Breastfeeding during immunizations or other painful procedures

compiled by Kelly Bonyata, IBCLC

Breastfeeding during a painful procedure such as a heel-stick for newborn screening provides analgesia to infants.

– American Academy of Pediatrics policy statement on breastfeeding

Research indicates that breastfeeding your baby during a minor painful procedure (immunization, blood draw, etc.) is a safe and effective method of pain relief.

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Check out the “Be Sweet to Babies” project for more on reducing pain during screening and other painful procedures.

References (most recent listed first)

Breastfeeding and breastmilk as pain relief

Jebreili M, et al. Comparison of Breastmilk Odor and Vanilla Odor on Mitigating Premature Infants’ Response to Pain During and After Venipuncture. Breastfeed Med. 2015 Sep;10(7):362-5. doi: 10.1089/bfm.2015.0060. Epub 2015 Aug 7.

Rosali L, et al. Efficacy of expressed breast milk in reducing pain during ROP screening–a randomized controlled trial. J Trop Pediatr. 2015 Apr;61(2):135-8. doi: 10.1093/tropej/fmu073. Epub 2014 Dec 25.

Zhu J, et al. Pain relief effect of breast feeding and music therapy during heel lance for healthy-term neonates in China: a randomized controlled trial. Midwifery. 2015 Mar;31(3):365-72. doi: 10.1016/j.midw.2014.11.001. Epub 2014 Nov 11.

Marín Gabriel MÁ, et al. Analgesia with breastfeeding in addition to skin-to-skin contact during heel prick. Arch Dis Child Fetal Neonatal Ed. 2013 Nov;98(6):F499-503. doi: 10.1136/archdischild-2012-302921. Epub 2013 Jul 9.

Bembich S. Functional neuroimaging of breastfeeding analgesia by multichannel near-infrared spectroscopy. Neonatology. 2013;104(4):255-9. doi: 10.1159/000353386. Epub 2013 Sep 21.

Sahoo JP, Rao S, Nesargi S, Ranjit T, Ashok C, Bhat S. Expressed breast milk vs 25% dextrose in procedural pain in neonates, a double blind randomized controlled trial. Indian Pediatr. 2013 Feb;50(2):203-7. Epub 2012 Jul 5.

Boroumandfar K, Khodaei F, Abdeyazdan Z, Maroufi M. Comparison of vaccination-related pain in infants who receive vapocoolant spray and breastfeeding during injection. Iran J Nurs Midwifery Res. 2013 Jan;18(1):33-7.

Ou-Yang MC, Chen IL, Chen CC, Chung MY, Chen FS, Huang HC. Expressed breast milk for procedural pain in preterm neonates: a randomized, double-blind, placebo-controlled trial. Acta Paediatr. 2013 Jan;102(1):15-21. doi: 10.1111/apa.12045. Epub 2012 Nov 1.

Shah PS, Herbozo C, Aliwalas LL, Shah VS. Breastfeeding or breast milk for procedural pain in neonates. Cochrane Database Syst Rev. 2012 Dec 12;12:CD004950. doi: 10.1002/14651858.CD004950.pub3.

Okan F, Ozdil A, Bulbul A, Yapici Z, Nuhoglu A. Analgesic effects of skin-to-skin contact and breastfeeding in procedural pain in healthy term neonates. Ann Trop Paediatr. 2010;30(2):119-28.

Shah PS, Aliwalas L, Shah V. Breastfeeding or breastmilk to alleviate procedural pain in neonates: a systematic review.. Breastfeed Med. 2007 Jun;2(2):74-82.

Section on Breastfeeding. Breastfeeding and the Use of Human Milk. Pediatrics 2005 (Feb 1);115(2):496-506. “Breastfeeding during a painful procedure such as a heel-stick for newborn screening provides analgesia to infants.

Shendurnikar N, Gandhi K. Analgesic effects of breastfeeding on heel lancing. Indian Pediatr. 2005;42(7):730-2.

Zempsky WT, Cravero JP; American Academy of Pediatrics Committee on Pediatric Emergency Medicine and Section on Anesthesiology and Pain Medicine. Relief of pain and anxiety in pediatric patients in emergency medical systems. Pediatrics. 2004 Nov;114(5):1348-56. “Skin-to-skin contact of an infant with his or her mother and breastfeeding during a procedure decrease pain behaviors associated with painful stimuli.”

Upadhyay A, Aggarwal R, Narayan S, Joshi M, Paul VK, Deorari AK. Analgesic effect of expressed breast milk in procedural pain in term neonates: a randomized, placebo-controlled, double-blind trial. Acta Paediatr. 2004 Apr;93(4):518-22.

Gradin M, Finnstrom O, Schollin J. Feeding and oral glucose–additive effects on pain reduction in newborns. Early Hum Dev. 2004 Apr;77(1-2):57-65. (Note that infants were only breastfed before–not during–the blood draws in this study.)

Potter B, Rindfleisch K. Breastfeeding reduces pain in neonates. J Fam Pract. 2003 May;52(5):349, 352.

Carbajal R, Veerapen S, Couderc S, Jugie M, Ville Y. Analgesic effect of breast feeding in term neonates: randomised controlled trial. BMJ 2003 ( 4 January );326:13.

Gray L, Miller LW, Philipp BL, Blass EM. Breastfeeding is analgesic in healthy newborns. Pediatrics 2002;109(4):590-593.

Other interventions as pain relief

Other effective interventions include skin to skin contact, sugar water and/or non-nutritive sucking on a pacifier, warmth, swaddling, multisensory stimulation, and acupuncture.

Karaca Ciftci E, Kardas Ozdemir F, Aydın D. Effect of flick application on pain level and duration of crying during infant vaccination. Ital J Pediatr. 2016 Jan 21;42(1):8. doi: 10.1186/s13052-016-0218-y.

Pillai Riddell RR, et al. Non-pharmacological management of infant and young child procedural pain. Cochrane Database Syst Rev. 2015 Dec 2;12:CD006275. doi: 10.1002/14651858.CD006275.pub3.

Gray L, et al. Sucrose and warmth for analgesia in healthy newborns: an RCT. Pediatrics. 2015 Mar;135(3):e607-14. doi: 10.1542/peds.2014-1073. Epub 2015 Feb 16.

Ravishankar A, et al. Oral dextrose for analgesia in neonates during nasogastric tube insertion: a randomised controlled trial. J Paediatr Child Health. 2014 Feb;50(2):141-5. doi: 10.1111/jpc.12392. Epub 2013 Oct 18.

Bueno M, et al. A systematic review and meta-analyses of nonsucrose sweet solutions for pain relief in neonates. Pain Res Manag. 2013 May-Jun;18(3):153-61.

Naughton KA. The combined use of sucrose and nonnutritive sucking for procedural pain in both term and preterm neonates: an integrative review of the literature. Adv Neonatal Care. 2013 Feb;13(1):9-19; quiz 20-1. doi: 10.1097/ANC.0b013e31827ed9d3.

Stevens B, Yamada J, Lee GY, Ohlsson A. Sucrose for analgesia in newborn infants undergoing painful procedures. Cochrane Database Syst Rev. 2013 Jan 31;1:CD001069. doi: 10.1002/14651858.CD001069.pub4.

Pandey M, Datta V, Rehan HS. Role of sucrose in reducing painful response to orogastric tube insertion in preterm neonates. Indian J Pediatr. 2013 Jun;80(6):476-82. doi: 10.1007/s12098-012-0924-4. Epub 2012 Dec 21.

Gray L, Lang CW, Porges SW. Warmth is analgesic in healthy newborns. Pain. 2012 May;153(5):960-6. doi: 10.1016/j.pain.2011.12.017. Epub 2012 Mar 15.

Harrington JW, et al. Effective analgesia using physical interventions for infant immunizations. Pediatrics. 2012 May;129(5):815-22. doi: 10.1542/peds.2011-1607. Epub 2012 Apr 16.

Ecevit A, et al. Acupuncture in preterm babies during minor painful procedures. J Tradit Chin Med. 2011 Dec;31(4):308-10.

Saeidi R, et al. Use of “kangaroo care” to alleviate the intensity of vaccination pain in newborns. Iran J Pediatr. 2011 Mar;21(1):99-102.

Kandasamy Y, Smith R, Wright IM, Hartley L. Pain relief for premature infants during ophthalmology assessment. J AAPOS. 2011;15(3):276-80.

Elserafy FA, Alsaedi SA, Louwrens J, Bin sadiq B, Mersal AY. Oral sucrose and a pacifier for pain relief during simple procedures in preterm infants: a randomized controlled trial. Ann Saudi Med. 2009;29(3):184-8.

Carbajal R, Lenclen R, Gajdos V, Jugie M, Paupe A. Crossover trial of analgesic efficacy of glucose and pacifier in very preterm neonates during subcutaneous injections. Pediatrics. 2002 Aug;110(2 Pt 1):389-93.

Bellieni CV, Bagnoli F, Perrone S, Nenci A, Cordelli DM, Fusi M, et al. Effect of multisensory stimulation on analgesia in term neonates: a randomized controlled trial. Pediatr Res 2002; 51: 460-463.

Johnston CC, et al. Routine sucrose analgesia during the first week of life in neonates younger than 31 weeks’ postconceptional age. Pediatrics. 2002 Sep;110(3):523-8.

Anand KJS, the International Evidence-Based Group for Neonatal Pain. Consensus statement for the prevention and management of pain in the newborn. Arch Pediatr Adolesc Med 2001; 155: 173-180.

Stevens B, Taddio A, Ohlsson A, Einarson T. Sucrose for analgesia in newborn infants undergoing painful procedures. Cochrane Database Syst Rev 2001;(4):CD001069.

Gray L, Watt L, Blass EM. Skin-to-skin contact is analgesic in healthy newborns. Pediatrics 2000; 105(1): E14.

Carbajal R, Chauvet X, Couderc S, Olivier-Martin M. Randomised trial of analgesic effects of sucrose, glucose, and pacifiers in term neonates. BMJ 1999; 319: 1393-1397.

Blass EM, Watt LB. Suckling- and sucrose-induced analgesia in human newborns. Pain 1999; 83: 611-623.

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