A Review of CAM for Procedural Pain in Infancy: Part I. Sucrose and Non‐Nutritive Sucking

Abstract

There is increasing concern regarding the number of painful medical procedures that infants must undergo and the potential risks of alleviating infant pain with conventional pharmacologic agents. This article is Part I of a two-part series that aims to provide an overview of the literature on complementary and alternative (CAM) approaches for pain and distress related to medical procedures among infants up to six weeks of age. The focus of this article is a review of the empirical literature on sucrose with or without non-nutritive sucking (NNS) for procedural pain in infancy. Computerized databases were searched for relevant studies including prior reviews and primary trials. The most robust evidence was found for the analgesic effects of sucrose with or without NNS on minor procedural pain in healthy full-term infants. Despite some methodological weaknesses, the literature to date supports the use of sucrose, NNS and other sweetened solutions for the management of procedural pain in infancy.

Sweet Solution Analgesia

“…All sweet solutions are administered in the same way, on the infants' lateral side of the tongue prior to or 2 min before the procedure through a syringe slowly over 30 s [9,18]. Another administration technique is through the use of non-nutritive sucking using paciier to improve its efectiveness [11,19].…”

“…Although there is no evidence yet about the dose-response efects [21], dose ranging from 0.5 to 2 mL of 12-24% strength show pain-relief efect [11,22]. For premature neonates, dose is calculated in accordance to their weight/volume ratio.…”

“…Although infant's pain is not expressed as conscious memory, memories of pain may be recorded biologically and alter brain development and subsequent behavior. Some recent studies have reported that simple and benign interventions such as oral sweet solutions [5,8,9], milk [10] or sucking a paciier [11] reduce pain in neonates during procedures. Pain relieving efects of sweet solutions such as sucrose have been examined in term and preterm neonates [12,13].…”

Sucrose for Procedural Pain Management in Infants

“…1,61,63 The same argument applies to glucose, because many studies have shown that glucose, if sufficiently concentrated, also reduces pain in infants. 1,78,79 However, although basic science and clinical researchers and clinicians continue to address the knowledge and research gaps relating to analgesic effects and mechanisms of sucrose, we need to remain cognizant that untreated or poorly treated pain in fragile infants has well-documented short-term adverse consequences and potential longer-term negative effects. 4 Clinicians therefore have an ethical responsibility to minimize pain exposure; use sucrose appropriately for single painful procedures, along with other evidence-based strategies including NNS, kangaroo care, and breastfeeding when feasible; 80 and monitor use and effectiveness of these strategies over short-and long-term periods.…”

Procedural Pain Management for Children Receiving Physiotherapy

“…There have been several reviews describing the literature in support of oral sucrose and non-nutritive sucking for procedural pain in infants. [59][60][61] A small amount (between 0.05 and 0.5 mL) of a 24% sucrose solution is provided orally to the infant. Two minutes prior to the beginning of the procedure, the sucrose is placed either directly on the infant's tongue or on a pacifier that is placed in the infant's mouth.…”