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Clin Perinatol. 2019 Dec;46(4):709-730. doi: 10.1016/j.clp.2019.08.006. Epub 2019 Aug 26.

Nonpharmacologic Management of Pain During Common Needle Puncture Procedures in Infants: Current Research Evidence and Practical Considerations: An Update.

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Nursing and Child Health Evaluative Sciences, The Hospital for Sick Children, 555 University Avenue, Toronto M5G 1X8, Canada.
Department of Pediatrics, IWK Health Centre, School of Nursing, Faculty of Health Professions, Dalhousie University, Halifax, Nova Scotia, Canada.
Ingram School of Nursing, McGill University, Montreal, Canada; IWK Health Centre, 5850/5980 University Avenue, Halifax B3K 6R8, Canada.
Clinical, Social and Administrative Pharmacy, Leslie Dan Faculty of Pharmacy, University of Toronto, Child Health Evaluative Sciences, The Hospital for Sick Children, 144 College Street, Toronto, Ontario M5S 3M2, Canada. Electronic address:


Infants undergo painful procedures involving skin puncture as part of routine medical care. Pain from needle puncture procedures is suboptimally managed. Numerous nonpharmacologic interventions are available that may be used for these painful procedures, including swaddling/containment, pacifier/non-nutritive sucking, rocking/holding, breastfeeding and breastmilk, skin-to-skin care, sweet tasting solutions, music therapy, sensorial saturation, and parental presence. Adoption these interventions into routine clinical practice is feasible and should be a standard of care in quality health care for infants. This review summarizes the epidemiology of pain from common needle puncture procedures in infants, the effectiveness of nonpharmacologic interventions, implementation considerations, and unanswered questions.


Effectiveness; Needle puncture; Neonates; Nonpharmacologic management; Pain; Pain relief


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