for the main comparison.

Breastfeeding compared with control for procedural pain relief
Patient or population: Healthy full‐term newborns Settings: Neonatal ward Intervention: Breastfeeding or supplemental breast milk Comparison: Control
Outcomes	Illustrative comparative risks* (95% CI)		Relative effect (95% CI)	No. of Participants (studies)	Quality of the evidence (GRADE)	Comments
	Assumed risk	Corresponding risk
	Control	Breastfeeding or supplemental breast milk
Percentage of time crying (Breastfeeding versus control)	The mean percentage of time crying ranged across control groups from 43% to 65.6%	The mean percentage of time crying in the intervention groups was lower and ranged from 4% to 33%		227	⊕⊕⊕⊝ moderate	Three studies evaluated this outcome, and overall there was a statistically significant reduction in percentage of time crying in the breastfeeding group
Duration of crying (seconds) (Breastfeeding versus control)	The mean duration of crying ranged across control groups from 5 to 184 seconds	The mean duration of crying in the intervention groups was lower and ranged from 8.8 to 75.8 seconds		539	⊕⊕⊕⊝ moderate	There seems to be a tendency towards a reduction in duration of crying in the breastfeeding group, except when it was compared with formula feeding
Neonatal Infant Pain Scale (NIPS) (Breastfeeding versus control)	The mean NIPS ranged across control groups from 0.3 to 5.6	The mean NIPS in the intervention groups was lower, with a mean of 0.9		102	⊕⊕⊕⊝ moderate	Only one study evaluated this outcome and there was no statistically significant difference between breastfeeding and sucrose, but there was a decrease in NIPS when compared to no intervention
Neonatal Facial Coding Score (NFCS) (Breastfeeding versus control)	The mean NFCS ranged across control groups from 0.94 to 7.1	The mean NFCS in the intervention groups was lower, ranging from 0.62 to 2.9		240	⊕⊕⊕⊝ moderate	Two studies evaluated NFCS.,Breastfeeding reduced NFCS, except when compared with formula feeding (where there was no statistically significant difference)
Percentage of time crying (Supplemental breast milk versus control)	The mean percentage of time crying ranged across control groups from 76% to 90%	The mean percentage of time crying in the intervention groups was higher, with a mean of 91%		80	⊕⊕⊕ moderate	Only one study evaluated this outcome, and there was no statistically significant difference between supplemental breast milk and control
Duration of crying (seconds) (Supplemental breast milk versus control)	The mean duration of crying ranged across control groups from 9.13 to 157.05 seconds	The mean duration of crying in the intervention groups was similar to control group, ranging from 22.04 to 151.34 seconds		730	⊕⊕⊕⊝ moderate	Seven studies evaluated this outcome, and there was no statistically significant difference between supplemental breast milk and control
Neonatal Infant Pain Scale (NIPS) (Supplemental breast milk versus control)	The mean NIPS ranged across control groups from 2.6 to 5.1	The mean NIPS in the intervention groups was similar with a mean score of 4.8		120	⊕⊕⊝⊝ moderate	Only one study evaluated this outcome. It did not show any statistically significant difference between supplemental breast milk and control groups, but it was a low quality study
Neonatal Facial Coding Score (NFCS) at 3 minutes (Supplemental breast milk versus control)	The mean NFCS at 3 minutes ranged across control groups from 2.6 to 3.54	The mean NFCS at 3 minutes in the intervention groups was similar, ranging from 0.6 to 3.08		223	⊕⊕⊕⊝ moderate	No statistically significant difference was shown between supplemental breast milk and control
*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval
GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate.