Cochrane Review: Non‐pharmacological management of infant and young child procedural pain
Bibliographic record
Abstract
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. Objectives 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). Search methods We searched CENTRAL inThe 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. Selection criteria 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. Data collection and analysis 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. Main 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. Authors' 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. Plain Language Summary Non‐pharmacological interventions for acute pain in infants We examined 13 different types of commonly investigated non‐pharmacological treatments (excluding breastmilk, sucrose, and music) to determine their efficacy for pain reactions after an acutely painful procedure (right after the needle ('pain reactivity') and less immediate pain reactions ('immediate pain‐related regulation').Fifty‐one randomized controlled trials were included involving 3396 participants. For preterm infants, there was sufficient evidence to recommend kangaroo care, sucking‐related interventions, and swaddling/facilitated tucking interventions for both pain reactivity and immediate pain‐related regulation. For neonates, there was sufficient evidence to recommend sucking‐related interventions as an effective treatment for pain reactivity and immediate pain‐related regulation.Rocking/holding was also found to be efficacious for neonatal immediate pain‐related regulation.For older infants, there were no treatments reviewed that demonstrated sufficient evidence. Due to significant differences in the magnitude of treatment effects among studies (heterogeneity), some analyses that found a lack of treatment effect need to be interpreted with caution.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.018 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.007 | 0.005 |
| Bibliometrics | 0.008 | 0.008 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.011 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".