Relieving the pain

As a parent, you do not want to see your child to suffer in whatever way. This is probably one of your greatest worries. That is why this section explains some of the ways of controlling the pain and reducing the stress for the baby.

During the time of special care, babies need different medical tests and procedures, which can often be painful for the baby. This refers to children subject to intensive treatment due to different kinds of diseases. The procedures are performed unless they are absolutely necessary,

The newborn baby must be protected from any painful procedure, which is not absolutely necessary for his/her health – extract from a Draft Law on the Rights of the Newborn Baby.

Any medical manipulation brings both risks and benefits, but the use of analgesics is not obligatory. If a procedure has to be applied to the child, who is more painful and unpleasant than the average, a medicine can be given to relieve the pain. The dose is based on the baby’s weight. If the baby needs an operation, a full anaesthesia is applied.

The neonatal unit should follow a policy of relieving the pain. Always signal if you think the baby feels a pain and needs help.

Over the recent 10-15 years, the attention of the medical staffs has been focused on the pain suffered by the youngest patients. Achievements in this area outside Bulgaria are already available and are applied in practice. However, in this country the problem is not discussed enough yet and is even neglected.

Yearlong research in this area has proved the necessity of the so-called family centres for intensive care for premature babies or babies with health problems. It has been proved that care in such centres reduces stress and pain, and guarantees parents’ support. According to the American Academy of Paediatrics (AAP), this helps:

• preserve the baby’s emotional state;
• ensure physical and social bond between the parents and the newborn;
• the pain and stress of the treatment is reduced.

All this has a favourable effect on the baby’s state, including on his/her weight, the need for supporting breathing and tube-feeding, as well as on reducing the length of his/her hospital stay.

Despite the lack of such family centres in Bulgaria, some simple steps could help a lot. For example, research shows that familiar smells like that of breast milk or the parent’s skin could have a calming effect on a baby at blood sampling. This applies fully to premature babies as well.

Other non-pharmacological methods that can help control the baby’s pain are:

• Breastfeeding the baby during the time of the test or manipulation. Breastfeeding has an analgesic effect and it is applicable to full term infants in stable condition. It is inapplicable to babies below 34-36 gestation weeks because of lack of a sucking reflex, as well as in cases when their condition does not allow it.
• Putting a little breast milk or sweet solution (glucose) on the baby’s tongue. It does not cause side effects. The analgesic effect is related to release of β–endorphin in the brain.
• ‘Kangaroo’ care. Rey and Martinez first applied it in 1983. ‘Kangaroo’ care helps reduce the pain based on the mother’s touch and the ‘skin-to-skin contact’. At the same time, it leads to stabilising the newborn infant’s condition and temperature, and reduces the time of crying. It lowers heart-rate variability and oxygen saturation resulting from the pain. It facilitates breastfeeding and is favourable to the child’s later development.
• Music therapy. While still in the womb, the baby can perceive sounds (after the 29th gestation week). After the birth, the mother’s voice has a calming effect on the baby. Music reduces the cortisol levels and improves the premature baby’s physiological stability. ‘The Mozart effect’ – Mozart’s music has a special emotional charge and it significantly excels in its healing power the works of other composers like Beethoven, Schumann, Ferentz List and others. The ‘Mozart effect’ helps recover the energy balance, which is commonly referred to as health. Apart from this, it creates harmony in the organism and has a favourable effect on the brain activity.

Of course, besides all these methods it is always possible to resort to medicamentous anaesthesia (analgesia). The doctor decides when it is necessary. Watch your baby for signs of stress and alarm the nurse and the doctors if the baby needs pain relief.

Other factors influencing the stress and pain in the baby are the mother’s voice, the contact, the embrace, the skin-to-skin contact, etc. Ask your neonatologist to let you touch your baby to fondle and cuddle him/her or to play music for them. Ask the doctor about the pain your child feels and how you can help reduce it. Doctors’ efforts to reduce stress in premature babies are aimed at providing quiet, darkened and peaceful environment for their treatment and growth. This is achieved by limiting the volume of sound alarms and signals in the intensive care unit. Another stress factor for babies is the twenty-four hour luminescent lighting in intensive care units. For this purpose, special covers are put on incubators. This makes the environment closer to the mother’s womb. The attending medical staff takes care and performs manipulations to the premature infants as gently as possible, according to the feeding and sleep schedule, etc.

Future research in this area is focused on studying, prevention and reduction to complete elimination of pain in the neonatal period. This is an additional precondition for achievement of the most important goal – saving the baby’s health, later development and quality of life.