Does My Preemie Feel Pain? Preemies and Pain in the NICU

Preemies do feel pain, a comparison of attitudes towards pain in premature babies in the NICU.

By Allison Martin, MPA

Most people would agree that young babies feel pain, even babies born prematurely. Surely, you would be surprised to think otherwise. However, despite scientific evidence, the idea that preemies do not feel pain is still prevalent.

When my son was born extremely premature I was told by a neonatal doctor, a neonatal nurse and my obstetrician that my preemie baby could not feel pain. I still remember the scenes today, my son was getting yet another frequent heel prick for a blood test or having his tubing changed, and he so was clearly in pain. By looking at his tiny face, you could see he was in agony.

Luckily, most doctors and nurses even then did not truly believe that preemies did not feel pain of the invasive treatment they endured, but they did seem to feel helpless to do anything to relieve pain in preemies in the NICU at the time.

This was especially ironic because as parents we were not allowed to touch or hold our preemie for many, many months, because it might cause him distress. Now it has been proven that this is the exact opposite of the type of touch that young babies should be exposed to, but it remains a problem in some NICUs today. All babies, including preemies, need loving touch and pain should be avoided.

Luckily, more and more neonatologists and other NICU professionals are cognizant of pain in preemies. Unfortunately, the idea that young preemies can not feel pain is still a belief in many NICUs and pain management is not practiced to the extend it should be.

The well documented book Merenstein and Gardner's Handbook of Neonatal Intensive Care, provides a whole chapter on pain and pain relief in neonates, and responds to several incorrect ideas that neonatologists may have that preclude the administration of analgesia or anesthesia agents when they are needed.

Erroneous Assumptions of Preemie Pain Study Based Realities of Preemie Pain
Preemie's do not feel pain because their nervous systems are not yet developed. The central nervous system of pre-term infants is "much more mature than previously thought. Pain pathways are myelinated in the fetus during the second and third trimesters … even thinly myelinated or nonmyelinated fibers carry pain stimuli. Incomplete myelination implies only a slower transmission" which matters less in their tiny preemie bodies.
Preemies do not remember the NICU A preemie’s "memory is much greater than was previously thought."
You can not identify pain in a preemie. A "neuropsychologic complex of altered pain threshold and pain-related behavior" in preemies has been identified.
It is unsafe to give pain medication to a preemie. “Local and systemic drugs now available, plus new techniques and devices for monitoring, enable preemies to be safely anesthetized and provide safe and effective analgesia while maintaining a stable environment.”

As described in the Merenstein and Gardner's Handbook of Neonatal Intensive Care, pain relief helps the preemie baby by “decreasing physiologic instability, hormonal and metabolic stress, and the behavioral reactions accompanying painful procedures.”

Several professional guidelines call for the use of pain relief in premature babies including the Committee on Fetus and Newborn of the American Academy of Pediatrics (AAP) and the National Association of Neonatal Nurses (NANN).

As a mother, I can say it is highly stressful to see your child experience what is obviously acute pain and feel unable to prevent it.

In addition, pain so early on in life causes long term impacts that many preemie parents have noticed, which are now clinically affirmed as more common among children born prematurely. For example, these include being over or under sensitive to pain, highly rates of autism (which includes unusual reaction to stimuli), increased sensory disorder problems, learning disabilities such as eye-hand coordination, difficulties locating their bodies in space and navigating the environment without bumping into things (often labeled as “clumsiness”), increased sensitivity demonstrated by higher rates of ADHD, and so on.

I hope this information encourages NICU professionals to be more proactive, and for parents to speak out for the protection of their premature babies from ongoing and unnecessary pain in the NICU.

Allison Martin is a biologist active in parent advocacy.