Pain Perception In Infants

Abstract

Pain Perception In Infants For many years, a pervasive assumption in medical community has been that are incapable of perceiving pain. One consequence of this widespread perspective, according to K.J.S. Anand and P.R. Hickey, is that are frequently not given analgesic or anesthetic agents during invasive procedures, including surgery (New England Journal of Medicine 317:21 [November 19, 1987], 1322-29). Recently, however, parents and pediatric nurses have moved to forefront in challenging such clinical practices and their underlying rationale. Their concerns over infliction of unnecessary on newborns have been supported not only by practitioners, but also by professional organizations such as American Academy of Pediatrics and American Society of Anesthesiologists. Anand and Hickey's comprehensive analysis offers empirical support of facts and data to what had previously been a largely theoretical argument. According to Anand and Hickey, several medical and conceptual arguments have supported traditional practice of surgical interventions on with minimal or no attempts at pain-relief: (1) myelin, coating that allows rapid of nerve impulses, is not fully developed in neonates; (2) memory of painful experiences, considered crucial to interpreting pain, may not exist in infants; (3) a high threshold protects from during birth; (4) responses of to painful stimuli are reflexive in nature. In addition, other commentators have indicated that number and complexity of connections between nerves in brains of are insufficient for adequate (adult-like) processing of painful stimuli. Thus, even if pain transmission is present, would not experience it as suffering. Based on their own research and a comprehensive summary of relevant literature, Anand and Hickey conclude that the neurochemical systems now known to be associated with and modulation are intact and functioning in newborns. Moreover, although it is unclear that a neonate subjectively experiences in a manner similar to older chidren and adults, there is evidence of physiologic and perhaps even a psychological form of stress in premature or full-term neonates in response to painful stimuli. Accordingly, humane considerations...apply as forcefully to care of and young, nonverbal infants as with children and adults, particularly with respect to risks and benefits of using or withholding analgesia or anesthesia. Age, then, should not be criterion in such decisions. In an editorial accompanying Anand/Hickey report, Anne B. Fletcher of Children's Hospital National Medical Center in Washington, DC, observes that inadequate attention paid to physiologic or possible psychological damage to from such procedures as needle sticks, circumcisions, heel sticks, venipunctures, intubations, chest-tube insertions, and suctioning should not be attributed to maliciousness or indifference (pp. …