Why it's so hard to treat pain in infants
Doctors once believed that infants—especially premature babies—did not feel pain, and if they did, they would not remember it.
This might sound like Medieval medicine. But as recently as the 1980s, babies undergoing surgery were given a muscle relaxant to paralyze them while in the operating room but were not given any pain medication, says Fiona Moultrie, a pediatrician and researcher at the University of Oxford who focuses on neonatal pain. “At the time, it was assumed that most of the behaviors that infants were exhibiting were just reflexes.”
Over the next decades, studies documented changes in infant behavior, stress hormones, and brain activity, proving that even the tiniest babies did indeed suffer pain. Research also revealed that continued pain could derail a child’s short- and long-term neurological, social, and motor development, especially in fragile, preterm babies born earlier than 37 weeks, says Björn Westrup, a neonatologist and researcher at the Karolinska Institute near Stockholm, Sweden.
Rapid advances in medicine now allow very fragile, tiny, preterm babies to survive. But preemies may spend weeks or months in the hospital undergoing the constant, often painful procedures needed to save their lives. Strategies to make such procedures less traumatic are vital, as premature births are rising globally. In the United States alone, about 380,000 babies are born prematurely each year, or about one in 10 births. Worldwide, it’s about 15 million.
The medical profession tries to manage or prevent infant suffering with drugs such as ibuprofen (for mild to moderate pain) and fentanyl (used to alleviate extreme pain). For most analgesic drugs, though, the proper dosage, effectiveness, or effects on the brain remain unknown, so increasingly, hospitals are incorporating non-pharmaceutical interventions that center on techniques known as developmental care, which keep babies and their families together rather than isolating infants in incubators.
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