Pain in babies, and whether babies feel
pain
Pain is a distressing feeling often caused by intense or damaging stimuli. The International Association for the Study of Pain defines pain as "an unpleasant sensory and emotional experience associated with, or resembling that associated with, ...
, has been a large
subject of debate within the medical profession for centuries. Prior to the late nineteenth century it was generally considered that babies
hurt more easily than adults. It was only in the last quarter of the 20th century that scientific techniques finally established babies definitely do experience pain – probably more than adults – and developed reliable means of
assessing and of
treating it. As recently as 1999, it was widely believed by medical professionals
that babies could not feel pain until they were a year old, but today it is believed newborns and likely even fetuses beyond a certain age can experience pain.
Effects
There are a number of
metabolic
Metabolism (, from el, μεταβολή ''metabolē'', "change") is the set of life-sustaining chemical reactions in organisms. The three main functions of metabolism are: the conversion of the energy in food to energy available to run cell ...
and
homeostatic
In biology, homeostasis (British also homoeostasis) (/hɒmɪə(ʊ)ˈsteɪsɪs/) is the state of steady internal, physical, and chemical conditions maintained by living systems. This is the condition of optimal functioning for the organism and i ...
changes which result from untreated pain, including an increased requirement for
oxygen
Oxygen is the chemical element with the symbol O and atomic number 8. It is a member of the chalcogen group in the periodic table, a highly reactive nonmetal, and an oxidizing agent that readily forms oxides with most elements as wel ...
, accompanied by a reduction in the efficiency of
gas exchange
Gas exchange is the physical process by which gases move passively by Diffusion#Diffusion vs. bulk flow, diffusion across a surface. For example, this surface might be the air/water interface of a water body, the surface of a gas bubble in a liqui ...
in the
lungs
The lungs are the primary organs of the respiratory system in humans and most other animals, including some snails and a small number of fish. In mammals and most other vertebrates, two lungs are located near the backbone on either side of th ...
. This combination can lead to inadequate oxygen supply, resulting in potential
hypoxemia
Hypoxemia is an abnormally low level of oxygen in the blood. More specifically, it is oxygen deficiency in arterial blood. Hypoxemia has many causes, and often causes hypoxia as the blood is not supplying enough oxygen to the tissues of the body ...
. In addition, a rise in
stomach acid
Gastric acid, gastric juice, or stomach acid is a digestive fluid formed within the stomach lining. With a pH between 1 and 3, gastric acid plays a key role in digestion of proteins by activating digestive enzymes, which together break down the ...
ity accompanies the
stress reaction precipitated by pain, and there is a risk of aspirating this into the lungs, further endangering lung integrity and tissue oxygenation. In cases of acute, persistent pain, the metabolism becomes predominantly
catabolic
Catabolism () is the set of metabolic pathways that breaks down molecules into smaller units that are either oxidized to release energy or used in other anabolic reactions. Catabolism breaks down large molecules (such as polysaccharides, lipids, ...
, causing reduced efficiency of the
immune system
The immune system is a network of biological processes that protects an organism from diseases. It detects and responds to a wide variety of pathogens, from viruses to parasitic worms, as well as cancer cells and objects such as wood splinte ...
and a breakdown of proteins caused by the action of the
stress hormone
Stress hormones are secreted by endocrine glands to modify one's internal environment during times of stress. By performing various functions such as mobilizing energy sources, increasing heart rate, and downregulating metabolic processes which a ...
s. In combination, healing of damaged or infected tissue may be impaired, and
morbidity
A disease is a particular abnormal condition that negatively affects the structure or function of all or part of an organism, and that is not immediately due to any external injury. Diseases are often known to be medical conditions that a ...
and
mortality
Mortality is the state of being mortal, or susceptible to death; the opposite of immortality.
Mortality may also refer to:
* Fish mortality, a parameter used in fisheries population dynamics to account for the loss of fish in a fish stock throug ...
increased.
The
neuropsychological effect on the
bonding between mother and child, on later contact with health professionals, and on personal and social psychological well-being is difficult to quantify. Research suggests that babies exposed to pain in the neonatal period have more difficulty in these areas. Professionals working in the field of
neonatal
An infant or baby is the very young offspring of human beings. ''Infant'' (from the Latin word ''infans'', meaning 'unable to speak' or 'speechless') is a formal or specialised synonym for the common term ''baby''. The terms may also be used to ...
pain have speculated that adolescent
aggression
Aggression is overt or covert, often harmful, social interaction with the intention of inflicting damage or other harm upon another individual; although it can be channeled into creative and practical outlets for some. It may occur either reacti ...
and
self-destructive behaviour
Self-destructive behavior is any behavior that is harmful or potentially harmful towards the person who engages in the behavior.
Self-destructive behaviors have been shown by many people throughout the years. It is on a continuum, with one extr ...
, including
suicide
Suicide is the act of intentionally causing one's own death. Mental disorders (including depression, bipolar disorder, schizophrenia, personality disorders, anxiety disorders), physical disorders (such as chronic fatigue syndrome), and s ...
, may, in some cases, be attributed to the long-term effects of untreated neonatal pain.
Pathophysiology
The present understanding of pain in babies is largely due to the recognition that the
fetal
A fetus or foetus (; plural fetuses, feti, foetuses, or foeti) is the unborn offspring that develops from an animal embryo. Following embryonic development the fetal stage of development takes place. In human prenatal development, fetal develo ...
and newborn unmyelinated
nerve fibres
An axon (from Greek ἄξων ''áxōn'', axis), or nerve fiber (or nerve fibre: see spelling differences), is a long, slender projection of a nerve cell, or neuron, in vertebrates, that typically conducts electrical impulses known as action po ...
are capable of relaying information, albeit slower than would be the case with
myelin
Myelin is a lipid-rich material that surrounds nerve cell axons (the nervous system's "wires") to insulate them and increase the rate at which electrical impulses (called action potentials) are passed along the axon. The myelinated axon can be ...
ated fibres. At birth a baby has developed the
neural pathway
In neuroanatomy, a neural pathway is the connection formed by axons that project from neurons to make synapses onto neurons in another location, to enable neurotransmission (the sending of a signal from one region of the nervous system to ano ...
s for
nociception
Nociception (also nocioception, from Latin ''nocere'' 'to harm or hurt') is the sensory nervous system's process of encoding noxious stimuli. It deals with a series of events and processes required for an organism to receive a painful stimulus, co ...
and for experiencing pain, but the pain responses are an immature version of that of an adult. There are a number of differences in both nerve structure and in the quality and extent of nerve response which are considered to be pertinent to understanding
neonatal
An infant or baby is the very young offspring of human beings. ''Infant'' (from the Latin word ''infans'', meaning 'unable to speak' or 'speechless') is a formal or specialised synonym for the common term ''baby''. The terms may also be used to ...
pain.
The nerves of young babies respond more readily to noxious stimuli
A stimulus is something that causes a physiological response. It may refer to:
* Stimulation
** Stimulus (physiology), something external that influences an activity
** Stimulus (psychology), a concept in behaviorism and perception
* Stimulus (eco ...
, with a lower threshold to stimulation, than those of adults. A baby's threshold for sensitization
Sensitization is a non-associative learning process in which repeated administration of a stimulus results in the progressive amplification of a response. Sensitization often is characterized by an enhancement of response to a whole class of stim ...
is also substantially decreased, whilst the process involves a much larger area of sensitization with each trauma. The neural pathways that descend from the brain
A brain is an organ that serves as the center of the nervous system in all vertebrate and most invertebrate animals. It is located in the head, usually close to the sensory organs for senses such as vision. It is the most complex organ in a v ...
to the spinal cord
The spinal cord is a long, thin, tubular structure made up of nervous tissue, which extends from the medulla oblongata in the brainstem to the lumbar region of the vertebral column (backbone). The backbone encloses the central canal of the spi ...
are not well developed in the newborn, resulting in the ability of the central nervous system to inhibit nociception being more limited than in the adult.[Howard RF. ''Developmental Factors and Acute Pain in Children.'' in Pain 2005 – An Updated Review: Refresher Course Syllabus, ed. Justins DM. IASP Press, Seattle, 2005.]
There are also indication that the neonate's nervous system
In biology, the nervous system is the highly complex part of an animal that coordinates its actions and sensory information by transmitting signals to and from different parts of its body. The nervous system detects environmental changes th ...
may be much more active than that of an adult, in terms of transforming its connections and central nerve pathways in response to stimuli. The ongoing process of neural pathway development, involving both structural and chemical changes of the nervous system, have been shown to be affected by pain events, both in the short term and potentially into adult life.
Diagnosis
Some of the signs of pain in babies are obvious, requiring no special equipment or training. The baby is crying and irritable when awake, develops a disturbed sleep pattern, feeds poorly, and shows a fearful, distrustful reaction towards care-givers.
The classical International Association for the Study of Pain
The International Association for the Study of Pain (IASP) is an international learned society promoting research, education, and policies for the understanding, prevention, and treatment of pain. IASP was founded in 1973 under the leadership of ...
definition of pain[
This often quoted definition was first formulated by an IASP Subcommittee on Taxonomy:]
It is derived from Harold Merskey's 1964 definition: "An unpleasant experience that we primarily associate with tissue damage or describe in terms of tissue damage or both."
as a subjective, emotional experience that is ''described in terms of tissue damage'', depends on the patient being able to self-report pain, which is little use in diagnosing and treating pain in babies. More significant are non-verbal responses, of which there are two kinds: gross physical movements and physiological response measurements. The former are simple direct observation, while the latter requires specific equipment to monitor blood pressure
Blood pressure (BP) is the pressure of circulating blood against the walls of blood vessels. Most of this pressure results from the heart pumping blood through the circulatory system. When used without qualification, the term "blood pressure" r ...
and stress hormone
Stress hormones are secreted by endocrine glands to modify one's internal environment during times of stress. By performing various functions such as mobilizing energy sources, increasing heart rate, and downregulating metabolic processes which a ...
levels.
The cry response is increasingly important, as researchers are now able to differentiate between different kinds of cry: classed as "hungry", "angry", and "fearful or in pain". Interpretation is difficult, however, depending on the sensitivity of the listener, and varies significantly between observers.
Studies have sought additional, visible and easily definable indicators of pain and in particular the high level of pain detected in babies when hungry, compared to pain levels in further developed children. Combinations of crying with facial expression
A facial expression is one or more motions or positions of the muscles beneath the skin of the face. According to one set of controversial theories, these movements convey the emotional state of an individual to observers. Facial expressions are a ...
s, posture
Posture or posturing may refer to:
Medicine
* Human position
** Abnormal posturing, in neurotrauma
**Spinal posture
** List of human positions
* Posturography, in neurology
Other uses
* Posture (psychology)
In humans, posture can provide a s ...
and movements, aided by physiological measurements, have been tested and found to be reliable indicators. A number of such observational scales have been published and verified Even with noticeable responses from an infant, the underlying problem may be hidden. Due to the inability to speak or the side effects of the illness, it may be difficult to receive a proper diagnosis, causing infant diagnosis to be one of the hardest to do in the medical field.
Children and Infants' Postoperative Pain Scale
The Children and Infants Postoperative Pain Scale (ChIPPS) is often used in the assessment of hospitalised babies. The scale requires no special measurements, and is therefore applicable across a wide range of circumstances.
Described in 2000, the scale uses a measurement of five items, each rated as 0, 1, or 2 based on the following parameters:
Total score indicates how the baby should be managed according to the scale:
* 0–3 No requirement for treating pain,
* 4–10 Progressively greater need for analgesia.
All observations, both movement and physiological, tend to decrease when pain is persistent, thus rendering the scale unreliable in acute or prolonged cases. In addition, hyperalgesia
Hyperalgesia ( or ; 'hyper' from Greek ὑπέρ (huper, “over”), '-algesia' from Greek algos, ἄλγος (pain)) is an abnormally increased sensitivity to pain, which may be caused by damage to nociceptors or peripheral nerves and can ...
and allodynia
Allodynia is a condition in which pain is caused by a stimulus that does not normally elicit pain. For example, bad sunburn can cause temporary allodynia, and touching sunburned skin, or running cold or warm water over it, can be very painful. It i ...
, occur more quickly and more extensively in babies than in adults. Day to day changes in the response to a specific injury may therefore become unpredictable and variable.
Treatment
Where the baby is to undergo some form of planned procedure, health professionals will take steps to reduce pain to a minimum, though in some circumstances it may be not be possible to remove all pain.
In case of illness, accident and post operative pain, a graded sequence of treatment is becoming established as standard practice. Research is making it easier and simpler to provide the necessary care, with a clearer understanding of the risks and possible side effect
In medicine, a side effect is an effect, whether therapeutic or adverse, that is secondary to the one intended; although the term is predominantly employed to describe adverse effects, it can also apply to beneficial, but unintended, consequence ...
s.
Measures not involving medication
Comforting
Touching, holding, stroking, keeping warm, talking and singing/music are ways in which adults have been comforting babies since the start of human history. This way of managing pain is shared with other primate
Primates are a diverse order of mammals. They are divided into the strepsirrhines, which include the lemurs, galagos, and lorisids, and the haplorhines, which include the tarsiers and the simians (monkeys and apes, the latter including huma ...
s, where the actions are performed both by female and male adults. Children who are able to verbalise pain report it to be an ineffective strategy and this is assumed to also be true of babies.
While the pain of a procedure may or may not be affected, the fear is visibly reduced. This works to ameliorate the negative effects of fear in health care situations. It is, therefore, considered good practice to involve parents or care-givers directly, having them present and in contact with the baby whenever possible before a minor painful procedure, such as the drawing of blood, or prior to giving a local anaesthetic injection.
Oral stimulation
Breastfeeding
Breastfeeding, or nursing, is the process by which human breast milk is fed to a child. Breast milk may be from the breast, or may be expressed by hand or pumped and fed to the infant. The World Health Organization (WHO) recommends that br ...
, the use of a pacifier
A pacifier is a rubber, plastic, or silicone nipple substitute given to an infant to suckle upon between feedings to quiet its distress by satisfying the need to suck when it does not need to eat. Pacifiers normally have three parts: an elongate ...
and the administration of sugar orally has been proven to reduce the signs of pain in babies. Electroencephalograph
Electroencephalography (EEG) is a method to record an electrogram of the spontaneous electrical activity of the brain. The biosignals detected by EEG have been shown to represent the postsynaptic potentials of pyramidal neurons in the neocortex ...
ic changes are reduced by sugar, but the mechanism for this remains unknown; it does not seem to be endorphin
Endorphins (contracted from endogenous morphine) are chemical signals in the brain that block the perception of pain and increase feelings of wellbeing. They are produced and stored in an area of the brain known as the pituitary gland.
Hist ...
mediated. As in comforting, it is unknown whether the physical pain is reduced, or whether it is the level of anxiety which is affected. However, the reduction in pain behaviour is assumed to be accompanied by a reduction in pain-related disorders, both immediate and longer term.
Oral sugar
Sugar taken orally reduces the total crying time but not the duration of the first cry in newborns undergoing a painful procedure (a single lancing of the heel). It does not moderate the effect of pain on heart rate and a recent single study found that sugar did not significantly affect pain-related electrical activity
This is a list of electrical phenomena. Electrical phenomena are a somewhat arbitrary division of electromagnetic phenomena.
Some examples are:
*Biefeld–Brown effect — Thought by the person who coined the name, Thomas Townsend Brown, to ...
in the brains of newborns one second after the heel lance procedure. Sweet oral liquid moderately reduces the incidence and duration of crying caused by immunization injection in children between one and twelve months of age.
Sensorial Saturation
It is based on the competition of various gentle stimuli with pain
Pain is a distressing feeling often caused by intense or damaging stimuli. The International Association for the Study of Pain defines pain as "an unpleasant sensory and emotional experience associated with, or resembling that associated with, ...
transmission to the central nervous system: the so-called gate control theory of pain (proposed by Patrick David Wall
Patrick David Wall (25 April 1925 – 8 August 2001) was a British neuroscientist described as 'the world's leading expert on pain' and best known for the gate control theory of pain.
Early life and education
Wall was born in Nottingham on ...
and Ronald Melzack
Ronald Melzack (July 19, 1929 – December 22, 2019) was a Canadian psychologist and professor of psychology at McGill University. In 1965, he and Patrick David Wall revolutionized pain research by introducing the gate control theory of pain. ...
in 1965). Sensorial saturation follows a "3Ts" rule: using touch, taste and talk to distract the baby and antagonize pain. In babies treated with Sensorial Saturation, a reduction in crying time and pain score were noted, with respect to a control group and with respect to groups in which only oral sugar, only sucking, or a combination of the two was used. The "3Ts" stimuli (touch, talk, and taste)given throughout the painful procedure increase the well-known analgesic effect of oral sugar. Sensorial Saturation has been included in several international guidelines for analgesia
Other techniques
Other "old fashioned" techniques are being tested with some success. "Facilitated tucking", swaddling
Swaddling is an age-old practice of wrapping infants in blankets or similar cloths so that movement of the limbs is tightly restricted. Swaddling bands were often used to further restrict the infant. Swaddling fell out of favour in the 17th cent ...
and "kangaroo care
Kangaroo care also called skin-to-skin contact (SSC), is a technique of newborn care where babies are kept chest-to-chest and skin-to-skin with a parent, typically their mother (occasionally their father).
Kangaroo care, named for the similarity ...
" have been shown to reduce the response of babies to painful or distressful circumstances, while a comprehensive technique of nursing, called "developmental care", has been developed for managing pre-term infants.
Measures involving medication
Local anaesthetics
A variety of ''topical anaesthetic A topical anesthetic is a local anesthetic that is used to numb the surface of a body part. They can be used to numb any area of the skin as well as the front of the eyeball, the inside of the nose, ear or throat, the anus and the genital area. Topi ...
'' creams have been developed, ranging from single agents with good skin penetration, to eutectic mixtures of agents and technologically modern formulations of lignocaine
Lidocaine, also known as lignocaine and sold under the brand name Xylocaine among others, is a local anesthetic of the amino amide type. It is also used to treat ventricular tachycardia. When used for local anaesthesia or in nerve blocks, lidoca ...
in microspheres. They are effective in suitable procedures, if correctly and timeously applied. Disadvantages are the slow onset of adequate anaesthesia, inadequate analgesia for larger procedures, and toxicity of absorbed medication.
Local infiltration
Infiltration may refer to:
Science, medicine, and engineering
*Infiltration (hydrology), downward movement of water into soil
*Infiltration (HVAC), a heating, ventilation, and air conditioning term for air leakage into buildings
*Infiltration (me ...
anaesthesia, the infiltration of anaesthetic agent directly into the skin and subcutaneous tissue where the painful procedure is to be undertaken, may be effectively used to reduce pain after a procedure under general anaesthesia
General anaesthesia (UK) or general anesthesia (US) is a medically induced loss of consciousness that renders the patient unarousable even with painful stimuli. This effect is achieved by administering either intravenous or inhalational general ...
. To reduce the pain of the initial injection, a topical anaesthetic ointment may be applied.
Regional anaesthesia requires the injection of local anaesthetic around the nerve trunks that supply a limb, or into the epidural space
In anatomy, the epidural space is the potential space between the dura mater and vertebrae ( spine).
The anatomy term "epidural space" has its origin in the Ancient Greek language; , "on, upon" + dura mater also known as "epidural cavity", "ext ...
surrounding the spinal cord
The spinal cord is a long, thin, tubular structure made up of nervous tissue, which extends from the medulla oblongata in the brainstem to the lumbar region of the vertebral column (backbone). The backbone encloses the central canal of the spi ...
. It is used for pain relief after surgery, but requires special facilities for observation of the baby until the effect has worn out.
Analgesics
As the site of pain in babies is difficult to confirm, analgesics
An analgesic drug, also called simply an analgesic (American English), analgaesic (British English), pain reliever, or painkiller, is any member of the group of drugs used to achieve relief from pain (that is, analgesia or pain management). It i ...
are often advised against until a proper diagnosis
Diagnosis is the identification of the nature and cause of a certain phenomenon. Diagnosis is used in many different disciplines, with variations in the use of logic, analytics, and experience, to determine " cause and effect". In systems engin ...
has been performed. For all analgesic drugs, the immaturity of the baby's nervous system and metabolic pathways, the different way in which the drugs are distributed, and the reduced ability of the baby to excrete the drugs though the kidneys make the prescription of dosage important. The potentially harmful side effects of analgesic drugs are the same for babies as they are for adults and are both well known and manageable.
There are three forms of analgesia suitable for the treatment of pain in babies: paracetamol
Paracetamol, also known as acetaminophen, is a medication used to treat fever and mild to moderate pain. Common brand names include Tylenol and Panadol.
At a standard dose, paracetamol only slightly decreases body temperature; it is inferior ...
(acetaminophen), the nonsteroidal anti-inflammatory drug
Non-steroidal anti-inflammatory drugs (NSAID) are members of a therapeutic drug class which reduces pain, decreases inflammation, decreases fever, and prevents blood clots. Side effects depend on the specific drug, its dose and duration of ...
s, and the opioid
Opioids are substances that act on opioid receptors to produce morphine-like effects. Medically they are primarily used for pain relief, including anesthesia. Other medical uses include suppression of diarrhea, replacement therapy for opioid us ...
s. Paracetamol is safe and effective if given in the correct dosage. The same is true of the nonsteroidal anti-inflammatory drugs, such as ibuprofen
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that is used for treating pain, fever, and inflammation. This includes painful menstrual periods, migraines, and rheumatoid arthritis. It may also be used to close a patent ductus arte ...
(aspirin
Aspirin, also known as acetylsalicylic acid (ASA), is a nonsteroidal anti-inflammatory drug (NSAID) used to reduce pain, fever, and/or inflammation, and as an antithrombotic. Specific inflammatory conditions which aspirin is used to treat inc ...
is seldom used). Of the opioids, morphine
Morphine is a strong opiate that is found naturally in opium, a dark brown resin in poppies (''Papaver somniferum''). It is mainly used as a analgesic, pain medication, and is also commonly used recreational drug, recreationally, or to make ...
and fentanyl
Fentanyl, also spelled fentanil, is a very potent synthetic opioid used as a pain medication. Together with other drugs, fentanyl is used for anesthesia. It is also used illicitly as a recreational drug, sometimes mixed with heroin, cocaine ...
are most often used in a hospital setting, while codeine
Codeine is an opiate and prodrug of morphine mainly used to treat pain, coughing, and diarrhea. It is also commonly used as a recreational drug. It is found naturally in the sap of the opium poppy, ''Papaver somniferum''. It is typically use ...
is effective for use at home. Clonidine
Clonidine, sold under the brand name Catapres among others, is an α2-adrenergic agonist medication used to treat high blood pressure, ADHD, drug withdrawal ( alcohol, opioids, or nicotine), menopausal flushing, diarrhea, spasticity, and c ...
is thought to have potential to reduce pain in newborn babies but it has yet to be tested in clinical trials.
History
Pre late 19th century
Before the late nineteenth century, babies were considered to be more sensitive to pain than adults. Doris Cope[Cope DK. ''Neonatal Pain: The Evolution of an Idea.'' The American Association of Anesthesiologists Newsletter, September 1998. Electronic text available at www.asahq.org/Newsletters/1998/09_98/Neonatal_0998.html. Accessed 20070312.] quotes paediatric surgeon Felix Würtz of Basel, writing in 1656:
Late 19th century
In the late nineteenth, and first half of the twentieth century, doctors were taught that babies did not experience pain, and were treating their young patients accordingly. From needle sticks to tonsillectomies
Tonsillectomy is a surgical procedure in which both palatine tonsils are fully removed from the back of the throat. The procedure is mainly performed for recurrent tonsillitis, throat infections and obstructive sleep apnea (OSA). For those with ...
to heart operations were done with no anaesthesia
Anesthesia is a state of controlled, temporary loss of sensation or awareness that is induced for medical or veterinary purposes. It may include some or all of analgesia (relief from or prevention of pain), paralysis (muscle relaxation), am ...
or analgesia
Pain management is an aspect of medicine and health care involving relief of pain (pain relief, analgesia, pain control) in various dimensions, from acute and simple to chronic and challenging. Most physicians and other health professionals ...
, other than muscle relaxation
Muscle contraction is the activation of Tension (physics), tension-generating sites within muscle cells. In physiology, muscle contraction does not necessarily mean muscle shortening because muscle tension can be produced without changes in muscl ...
for the surgery. The belief was that in babies the expression of pain was reflex
In biology, a reflex, or reflex action, is an involuntary, unplanned sequence or action and nearly instantaneous response to a stimulus.
Reflexes are found with varying levels of complexity in organisms with a nervous system. A reflex occurs ...
ive and, owing to the immaturity of the infant brain
A brain is an organ that serves as the center of the nervous system in all vertebrate and most invertebrate animals. It is located in the head, usually close to the sensory organs for senses such as vision. It is the most complex organ in a v ...
, the pain could not really matter.
Cope considers it probable that the belief arose from misinterpretation of discoveries made in the new science of embryology
Embryology (from Greek ἔμβρυον, ''embryon'', "the unborn, embryo"; and -λογία, '' -logia'') is the branch of animal biology that studies the prenatal development of gametes (sex cells), fertilization, and development of embryos and ...
. Dr Paul Flechsig
Paul Emil Flechsig (29 June 1847, Zwickau, Kingdom of Saxony – 22 July 1929, Leipzig) was a German neuroanatomist, psychiatrist and neuropathologist. He is mainly remembered today for his research of myelinogenesis.
Biography
Born in Zwickau, h ...
equated the non-myelinisation of much of a baby's nervous system
In biology, the nervous system is the highly complex part of an animal that coordinates its actions and sensory information by transmitting signals to and from different parts of its body. The nervous system detects environmental changes th ...
with an inability to function.
It was generally believed that babies would not remember any pain that they happened to feel, and that lack of conscious memory meant lack of long-term harm. Scientific studies on animals with various brain lesions were interpreted as supporting the idea that the responses seen in babies were merely spinal reflex
In biology, a reflex, or reflex action, is an involuntary, unplanned sequence or action and nearly instantaneous response to a stimulus.
Reflexes are found with varying levels of complexity in organisms with a nervous system. A reflex occurs ...
es. Furthermore, the whole effort of relieving pain was considered futile since it was thought to be impossible to measure the child's pain.
This, coupled with a concern that use of opiate
An opiate, in classical pharmacology, is a substance derived from opium. In more modern usage, the term ''opioid'' is used to designate all substances, both natural and synthetic, that bind to opioid receptors in the brain (including antagonis ...
s would lead to addiction, and the time and effort needed to provide adequate analgesia to the newborn, contributed to the medical profession's continued practice of not providing pain relief for babies.
Mid-1980s
In the United States, a major change in practice was brought about by events surrounding one operation. Infant Jeffrey Lawson underwent open heart surgery in 1985. His mother, Jill R. Lawson, subsequently discovered that he had been operated on without any anaesthesia, other than a muscle relaxant. She started a vigorous awareness campaign which created such a public, and medical, reaction that by 1987[Boffey PM. LEAD: ''Infants' Sense of Pain Is Recognized, Finally''. The New York Times, November 24, 1987]
New York Times Article Accessed 20070323.
/ref> medical opinion had come full circle.
A number of studies on the measurement of pain in young children, and on ways of reducing the injury response began, and publications on the hormonal
A hormone (from the Greek participle , "setting in motion") is a class of signaling molecules in multicellular organisms that are sent to distant organs by complex biological processes to regulate physiology and behavior. Hormones are required fo ...
and metabolic
Metabolism (, from el, μεταβολή ''metabolē'', "change") is the set of life-sustaining chemical reactions in organisms. The three main functions of metabolism are: the conversion of the energy in food to energy available to run cell ...
responses of babies to pain stimuli began to appear, confirming that the provision of adequate anaesthesia and analgesia was better medicine on both humanitarian and physiological grounds.
It is now accepted that ''the neonate responds more extensively to pain'' than the adult does, and that exposure to severe pain, without adequate treatment, can have long-term consequences. Despite the difficulty of assessing how much pain a baby is experiencing, and the practical problem of prescribing the correct dosage or technique for treatment, modern medicine is firmly committed to improving the quality of pain relief for the very young.
The effective treatment of pain benefits the baby immediately, reduces some medium-term negative consequences, and likely prevents a number of adult psycho-physiological problems.
See also
* Fetal pain
Prenatal perception is the study of the extent of somatosensory and other types of perception during pregnancy. In practical terms, this means the study of fetuses; none of the accepted indicators of perception are present in embryos. Studies in th ...
References
External links
The First Ache
by Annie Murphy Paul New York Times, February 10, 2008.
{{Citizendium
Pain
Nociception
Neonatology