Pain Management for Your Baby in the NICU

We recommend these methods as a first step to reduce pain during medical procedures. You can partner with your nurse to learn which measures are appropriate for your baby and how you can help with them.

Sugar water (sucrose) can help lower pain during procedures that break the skin, like injections, blood draws and heel sticks. Your nurse may choose to give, just before and during a procedure, by squirting a few drops in your baby’s mouth or offering them a pacifier that has been dipped in sugar water.

Sucking can help lower pain during small procedures, like a heel stick. Sucking has a calming effect. It helps reduce your baby’s immediate reaction to pain. This can be sucking on a pacifier or a clean finger (non-nutritive sucking), breastfeeding, chestfeeding, or offering a swab dipped in breastmilk to cover the gums and tongue (Oral Cares).

Swaddling or tucking a blanket closely around your baby can lower pain and give comfort if they need care that might be uncomfortable, such as suctioning or placing a feeding tube. This is not as effective as sugar water for procedures that break the skin, like injections and blood draws.

Skin-to-skin care is when your baby is held on your chest with no clothing or blankets between you. It can help your baby grow, bond with you, and is good for brain development. Read our handout on “Kangaroo Care.”

seattlechildrens.org/pdf/PE2918.pdf

Depending on your baby’s age and medical needs, acupuncture, massage, music therapy and family voice recordings may be helpful to them. Read our handout on “Soothing Your Baby.”

www.seattlechildrens.org/pdf/PE593.pdf

Providers prescribe pain medicines for your baby to lower their pain when non-medicine options are not enough. This is a list of the most common pain medicines that providers prescribe for pain. It does not include all the medicines in the NICU. Ask your medical team for more information about your baby’s pain medicines.

Acetaminophen (Tylenol) is a medicine that is safe and effective at lowering pain, like after surgery. It can help reduce the need for stronger pain medicines.

Opioids are very effective relief of moderate to severe pain. They can make your baby feel sleepy and calm (sedation). They lower your baby’s stress from pain (physiologic stress response).

Opioids can have side effects, including slower breathing (respiratory depression), low blood pressure (hypotension) and constipation. Over time, the body can get used to them (tolerance). This makes your baby need more pain medicine than in the past to get the same level of pain relief.

Examples include:

• Morphine
• Hydromorphone (Dilaudid)
• Fentanyl
• Methadone

Benzodiazepines can make your baby sleepy and calm (sedation) and relax their muscles. They do not relieve pain.

They may be prescribed by providers for procedures to help keep your baby still, like during imaging tests (X-ray, CT scan and MRI). Providers prescribe them at the same time as other pain medicines for larger procedures, such as surgeries.

Side effects can include making your baby too sleepy (excessive sedation), slower breathing (respiratory depression), muscle jerking and low blood pressure (hypotension). An opposite reaction can happen to some babies, and they may become more agitated, in which case the medicine would be stopped.

Examples include:

• Midazolam (Versed)
• Lorazepam (Ativan)

Dexmedetomidine and Clonidine have strong calming effects and some pain-relieving effects. They do not cause as much problem with slower breathing (respiratory depression) as opioids and benzodiazepines. Side effects can include lower heart rate and lower blood pressure.

If your baby needs these pain medicines for a less than 7 days, they can be stopped quickly. If your baby needs these medicines for a longer time, their body may get used to the medicine. Your baby’s care team will discuss this with you and make a plan to safely stop using them (weaning plan).