A considerable body of evidence supports the efficacy of sucrose, with or without non-nutritive sucking (NNS), as a non-pharmacological pain-relieving method for minor procedural pain in healthy term infants (). A recent Cochrane review (8
) reported that good evidence exists for the efficacy of oral sucrose given to infants 2 min prior to heel stick procedures, in reducing both behavioral and physiological pain responses. NNS alone or in combination with sucrose has also been found to reduce physiological pain response and cry behaviors in circumcision relative to standard care or no intervention and to add analgesic effect when used in combination with a conventional analgesic block. Data from existing research further suggests that sucrose is an effective and possibly superior alternative to EMLA, a conventional pharmacological analgesic (41
). Sucrose has also been found to be superior to breast milk and breast feeding as a procedural analgesic in full-term newborns, when the verbal and tactile cues of nursing are controlled (38
There is also substantial evidence to suggest that NNS alone reduces elevations in heart rate and pain behavior in response to heel sticks and needle insertions (). Adding sucrose to the pacifier may increase the rate of sucking and provide an additive effect, as illustrated by the several investigations that have found superior analgesic effects with sucrose combined with NNS, when compared with either intervention alone in both full-term and preterm neonates. However, Stevens et al.
) has stressed that infants appear to receive continuing benefit from sucrose for several minutes after administration, allowing the performance of one or more painful procedures, while the pacifier relieves distress only while the baby is actually engaged in sucking. Finally, sucrose or another sweet solution may provide an important baseline or additive effect in combination with some other interventions such as holding (25
) or sensory stimulation (26
Mixed findings have been reported regarding the use of sucrose in preterm and sick infants. Whereas some investigators have found little difference between sucrose and placebo in reducing preterm infant distress to eye exams (32
) and other procedures including heel sticks (30
), other researchers have found sucrose an effective analgesic for preterm neonates (). Findings from the negative studies may have been skewed by small sample size or limited outcome measures. Also, two well-conducted trials of sick infants (6
) have shown that sucrose administration failed to reduce pain behavior during heel sticks, although sucrose did appear to provide analgesic benefits during recovery. Thus, the benefits obtained from the use of sucrose in alleviating minor procedural pain among preterm or sick infants remain unclear.
Several researchers have demonstrated the effects of other sweet solutions including glucose, fructose and artificial sweetener in reducing minor procedural distress in full-term infants (). Glucose in particular has been shown to offer equivalent analgesia with or without NNS in very premature infants receiving venipuncture (4
) and to provide a significant additive effect to breastfeeding in reducing crying and pain response in full-term infants (40
On the whole, it appears that sucrose, NNS and sweetened solutions hold considerable promise for reducing infant procedural pain. The findings extend to a number of procedures, including both minor (e.g. heel sticks) and major (i.e. circumcision) procedures. Although it appears that sucrose administered approximately 2 min before the procedure on a pacifier to induce NNS may be the most consistent form of pain relief, a number of caveats exist. Most researchers have used small sample sizes and failed to report important aspects of their protocols with sufficient clarity, such as randomization and procedural standardization. Further well-controlled investigations using validated behavioral pain measures are called for.