title: Nonpharmacological management of procedural pain in infants and young children: an abridged Cochrane review.
abstract: BACKGROUND
  Acute pain and distress during medical procedures are commonplace for young children.
  
  
  OBJECTIVE
  To assess the efficacy of nonpharmacological interventions for acute procedural pain in children up to three years of age.
  
  
  METHODS
  Study inclusion criteria were: participants <3 years of age, involved in a randomized controlled or crossover trial, and use of a 'no treatment' control group (51 studies; n=3396). Additional studies meeting all criteria except for study design (eg, use of active control group) were qualitatively described (n=20).
  
  
  RESULTS
  For every intervention, data were analyzed separately according to age group (preterm-born, term-born neonate and older infant ⁄ young child) and type of pain response (pain reactivity, immediate pain-related regulation). The largest standardized mean differences (SMD) for pain reactivity were as follows: sucking-related interventions (preterm: -0.42 [95% CI -0.68 to -0.15]; neonate -1.45 [CI -2.34 to -0.57]), kangaroo care (preterm -1.12 [95% CI -2.04 to -0.21]), and swaddling ⁄ facilitated tucking (preterm -0.97 [95% CI -1.63 to -0.31]). For immediate pain-related regulation, the largest SMDs were: sucking-related interventions (preterm -0.38 [95% CI -0.59 to -0.17]; neonate -0.90 [CI -1.54 to -0.25]), kangaroo care 0.77 (95% CI -1.50 to -0.03]), swaddling ⁄ facilitated tucking (preterm -0.75 [95% CI -1.14 to -0.36]), and rocking ⁄ holding (neonate -0.75 [95% CI -1.20 to -0.30]). The presence of significant heterogeneity limited confidence in nonsignificant findings for certain other analyses.
  
  
  CONCLUSIONS
  Although a number of nonpharmacological treatments have sufficient evidence supporting their efficacy with preterm infants and healthy neonates, no treatments had sufficient evidence to support efficacy with healthy older infants ⁄ young children.
authors: Department of Psychology, York University, Toronto, Ontario, Canada. rpr@yorku.ca
authors: Rebecca
authors: R
authors: Pillai Riddell
authors: Nicole
authors: N
authors: Racine
authors: Kara
authors: K
authors: Turcotte
authors: Lindsay
authors: L
authors: Uman
authors: Rachel
authors: R
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: Diana
authors: D
authors: Lisi
mesh_terms: D002675:Child, Preschool; D018592:Cross-Over Studies; D016208:Databases, Factual / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D010146:Pain; D059408:Pain Management / Q000379:methods*; D016032:Randomized Controlled Trials as Topic