Hush Little Baby

Why do babies cry? Are they hungry, cranky, tired, or could it be they’re in pain? It’s a tough call – not only for parents but even for practiced pediatricians and nurses. Dr. Celeste Johnston, professor and associate director for research at the McGill School of Nursing and a consultant to the Nursing Department of the McGill University Health Centre (MUHC), is working on telling the difference between everyday cries and cries of pain. She is also trying to figure out what to do about making babies’ pain go away.

“My research is centered on trying to find ways of alleviating infant pain safely,” says Johnston. Her major focus is on pain in preterm infants. Premature babies may feel more pain than other infants because their coping mechanism is still at an immature stage. “If you think about it, [preterm infants] are meant to be in the protective environment of the womb at that age and they’re in this loud, noisy, really hostile environment.” These developmentally immature babies often become hypersensitive to pain. Sticking a baby’s heel to draw blood can be a very painful procedure for that child.

Johnston and her team are looking at various ways of diminishing pain in preterm babies. They found, for example, that skin-to-skin contact between premature babies and their mothers can reduce the discomfort caused by painful procedures. This “kangaroo care,” seems to promote a sense of security in the babies. “Preterm infants are comfortable in this position… and by promoting a quiet state and physiological stability, we’re hoping that the impact of a painful event, such as a heel stick, will be dampened.”Music, in the form of lullabies sung by the mothers, may also help soothe babies’ pain, Johnston points out. “Mothers have been using what we call ordinary, everyday comforting mechanisms for millennia, and we’re just now trying to take those mechanisms into the intensive care setting.” We may even learn something from animals about controlling pain in babies, says Johnston. She’s studying mother rats to see how they comfort their pups when they experience pain.

Johnston has also been looking at the effects of giving infants sugar during invasive Intensive Care Unit procedures (like the heel stick). The sugar may cause the release of pain suppressing endorphins. “Sweet-tasting substances seem to have an analgesic effect in newborns and premature infants, and we think that happens through the release of endorphins.” Surprisingly, this effect is dose dependent. Johnston and her team have found that giving more doses of sugar over a whole week in very premature infants may have some negative impact on development when the baby is at term age. Obviously more research is needed in this area.