Joe DiMaggio Children's Hospital

Infants have the ability to recognize and respond to painful procedures regardless of their age. Even premature infants recognize painful events since the nerves responsible for delivering the messages to the brain develop relatively early during fetal development.

The Wasie Neonatal Intensive Care Unit (NICU) at Joe DiMaggio Children's Hospital is very sensitive to the pain a new baby may be experiencing and continually assesses and manages that pain.

Pain Rating Scale

The NICU has adopted a scale to measure a baby's perception of pain based on behavioral cues. The scale is called the Acute Pain Rating Scale for Term and Preterm Neonates (APN). There are three areas that we assess: facial expression, limb movements and vocal expression.

Your baby's nurse will assess your baby for pain on admission, as well as every time vital signs are checked. The nurse will also use comfort measures, topical anesthetics or oral preparations as ordered for particular procedures to help prevent pain.

What Does This Information Mean to You?

As parents, you are vital members of the healthcare team. You can help the NICU staff determine if your baby is in pain. The more you care for your baby, the better you will know your baby. You can also be there to give comfort measures to help decrease your baby's pain. For infants, an important pain-relieving measure is simply to pick them up and hold them. Although our staff will pick up and hold your baby, they know that your baby has developed a certain bond with you – and that this bond helps give your baby a feeling of safety and security and helps decrease the perception of pain.

Other measures we will take to decrease your baby's pain are to swaddle your baby, offer a pacifier and reposition your baby. You can also provide "Kangaroo Care" to reduce pain.

If your baby is experiencing pain that requires medication, the NICU staff will discuss your baby's needs with the neonatologists, nurse practitioners or physician assistants. If needed, your baby will be prescribed pain medication in the form of topical anesthetics, oral pain medications and/or intravenous medications.

Some examples of pain medications include:

• Local anesthetics, such as EMLA cream, to numb the nerves that transmit pain signals, are used for procedures such as lumbar punctures
• Sucrose solution given orally prior to a procedure
• Non-narcotics, such as acetaminophen, for mild to moderate pain
• Narcotics, such as fentanyl and morphine, for more severe pain

Remember that pain relief is the right of every child. All members of the healthcare team and family play an important role in helping to prevent, minimize and manage pain appropriately.