Non-pharmacological pain relief

Neonates and infants

• Breastfeeding by mother as appropriate.
• Repositioning: positioning the infant appropriate to their gestational maturation, supporting limbs/ trunk. Rolls or position aids (or nests) can also be used.
• Swaddling: neonates can be wrapped in a cloth or blanket, with their arms and legs tucked in, to make them feel secure.
• Nesting: a positioning aid or roll placed around the neonate to help contain them and make them feel safe and secure by imitating a womb-like environment. It also helps keep the neonate's limbs aligned when they cannot be wrapped or swaddled.
• Facilitated tucking: holding a neonate so its limbs are close to the trunk. The neonate is held side-lying in a flexed position. This technique involves touch and positioning, and promotes a sense of control and security for the neonate.
• Decreasing environmental sensors, e.g. noise and light.
• Tactile soothing: still gentle touch can be provided by caregivers placing their hand on the neonate's head and abdomen/back.
• Talking to the neonate.
• Nappy change.
• Non-nutritive sucking: refers to using a dummy to promote sucking without breast milk or infant formula.
• Allowing the neonate to grasp a finger.
• Skin-to-skin care for the newborn (kangaroo care): nursing of the neonate on the bare skin of their mother or father, upright at a 40-60 degree angle and covered by parent's shirt/gown, with an additional blanket as required.
• Clustering, developmental or cue-based care: grouping care to minimise the number of times a neonate is handled. If neonates display signs of stress (such as increased heart rate or facial expression), fewer procedures can be clustered on the next occasion, and comfort measures can be provided. By reducing episodes of handling, periods of sleep can be protected, and stress can be minimised.

Children

• Explain procedures and conditions in age-appropriate language
• Choices in a care plan
• Parental/carer presence, cuddles and comforting techniques
• Deep breathing, guided imagery and imaginative play
• Storybooks
• Bubbles
• Cold packs
• Warm blankets and comfort measures
• TV shows or games
• Reduce stimuli, e.g. noise and lights

Adapted, with permission, from: The Royal Children's Hospital Melbourne, Clinical Guidelines (Nursing): Neonatal Pain Assessment.