It certainly hurts your heart to see your baby all “wired up and tubed.” But how much does this actually hurt your baby? The NICU staff is very mindful that there is a little person on the receiving end of all of those tubes and needles. We consider pain the “5th vital sign.”
When drawing blood, inserting an IV, intubating, or taking an axillary temperature (I know, I know, but babies HATE this) doctors and nurses are constantly monitoring for pain. Since pain and stress can slow a baby’s growth and healing, the NICU staff makes every effort possible to keep your baby as comfortable as possible by minimizing the amount of needle sticks, heel pokes, and other painful procedures.
If there are uncomfortable prongs in your baby’s nose or a tube in her trachea, many babies are not very accepting and will need medication to help keep them calm. To relieve discomfort, your baby may be given sedation or an analgesic; your doctor will weigh the risks and benefits associated with this on a case by case basis. Sedation is especially important if a baby has a tendency to “fight” the ventilator, which compromises breathing effectiveness and may cause trauma to the airway.
While preemies cannot speak up, and sometimes may not cry, they do feel. Although they cannot communicate with words, there are many ways that babies express when they are in pain. NICU parents, you will soon learn your baby’s behavior and will start to pick up on indications that he/she is in pain. Speak up if you think something is bothering them.
The Joint Commission has set standards for hospitalized patients in order to make pain assessments mandatory for every patient. In my NICU, we utilize “NPASS” as our pain scoring system—this is the most widely used tool across all NICUs.
Here are some examples of pain indicators that we are constantly watching for:
Increased heart rate or blood pressure
Respirations that are too fast or slow
Decreased oxygen level
Restless squirming
Pain expressions (e.g. facial grimacing, furrowed eyebrows)
Irritable, inconsolable crying
Stiffening of bodies
Arching of backs
Tense finger splaying or “stop sign” hands
Weight loss
Decompensation or Apnea/Bradycardia spells
Kicking, jerking or twitching
Retracting or pulling away from the pain source
Effective pain management is an essential standard of care in order to improve preemies’ clinical and neurodevelopmental outcomes. Here are some great and effective ways to treat pain:
Repositioning
Massage therapy
Hand hugs/firm pressure on your baby for containment
Diaper changes
Skin-to-skin contact
Holding, swaddling, rocking your baby
Providing a paci for NNS (with or without sucrose)
Minimizing light and noise stimuli
Singing or playing soothing music
Medications such as morphine, versed, ativan, fentanyl, tylenol, etc.
