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Judging pain in infants: behavioural, contextual, and developmental determinants
Heather D Hadjistavropoulos1, Kenneth D Craig, Ruth Eckstein Grunau
1Regina Health District, Regina, SK, Canada Department of Psychology, 2136 West Mall, The University of British Columbia, Vancouver, BC, V6T 1Z4, Canada Department of Paediatrics, University of British Columbia, Vancover, BC, Canada Newborn Care, British Columbia Children's Hospital, Vancouver, BC, Canada.
Pain
|February 20, 1998
Summary
Facial expressions are the most important cue for judging infant pain, more so than body movements or the invasiveness of a procedure. Caretakers often underestimate pain in preterm infants.
Area of Science:
- Neonatal care
- Pain perception
- Developmental psychology
Background:
- Caretakers use multiple cues to assess infant pain.
- The relative importance of these cues is not well understood.
- Understanding pain cues is crucial for effective neonatal pain management.
Purpose of the Study:
- To determine the predictive significance of behavioral, contextual, and developmental factors in judging infant pain.
- To investigate the unique contribution of facial activity, body movement, and gestational age to pain perception.
- To compare pain judgments across preterm and full-term neonates.
Main Methods:
- Judges viewed videotapes of neonates undergoing heel incisions.
- Infants varied in facial activity, body movement, and gestational age.
- Judges rated the infants' painful discomfort.
Main Results:
- Facial activity was the strongest predictor of pain judgments, accounting for 35% of the unique variance.
- Body movement (3%) and gestational age (1%) also contributed uniquely.
- Facial activity alone predicted 71% of pain variance, compared to 30% for body movement.
- Contextual information (procedure invasiveness) did not uniquely contribute to pain judgments.
- Early preterm infants were judged to be in less pain than older infants, despite the same procedure.
Conclusions:
- Facial activity is the most salient cue for assessing neonatal pain.
- Gestational age and body movement play minor roles in pain perception by caretakers.
- Caretakers may underestimate pain in preterm infants, contradicting neurobiological evidence of hypersensitivity.