title: Non-pharmacological management of infant and young child procedural pain.
abstract: BACKGROUND
  Infant acute pain and distress is commonplace. Infancy is a period of exponential development. Unrelieved pain and distress can have implications across the lifespan.
  
  
  OBJECTIVE
  To assess the efficacy of non-pharmacological interventions for infant and child (up to three years) acute pain, excluding breastmilk, sucrose, and music. Analyses accounted for infant age (preterm, neonate, older) and pain response (pain reactivity, pain-related regulation).
  
  
  METHODS
  We searched CENTRAL in The Cochrane Library (2011, Issue 1), MEDLINE (1966 to April 2011), EMBASE (1980 to April 2011), PsycINFO (1967 to April 2011), Cumulative Index to Nursing and Allied Health Literature (1982 to 2011), Dissertation Abstracts International (1980 to 2011) and www.clinicaltrials.gov. We also searched reference lists and contacted researchers via electronic list-serves.
  
  
  METHODS
  Participants included infants from birth to three years. Only randomized controlled trials (RCTs) or RCT cross-overs that had a no-treatment control comparison were eligible for inclusion in the analyses. We examined studies that met all inclusion criteria except for study design (e.g. had an active control) to qualitatively contextualize results.
  
  
  METHODS
  We refined search strategies with three Cochrane-affiliated librarians. At least two review authors extracted and rated 51 articles. Study quality ratings were based on a scale by Yates and colleagues. We analyzed the standardized mean difference (SMD) using the generic inverse variance method. We also provided qualitative descriptions of 20 relevant but excluded studies.
  
  
  RESULTS
  Fifty-one studies, with 3396 participants, were analyzed. The most commonly studied acute procedures were heel-sticks (29 studies) and needles (n = 10 studies). The largest SMD for treatment improvement over control conditions on pain reactivity were: non-nutritive sucking-related interventions (preterm: SMD -0.42; 95% CI -0.68 to -0.15; neonate: SMD -1.45, 95% CI -2.34 to -0.57), kangaroo care (preterm: SMD -1.12, 95% CI -2.04 to -0.21), and swaddling/facilitated tucking (preterm: SMD -0.97; 95% CI -1.63 to -0.31). For immediate pain-related regulation, the largest SMDs were: non-nutritive sucking-related interventions (preterm: SMD -0.38; 95% CI -0.59 to -0.17; neonate: SMD -0.90, 95% CI -1.54 to -0.25), kangaroo care (SMD -0.77, 95% CI -1.50 to -0.03), swaddling/facilitated tucking (preterm: SMD -0.75; 95% CI -1.14 to -0.36), and rocking/holding (neonate: SMD -0.75; 95% CI -1.20 to -0.30). The presence of significant heterogeneity limited our confidence in the lack of findings for certain analyses.
  
  
  CONCLUSIONS
  There is evidence that different non-pharmacological interventions can be used with preterms, neonates, and older infants to significantly manage pain behaviors associated with acutely painful procedures.
authors: Department of Psychology, York University, 4700 Keele Street, OUCH Laboratory, Atkinson College, Toronto, Ontario, Canada, M3J 1P3.
authors: Rebecca R
authors: RR
authors: Pillai Riddell
authors: Nicole M
authors: NM
authors: Racine
authors: Kara
authors: K
authors: Turcotte
authors: Lindsay S
authors: LS
authors: Uman
authors: Rachel E
authors: RE
authors: Horton
authors: Laila
authors: L
authors: Din Osmun
authors: Sara
authors: S
authors: Ahola Kohut
authors: Jessica
authors: J
authors: Hillgrove Stuart
authors: Bonnie
authors: B
authors: Stevens
authors: Alanna
authors: A
authors: Gerwitz-Stern
mesh_terms: D000208:Acute Disease; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D007224:Infant Care / Q000379:methods*; D007231:Infant, Newborn; D007234:Infant, Premature; D009339:Needles / Q000009:adverse effects*; D010146:Pain / Q000503:physiopathology; D059408:Pain Management; D011677:Punctures / Q000009:adverse effects*; D016032:Randomized Controlled Trials as Topic; D013391:Sucking Behavior