Premature babies have to endure to a lot of painful medical procedures, from blood draws to throat suctioning. Something as simple as a few drops of sugar water can ease that pain, but many preemies don't get that help. And adding the comfort of touch helps, too.
Preemies in three Swiss hospitals were given either sugar water, held tightly, or given both when they had heel sticks to draw blood during their first two weeks in neonatal intensive care units. The babies who got both sugar and an embrace called facilitated tucking suffered the least, compared to babies who got just sugar or who were just held.
Sugar alone worked better than holding alone, according to the study, which was published in Pediatrics. It's the latest of many that have shown that it is possible to relieve pain, even in the very young and fragile. Most preemies aren't good candidates for the pain-relieving drugs used in older children and adults. So it's been a huge relief to parents to know that treatments without drugs can work.
But that leaves open the question of which treatments work best, and how best to combine them to give the best possible relief. Sugar water has been recommended since the late 1990s as the go-to intervention, and multiple studies have proven that it helps the most, even for babies who are in the NICU for months.
Giving sugar water during painful procedures is recommended by an international group of clinicians. Forms of touch usually give less relief than sugar. Using a pacifier with sugar helps best, according to a 2011 review of 44 studies by the Cochrane Collaboration. But not all preemies can manage a pacifier. Other effective ways to reduce pain are kangaroo care, in which a parent holds the baby against their chest skin while the procedure is performed, followed by swaddling or facilitated tucking. With facilitated tucking, the baby is held firmly so he or she can't flail arms and legs.
Given this, it's time for all preemies to be given sugar with every painful procedure, as well as pacifiers and touch, says Denise Harrison. She's an assistant professor at the University of Ottawa School of Nursing, who studies pain relief in preemies. But many preemies still aren't getting that simple help, she says.
"Parents should be aware of what they can do," Harrison says. That includes asking that their child be given sugar water, and holding their child as much as possible. "We're getting better at letting parents hold their babies, but we need to take that much more to the next step, and get parents to hold their babies for much longer periods."
Harrison says that the benefits of sugar for pain relief are so clear that it was unethical of this new study to withhold it from the 24 babies who were only given facilitated tucking, especially since giving sucrose is the standard of care in the NICUs where the babies were treated. Giving the children small "rescue" doses of sucrose after the facilitated tucking would have let the scientists do their work while still letting the babies get the best standard of care, she says.