Is Breastfeeding a Pain Reliever for Baby? October 16, 2014 20:27

Written By Michelle Roth, BA, LCCE, IBCLC 

 

Your newborn is fussy – you nurse him. Your older baby has an upset tummy – you nurse him. Your toddler falls and bumps his head – you nurse him. You instinctively know that breastfeeding makes him feel good. Our goal as mothers is to protect our babies, keep them from harm. We don’t ever want to see our babies in pain – in fact, a mom’s hormones change when she hears her baby cry, oxytocin and prolactin surge, she gets that tiger mother instinct. She wants to protect her baby.

 

But what happens in baby’s first year? If you follow the schedule recommended by the CDC and AAP, your baby may have as many as 25 immunizations during the first year of life, including the Hepatits B vaccination within the first 48 hours of life. In fact, in this first couple of days of arrival outside your womb, your baby is poked and prodded multiple times. It may even start before birth: a scalp electrode for internal fetal monitoring, the force of too-strong induced contractions, a change in body chemistry by altering mom’s hormones of birth and maybe even baby’s own hormones, forceps or vacuum extraction to pull baby out, shoulder dystocia due to positioning, and more. Then at birth we briskly handle baby with vigorous suctioning and drying. We lance baby’s heel to obtain a blood sample, we give a prophylactic vitamin K injection shortly after birth, eye ointment, bathing … do we ever stop to consider if these events are painful for baby, or how we can conveniently and safely manage that pain?

 

Strangely, there’s a history of denying babies feel pain. But what we know now is not only do babies feel pain, but the effects of untreated pain may be long-lasting (AAP 2006, Shah 2012). The AAP recommends “routinely assessing pain, minimizing the number of painful procedures performed, [and] effectively using pharmacologic and nonpharmacologic therapies for the prevention of pain associated with routine minor procedures …” (AAP 2006). The use of sweetened water or a pacifier are probably the most researched means of non-pharmacological pain prevention for babies, but research about skin-to-skin contact and breastfeeding is also making its appearance and showing promising results (Agarwal 2011, Shah 2012).

 

In a 2002 study, Gray and colleagues studied whether babies being breastfed had better pain management during a standard newborn procedure than babies who were simply swaddled in a bassinet. These researchers looked at 30 infants randomly assigned to two groups – breastfeeding or standard care – for signs of distress during a heel lance to obtain a blood sample. These signs included crying, grimacing and heart rate changes. The results? Crying and grimacing were vastly reduced for babies who were actively breastfeeding: 91% and 84%, respectively, compared to the control group. The researchers add,

In fact, 11 of these 15 breastfeeding infants did not cry or grimace at all …. Only 1 of the 15 infants in the breastfeeding group cried at all during recovery. He did so for a total of 10 seconds. In contrast, the mean duration of crying during recovery for infants in the control group was 28 seconds (Gray 2002).  In addition, the heart rate readings were significantly different: babies being breastfed had a mean increase of 6 beats per minute, while in the control group that number was 29 beats per minute. Breastfed babies were more relaxed babies, even during a painful procedure.

 

Along the same lines, Uga et. al. found a significant difference between groups during heel lance. Two hundred babies were assigned to two conditions during standard metabolic screening – breastfeeding or standard care (caressing or pacifier use). Babies who were breastfeeding had significantly better pain management even when looking at individual segments of the pain scoring, such as limb movement, facial expression and vocalization. In fact, in the breastfeeding group “20 neonates obtained score 0 [out of 10], while no neonates in the control group got this score” (Uga 2008).

 

Another randomized controlled trial looked at the differences in pain management for babies in 4 categories: breastfeeding, being held by mother, sterile water administration, or glucose solution/pacifier use (Carbajal 2003). A sample of 180 babies was randomized to one of the 4 groups for a blood draw (venipuncture). Using two standardized pain scoring systems, 36% of the breastfeeding infants showed “no indication at all” that the test had happened. Pain scores for the infants in the breastfeeding group and the glucose/pacifier group were similar. In contrast, no infants being held by their mothers had pain reduction (both were clothed, and not skin-to-skin), and very few infants receiving sterile water had pain relief.

 

More recently, researchers wanted to tease apart whether the pain relief is from the substance (breastmilk versus glucose solution) or from the skin-to-skin contact between mom and baby (Gabriel 2013). What they found was that the babies with the best pain management were in a group where breastfeeding and skin-to-skin were combined. This unique study separated 136 babies into 4 categories: breastfeeding with skin-to-skin contact, sucrose (provided by syringe) with skin-to-skin, skin-to-skin only, and sucrose (by syringe) only. They found significantly lower pain scores for the babies in the breastfeeding and skin-to-skin group. Additionally, moderate-to-severe pain was also lower this group (11.4% compared to 31.4% in the sucrose plus skin-to-skin group, 51.5% in the skin-to-skin only group, and 51.5% in the sucrose only group).

 

Breastfeeding – such a multifaceted tool. It never ceases to amaze me that nature has created such a gift. In additional to all of its other benefits, breastfeeding is a free and simple way to help your baby deal with a painful world – emotionally and physically. Don’t be afraid to add this to your birth plan – you’d like to be holding your baby skin-to-skin and, more importantly, breastfeeding during any heel lances, injections or other procedures. Just because your birth facility hasn’t done it before doesn’t mean they can’t figure out how to do it now. When you visit the pediatric office, remind them that you’d like to nurse during immunizations. It won’t take any longer, and your baby will feel so much better. And don’t be afraid to make nursing your pain reliever of choice for the bumps and bruises of toddlerhood and beyond!

 

References:

Agarwal R. Breastfeeding or breast milk for procedural pain in neonates : RHL commentary (last revised: 1 June 2011).

The WHO Reproductive Health Library; Geneva: World Health Organization.

American Academy of Pediatrics, & Fetus and Newborn Committee. (2006). Prevention and management of pain in the

neonate: an update. Pediatrics, 118(5), 2231-2241. Reaffirmed May 2010.

Carbajal R, Veerapen S, Couderc S, Jugie M, & Ville Y. (2003). Analgesic effect of breast feeding in term neonates:

randomised controlled trial. BMJ: British Medical Journal, 326(7379), 13.

Gabriel MÁM, de Mendoza BDRH, Figueroa LJ, Medina V, Fernández BI, Rodríguez MV, Huedo VE, & Malagón L M.

(2013). Analgesia with breastfeeding in addition to skin-to-skin contact during heel prick. Archives of Disease in

Childhood-Fetal and Neonatal Edition, 98(6), F499-F503.

Gray L, Miller LW, Philipp BL, & Blass EM. (2002). Breastfeeding is analgesic in healthy newborns. Pediatrics, 109(4),

590-593.

Shah PS, Herbozo C, Aliwalas LL, Shah VS. Breastfeeding or breast milk for procedural pain in neonates. Cochrane

Database of Systematic Reviews 2012, Issue 12.

Uga E, Candriella M, Perino A, Alloni V, Angilella G, Trada M, Ziliotto AM, Rossi MB, Tozzini D, Tripaldi C, Vaglio M,

Grossi L, Allen M, & Provera S. (2008). Heel lance in newborn during breastfeeding: an evaluation of analgesic

effect of this procedure. Ital J Pediatr, 34(1), 3-7.