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Key messages

  • Pain is often unrecognised and under treated in infants. All caregivers should recognise sources of pain and implement appropriate pain reduction strategies.
  • Oral sucrose or other sweet-tasting solutions in small volumes, combined with non-nutritive sucking is effective to reduce pain in infants during minor procedures.
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Please note that all guidance is currently under review and some may be out of date. We recommend that you also refer to more contemporaneous evidence in the interim.

Newborns, including the very preterm, are capable of feeling pain. Pain is often unrecognised and under treated in infants.

Sick infants are exposed to numerous painful procedures over the course of their hospitalisation. It is important for all caregivers to recognise sources of pain and to implement appropriate pain reduction strategies.

Non-pharmacological measures to reduce pain:

  • reduction of noxious environmental stimuli
  • reduce multisensory stimulation
  • skin-to-skin contact
  • swaddling
  • non-nutritive sucking
  • breastfeeding.

Contraindications:

  • neonates/infants with known sucrose or fructose intolerance.

Oral sucrose 

Oral sucrose or other sweet tasting solutions in small volumes (0.05-1 mL) combined with non-nutritive sucking is effective in reducing pain in infants during minor procedures.

The concentrations of oral sucrose commonly used range from 24 to 33 per cent.

The mechanism is an orally mediated increase in endogenous opioids. There is no analgesic effect if sucrose is given directly into the stomach via a nasogastric tube. Sucrose is more effective if given with a dummy as the dummy promotes non-nutritional sucking, which contributes to calming.

Sucrose should be used in addition to other supportive non-pharmacological measures. Breastfeeding, skin-to-skin contact, cuddling or swaddling during procedures may be feasible depending on the condition of the infant and the nature of the procedure. 

Oral sucrose may be administered for minor painful procedures such as heel lance, venepuncture, intravenous catheter insertion, arterial puncture, eye examination, and lumbar puncture, intramuscular or subcutaneous injections.

Maximum dose administered per procedure

Patient group Nil orally < 1,500 g Babies 0-1 mth Infants 1-18 mths
Recommended maximum for a particular procedure 0.2 mL

0.2-0.5 mL

0.2-1 mL

1-2 mL

Recommended maximum in 24 hours 1 mL

2.5 mL

5 mL

5 mL

Note: The concentration of the sucrose product 24-33 per cent does not alter the recommended volume to be administered.

Administration of sucrose

Follow these guidelines when administering sucrose:

  • Two minutes prior to the procedure, administer a small amount (from 0.05 mL if infant is nil orally up to 0.25 mL) of sucrose onto the infant's tongue.
  • Offer a dummy if this is part of the infants care.
  • Repeat dose upon commencement of the procedure.
  • Continue to administer small volumes every two minutes.
  • Document administration of sucrose on medication chart.
  • Analgesic effects of oral sucrose last for only five to eight minutes.

Other forms of analgesia

Additional pharmacological therapy is required for minor procedures if the infant is critically ill, or when oral sucrose combined with non-nutritive sucking is insufficient to reduce pain. 

For a crying, irritable infant not undergoing painful procedures, who cannot be comforted by routine nursing measures, oral sucrose may be given and the response assessed.

Possible causes of pain and distress need to be sought and alternative pain and stress reduction strategies evaluated including use of the principals of developmental care.

More information

References

  • Academy of Pediatrics, Committee on Fetus and Newborn and Section on Surgery, Canadian Paediatric Society, and Fetus and Newborn Committee
  • Prevention and Management of Pain in the Neonate: An Update  Pediatrics 2006 118: 2231-2241.
  • Anand KJ, International Evidence-Based Group for Neonatal Pain. Consensus statement for the prevention and management of pain in the newborn. Arch Pediatr Adolesc Med 2001;155:173-180.
  • Franck LS. Some pain, some gain: Reflections on the past two decades of neonatal pain research and treatment. Neonatal Network 2002;21:37-41.
  • Royal Australasian College of Physicians. Guideline statement: Management of procedure-related pain in neonates. Sydney: Paediatrics & Child Health Division, The Royal Australasian College of Physicians; 2005.
  • Sucrose (oral) for procedural pain management in infants
  • Best Practice Clinical Guideline, Assessment and Management of Neonatal Pain - September 2007 

Get in touch

Centre of Clinical Excellence - Women and Children
Safer Care Victoria

Version history

First published: August 2013

Last reviewed: October 2018

Review by: February 2021

Uncontrolled when downloaded

Page last updated: 17 Feb 2021

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