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The effect of pain on infant behaviors
Insights
Infant pain behaviors change with age. While facial expressions indicate pain in younger infants, older infants
Area of Science:
- Pediatric pain assessment
- Infant development
- Pain management
Background:
- Assessing infant pain is challenging due to communication limitations.
- Developmental stage significantly influences pain expression and measurement.
- Objective pain indicators are crucial for effective clinical management.
Purpose of the Study:
- To compare facial, body, and cry behaviors, heart rate, palmar sweating, and acoustic cry measures across different levels of infant pain.
- To investigate the influence of infant age on pain-related behaviors and physiological responses.
Main Methods:
- Eighty-eight infants were categorized into a 16-cell matrix based on age (0-3, 4-6, 7-9, 10-12 months) and pain levels (none, mild, moderate, severe).
- Infant pain levels were determined by consensus among five pediatric clinical nurse specialists based on videotapes and clinical information.
- A two-way (pain level, age) MANOVA was used to compare coded infant behaviors and acoustic cry parameters.
Main Results:
- Infant behaviors indicative of pain varied significantly with developmental stage.
- Facial expressions were reliable pain indicators only in infants aged 0-3 months.
- Older infants showed less distinct facial and body behaviors, and cry measures, in response to pain due to developing intentionality; cry orientation and consolability emerged as potential indicators for this age group.
Conclusions:
- Infant pain assessment requires age-specific considerations.
- Facial expressions are most useful for pain assessment in very young infants.
- Cry orientation and consolability may serve as valuable clinical indicators for assessing pain in older infants.
Abstract:
Facial, body, and cry behaviors, heart rate, palmar sweating, and acoustic cry measures were compared across differing levels of infant pain. Eighty-eight infants were placed in a 16-cell matrix of 4 ages (0 to 3 mo., 4 to 6 mo., 7 to 9 mo., and 10 to 12 mo.) and levels of pain (LOP) (none, mild, moderate, severe) with 5 to 6 infants occupying each cell. Matrix placement was determined by agreement of > 75% among five pediatric clinical nurse specialists who viewed videotapes and read information about the infant's history, diagnosis, medical and/or surgical status, medications, and nutritional/fluid status. Coded infant behaviors and acoustic cry parameters were compared using a 2-level (LOP, age) MANOVA. Behaviors that differed across LOP were influenced by infant development. Facial expressions were clinically useful LOP indicators only for 0- to 3-month-old infants. Facial and body behaviors and cry measures that differed across LOP in younger infants did not differ in older infants due to the development of intentionality. Cry orientation and consolability may be useful clinical indicators of pain with older infants.