7

Nonpharmacological Methods

SUCROSE

Oral sucrose,¹ given 2 minutes prior to a painful procedure, has been shown to decrease heart rate, facial movement, and pain scores in term and preterm infants (Johnson, Stremler, Horton, & Friedman, 1999). Sucrose has been proven to be a safe and effective way to reduce pain from procedures such as a single heel lance and ­venipuncture (Stevens, Yamada, & Ohlsson, 2004). Optimal pain management of tissue-damaging procedural pain includes the use of sucrose and a pacifier (Fetus and Newborn Committee & Canadian Paediatric Society, 2007). Sucrose may also be beneficial in conjunction with other medication in ­moderate to severely painful procedures.

SWADDLING/CONTAINMENT/FACILITATED TUCKING

Swaddling is done by wrapping the newborn tightly in a blanket or commercial swaddler to provide containment. Figures 7.1 and 7.2 provide illustrations of both swaddling options.

Containment can also be provided to a preterm baby by using other positioning tools, such as bumpers, bean bags, linen rolls, and so forth, as shown in Figure 7.3. While in utero, the fetus was folded into the amniotic sack with secure, definite boundaries. Allowing an infant’s limbs to flail about ­without the re-creation of such boundaries can cause disorganization and stress, especially in premature infants. During painful situations, the neonate benefits from the comfort of containment, which provides a sense of security. A study of 40 very-low-­birth-weight infants showed that ­facilitated tucking appeared to effectively reduce some of the procedural pain of endotracheal suctioning (Ward-Larson, Horn, & Gosnell, 2004). This is in addition to other research that containment interventions, such as facilitated tucking, may cause significant decreases in the severity of the infant’s response to endotracheal suctioning (Evans, 1992; Taquino & Blackburn, 1994).

FIGURE 7.1.  Facilitated tucking using a blanket and a commercial swaddler.

FIGURE 7.2.  How to swaddle using a commercial swaddler.

FIGURE 7.3.  Facilitated tucking using a positional aid product (such as the Philips “Snuggle Up”).

TOUCH

The power of touch and its healing properties have been utilized for centuries. Recent scientific studies have demonstrated the healing properties of touch. In a study published in 1993, preterm infants experienced a consistent decrease in plasma cortisol levels after massage. Eleven stable infants with a median gestational age of 29 weeks, median birth weight of 980 grams, and median postnatal age of 20 days were studied. Blood samples were obtained to determine levels of adrenaline, noradrenaline, and cortisol 45 minutes before the start of massage and approximately 1 hour after completion of massage. Cortisol, but not catecholamine, concentrations decreased consistently after massage (median difference −35.8 mmol/L; 95% confidence interval, −0.5 to −94.0; Wilcoxon matched pairs; Acolet et al., 1993). A more recent study of 59 preterm infants was conducted using Yakson (a Korean touching method) and Gentle Human Touch (a technique used in the United States). The researchers set out to test urine stress hormones and behaviors of infants who had received these healing interventions. The study did not find a quantitative reduction in stress in neonates (through the urine stress hormone levels), but did find an increase in sleep states and a decrease in awake and fussy states (Im & Kim, 2009).

Healing touch, Reiki, and therapeutic touch are among many popular Eastern methods of tactile pain reduction that are used in the adult population, but are gaining recognition for use in neonates.

Other methods, such as craniosacral therapy, chiropractic adjustments, and the Alexander technique, are also new therapies for neonates. Although relatively new, many of these techniques have been around for a long time and have proven successful in adults.

NONNUTRITIVE SUCKING

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