| Sweet-tasting solutions: Sucrose and Glucose Administration |
Decrease changes of heart rate. Reduce crying time and facial grimacing. Lower pain scores (PIPP, NFCS scores) Physiological mechanism not entirely understood; may activate endogenous opioid and nonopioid pathways through
orotactile and orogustatory stimulation.
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Effective and safe for single does given to full-term and preterm infants. Use in heel stick, intramuscular injection, venipuncture, subcutaneous injections, bladder catheterization,
arterial puncture, insertion of nasogastric/orogastric tubes, eye examinations, and echocardiography. Manage short term (5-8 min) pain and usually given 2 minutes before the procedure. Administer on the
infant’s tongue with a pacifier, syringe, or cup. No clear recommendation of optimal dose (a 20-fold variation in the doses used) Recommended by IASP: 24% sucrose can be given:
24–26 wks GA: 0.1 mL 27–31 wks GA: 0.25 mL 32–36 wks GA: 0.5 mL >37 wks GA: 1 mL
Concerns: potential adverse effects for repeated, multiple dose regimens in preterm infants.
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| Skin-to-skin contact - Kangaroo |
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| Care (KC) |
Decrease crying time and facial grimacing. Improve behavioral states and sleep-wake patterns. Lower pain scores (e.g., PIPP, NFCS scores) Reduce recovery time. Decrease cortisol concentrations Promote autonomic maturation (e.g., heart rate variability). Reduce parental stress, anxiety and increase competence. Provide multi-sensory stimulation; activate β-endorphin release (endogenous opioid response) and
oxytocin mechanism.
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Use in heel stick, intramuscular injection, venipuncture, and subcutaneous injections, and pre and post
operation, Use pre, during and post procedures, 10-15 min, 30 – 80 min, or 2-3 hours. Effects last as the infant placed in the KC position and may also last after KC session.
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| Nonnutritive Sucking (NNS) |
Decrease changes of heart rate, respiratory rate, and oxygenation saturation. Decrease crying time. Decrease cortisol concentrations Lower pain scores (e.g., PIPP, NFCS scores) Mechanism of NNS on pain is unclear; may stimulate orotactile and mechanoreceptors in the mouth and regulate
behavioral states.
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Effective and safe in full-term and preterm infants. Use in heel stick, circumcision, intramuscular injection, venipuncture, and subcutaneous injections, and pre
and post operation, Administer NNS at least 3 min before the procedure Effective when pacifier is in the infant’s mouth; removal can lead to rebound distress. Best used in procedures with mild to moderate pain. Concerns: influence on initiation and sustainability of breastfeeding practice.
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| Formula, Breast milk, and Breastfeeding |
Decrease changes in heart rate Reduce crying time Lower pain scores (e.g., PIPP, NIPS, NFCS, DAN scores)
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Safe and effective for repeated administration in full-term and preterm infants. Use in heel stick, intramuscular injection, and venipuncture. May provide similar effectiveness to oral sucrose or glucose solutions
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| Facilitated Tucking (FT) |
Decrease changes in heart rate Reduce crying time Lower pain scores (e.g., PIPP, NIPS scores) Reduce parental stress and increase competence when parents participate in.
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Safe and effective in full-term and preterm infants. Use in heel stick, endotracheal suctioning, and venipuncture. Use FT before, during, and after procedures. Contraindication: infants with poor skin integrity (e.g., extreme prematurity or epidermolysis bullosa).
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| Swaddling |
Decrease changes of heart rate and oxygenation saturation. Reduce crying time. Lower pain scores (e.g., NIPS scores). Shorten pain recovery time. Reduce parental stress and increase competence when parents participate in.
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Safe and effective in preterm infants. Use in heel stick. Use swaddling before, during, and after procedures. Contraindication: infants with poor skin integrity (e.g., extreme prematurity or epidermolysis bullosa).
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| Heel Warming |
Decrease changes of heart rate and oxygenation saturation. Reduce crying time. Lower pain scores (e.g., NIPS scores). Shorten pain recovery time.
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