Several factors accounted for the initial explanations of common infant pain outcomes espoused during the 1950s to 1970s. However, recent research evidence has supported the anatomical and functional capacity of infants to perceive and respond to insults interpretable as pain. Although acute pain and distress during medical procedures are commonplace for young children, they remain undermanaged or unmanaged. The exhaustive version of this abridged review was prompted by the absence of comprehensive meta-analyses and significant gaps in the literature pertaining to the broad range of nonpharmacological interventions for managing acute pain and distress in young children from zero to three years of age. These types of analyses are essential for the development of management strategies to mitigate distress in young children undergoing acutely painful procedures.
Acute pain and distress during medical procedures are commonplace for young children.
To assess the efficacy of nonpharmacological interventions for acute procedural pain in children up to three years of age.
Study inclusion criteria were: participants <3 years of age, involved in a randomized controlled or crossover trial, and use of a ‘no-treatment’ control group (51 studies; n=3396). Additional studies meeting all criteria except for study design (eg, use of active control group) were qualitatively described (n=20).
For every intervention, data were analyzed separately according to age group (preterm-born, term-born neonate and older infant/young child) and type of pain response (pain reactivity, immediate pain-related regulation). The largest standardized mean differences (SMD) for pain reactivity were as follows: sucking-related interventions (preterm: −0.42 [95% CI −0.68 to −0.15]; neonate −1.45 [CI −2.34 to −0.57]), kangaroo care (preterm −1.12 [95% CI −2.04 to −0.21]), and swaddling/facilitated tucking (preterm −0.97 [95% CI −1.63 to −0.31]). For immediate pain-related regulation, the largest SMDs were: sucking-related interventions (preterm −0.38 [95% CI −0.59 to −0.17]; neonate −0.90 [CI −1.54 to −0.25]), kangaroo care 0.77 (95% CI −1.50 to −0.03]), swaddling/facilitated tucking (preterm −0.75 [95% CI −1.14 to −0.36]), and rocking/holding (neonate −0.75 [95% CI −1.20 to −0.30]). The presence of significant heterogeneity limited confidence in nonsignificant findings for certain other analyses.
Although a number of nonpharmacological treatments have sufficient evidence supporting their efficacy with preterm infants and healthy neonates, no treatments had sufficient evidence to support efficacy with healthy older infants/young children.