“There is a particular grimace that was described by Darwin in the 1800s that is recognized universally as pain,” she says. Their cries and facial expressions revealed what she calls “honest signaling,” behaviors that babies are born with that communicate distress. In 1986, she was among the first to publish evidence that infants’ heart rates and oxygen levels changed when they were subjected to painful procedures. In the early 1980s, Canadian newborn medicine researcher Celeste Johnston, an emeritus professor at McGill University in Montreal, was approached by nurses working in the NICU who wanted a way to measure pain in infants. Nurses need to lance their tiny heels for blood tests up to 10 times a day, and they are engulfed in IV lines, tubes, and wires. They are too weak to suckle and must be fed through tubes in the nose or mouth. The youngest, those under 36 weeks, have underdeveloped lungs and may be intubated and hooked up to a ventilator. “Brain maturation is based on sensory experience,” Filippa explains, “and the neonatal intensive care unit is very stressful.” How do babies express pain?īabies born extremely early are whisked from the delivery room to the NICU.
It’s loud, with machines beeping, alarms going off, people talking, and ventilators thumping and hissing. Inside a neonatal intensive care unit, or NICU, lights are bright and monitors blink. That’s critical, says Manuela Filippa, a researcher at the University of Geneva who studies prematurity,because separating sick babies from their parents compounds pain with toxic stress that creates serious developmental problems. 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.
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). In the United States alone, about 380,000 babies are born prematurely each year, or about one in 10 births.
Strategies to make such procedures less traumatic are vital, as premature births are rising globally. But preemies may spend weeks or months in the hospital undergoing the constant, often painful procedures needed to save their lives. Rapid advances in medicine now allow very fragile, tiny, preterm babies to survive.
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. 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. “At the time, it was assumed that most of the behaviors that infants were exhibiting were just reflexes.” 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. Doctors once believed that infants-especially premature babies-did not feel pain, and if they did, they would not remember it.
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