Pain in babies

The perception and experience of pain in babies has historically been a topic of considerable debate within the medical community. It was once believed that infants were more susceptible to pain than adults, but it wasn't until the late 20th century that scientific advancements definitively established that infants indeed experience pain, possibly even more acutely than adults. Modern medicine has since developed reliable methods to assess and treat this pain.

Human Male White Newborn Baby Crying

Historical Perspective

For centuries, the medical consensus held that infants were more sensitive to pain than adults. However, it was only in the last quarter of the 20th century that modern scientific techniques were employed to unequivocally demonstrate that babies not only feel pain, but might even experience it more profoundly than adults.

Effects of Untreated Pain

Untreated pain in babies can lead to several metabolic and homeostatic alterations:

• There is an increased demand for oxygen but a simultaneous decrease in efficient lung gas exchange, risking hypoxemia.
• Pain-induced stress results in heightened stomach acidity, which, if aspirated, can compromise lung tissue and oxygenation.
• Persistent acute pain causes a shift to catabolic metabolism, weakening the immune response and promoting protein degradation due to stress hormones. This may hinder the healing of injured or infected tissue and elevate morbidity and mortality rates.

Furthermore, untreated neonatal pain might influence the bond between mother and infant, future interactions with medical professionals, and even personal and societal psychological well-being. Some neonatal pain experts hypothesize that adolescent self-harm or aggression, and in extreme cases, even suicidal tendencies, might be linked to unaddressed pain experienced as a neonate.

Pathophysiology

Our current understanding of neonatal pain is rooted in recognizing that fetal and newborn nerve fibers, even if unmyelinated, can transmit information. At birth, infants have already developed neural pathways for nociception and for experiencing pain, albeit an immature version relative to adults. Several differences exist in nerve structure and responsiveness that are crucial to comprehending neonatal pain. For instance, a baby's nerves are more responsive to noxious stimuli, requiring a lower threshold for stimulation, than those of adults. Ongoing research indicates that a baby's nervous system might be more adaptive and dynamic in response to external stimuli than previously thought.

Diagnosis

Signs of pain in infants can sometimes be easily discerned. An inconsolable crying baby, irregular sleep patterns, poor feeding, and evident distrust toward caregivers are all indicative. However, the conventional definition of pain by the International Association for the Study of Pain, being an emotional, subjective experience, is inadequate for diagnosing infants since they cannot communicate their pain verbally. Non-verbal cues are thus essential. These range from physical movements to physiological responses like blood pressure shifts or stress hormone level changes. The nature of an infant's cry, especially when categorized as "hungry," "angry," or "in pain," is particularly significant. Interpreting these cues, however, can vary among observers. Numerous observational scales, combining crying with facial expressions and movements, supplemented by physiological measurements, have proven reliable for pain assessment.

Treatment

For scheduled medical procedures, health professionals aim to minimize pain for the infant, although complete elimination isn't always feasible. In cases of illness, injury, or post-operative recovery, a tiered treatment approach is now recognized as best practice. Contemporary research continuously refines this approach, providing clearer insights into associated risks and potential side effects.

See also

• Neonatology
• Pediatric pain management
• Nociception
• Stress hormones

This article incorporates material from the Citizendium article "Pain in babies", which is licensed under the Creative Commons Attribution-ShareAlike 3.0 Unported License but not under the GFDL.

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