ABM Clinical Protocol #23: Nonpharmacological Management of Procedure-Related Pain in the Breastfeeding Infant, Revised 2016

Abstract

A central goal of The Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient. These guidelines are not intended to be all-inclusive, but to provide a basic framework for physician education regarding breastfeeding .

Purpose

THE INTERNATIONAL EVIDENCE-BASED GROUP for Neonatal Pain and the American Academy of Pediatrics recommends that all neonatal units develop strategies to minimize the number of minor painful or stressful procedures and to provide effective nonpharmacological and/or pharmacological pain relief for newborns. The purpose of this protocol is to provide healthcare professionals with evidence-based guidelines on how to incorporate nonpharmacological or behavioral interventions to relieve procedure-induced pain in the breastfeeding infant.

Background

Newborns and young infants routinely experience pain associated with commonly used invasive procedures such as blood sampling and intramuscular injections (e.g., vaccinations and vitamin K) and, in some countries, circumcision (the removal of some or all of the foreskin [prepuce] from the penis). Reduction of pain is both a professional imperative and an ethical expectation because untreated pain has detrimental consequences such as greater pain sensitivity in later childhood and may lead to permanent neuroanatomical and behavioral abnormalities as demonstrated in animal models.

Moreover, pain is a source of concern and distress for new parents and may disturb mother–infant bonding. Pain reduction therapies are often underused for the numerous minor procedures that are part of routine medical and nursing care for neonates. Growing scientific and clinical evidence from both animal and human newborns points to the efficacy of natural, nonpharmacological interventions to reduce pain due to minor procedures. Parents should be educated about the benefits of using breastfeeding and human milk in these situations.