Analgesia for circumcision: effects on newborn behavior and mother/infant interaction

To test the effectiveness of acetaminophen for pain management during and after circumcision.

A randomized, double-blind, placebo controlled, pretest-posttest design.

Level III nursery at a Midwestern hospital.

Sixty full-term newborns, whose mothers had uncomplicated pregnancies and vaginal deliveries.

Administration of 10 mg/kg acetaminophen or placebo 1 hour before circumcision.

Behaviors (clarity of cues and responsiveness) were observed in newborns during a feeding interaction, and pain distress (percentage of time crying and heart rate) was assessed during and after the circumcision.

ANCOVA revealed significant group differences in subscales of the NCAFS (Nursing Child Assessment Feeding Scale) for newborns, whereas statistically significant differences for mothers were found in the sensitivity to cues and social-emotional growth-fostering scales. A significant increase in heart rate and crying time during the circumcision was noted; however, no significant difference was observed between groups. At the diaper change after the circumcision, the percentage of cry did suggest an effect from the analgesia.

These findings reinforce the reciprocal, synchronous nature of mother-infant interactions during the early postpartum period and the need for pain control after circumcision to promote neonatal comfort and improve mother-infant interaction.