrington KJ, Taddio A, Carbajal R, Filion F. Pain in Canadian NICUs: have we improved over the past 12 years? Clin J Pain. 2011;27(3):225-232. http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=prem&AN=21178602.

 

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