Parents key to reducing baby’s distress in the doctor’s office

Parents should cuddle their babies close to soothe them when they have to endure painful medical procedures, a York University study has found.

“Holding your baby against your chest, giving the baby something to suck, and rocking are effective ways to help babies with the pain they feel from heel pricks and immunizations,” says York psychology Professor Rebecca Pillai Riddell. “This can happen naturally, like when a mother breastfeeds during an immunization procedure. Unfortunately some physicians – for younger infants in particular – give immunizations with the infant lying on a table.”

Pillai Riddell, based in the Faculty of Health, heads up the Opportunity for Understanding Childhood Hurt (O.U.C.H.) Lab at York. Her team reviewed the results of more than 70 research studies in which non-pharmacological treatments were used to manage pain experienced by babies during routine procedures. Their systematic review of this primary research was published today as a Cochrane Review.

“Kangaroo care, which is skin-to-skin contact between the baby and the parent’s chest, works best for premature babies, along with a soother and swaddling,” says Pillai Riddell. “The baby is warm and is calmed by the parent’s scent and their heartbeat.”

Full-term newborns also respond to being swaddled tight, rocking/close holding, and sucking a pacifier before and after the injection, says Pillai Riddell.

But despite the growing number of infant immunizations every year, much more research is needed on what non-pharmacological strategies work for babies ranging in age from one month to three years. What is clear is that trying to distract a baby with a toy during the needle does not work, and repeated reassurance can make a child anxious, she said. Some of the same techniques used for the tiniest babies may work for this age group, says Pillai Riddell. There is also promising research that suggests older infants may be distracted by a video that is shown to them during the immunization procedure.

In the past, there’s been a myth that babies don’t remember pain, because they can’t talk about it, says Pillai Riddell.

“But words are not how they would process pain. We know now that they remember it with their bodies, so perhaps the next time they get a needle they may start crying and feel fearful even when the doctor simply comes near them,” says Pillai Riddell. “We also suspect that a lot of needle phobia and doctor avoidance later may result from this pain in the first year of life.”

She recommends parents try to avoid rushing just before an appointment, calm themselves before procedures, and respectfully ask the doctor to give the injection while they hold their baby.

“I believe parents do have the ability to reduce the distress their babies feel during painful procedures,” she says. “This is becoming more and more important as the number of vaccines available to protect our children increases. Children often have poke after poke after poke after poke in one appointment, with no pain management.”

Pillai Riddell, a Canadian Institute of Health Research (CIHR) New Investigator in Pain, has been awarded more than $1 million in funding from CIHR and the Ontario Ministry of Research and Innovation to follow a cohort of children from birth through early childhood, so she will be able to study their experience of pain as they learn to express it with words.. This Canadian cohort (The OUCH Cohort) is the largest in the world examining how caregivers can help infants recover from painful procedures.

An abridged version of her Cochrane Review will appear later this month in the Canadian journal Pain Research & Management.