Infant Pain Management

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Hi everyone, I am a student and this is my first post here at allnurses. I recently witnessed a circ for the first time and only sweetease was used. It was unbearable to watch, and I can't get those cries out of my head. I know there was nothing I could do, but I feel awful that this happened to this little boy as I just stood by. My problem is not the circ itself, but the fact that it was done without anything for the pain. We wouldn't do this to a grown man, or even a dog, without something for pain, so why is it ok to do it to a helpless baby? Since 1999 the American Academy of Pediatrics has recommended using pain relief for this procedure, so I was curious if the procedures done where you work use pain relief and what kind? Are parents informed that pain relief is available for their child if they want it? And as a nurse, what can be done so that we move forward and treat infants pain just as we do adults?

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Our babies are medicated with xylocaine and also given sweetease. Some of the doctors are really great about the medicating and give it ample time to kick in, but some of the others rush so fast you know it doesn't do them any good.

It makes me glad that my husband and I are opposed to circumcision unless medically necessary. Saves us from all the hassle of finding a doctor who does the procedure humanely.

ETA the xylocaine is given through local injection and as wtbcrna said, the babies tend to get upset anytime they're restrained like that and that is definitely part of it. The part where I know it's legitimately because of the pain is when they're totally fine with the sweetease and whatnot and then at a point of the procedure where it's obvious there would be pain they start crying hard.

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Specializes in Anesthesia.

I think this topic has been covered in depth on here before. Infants nervous systems are not fully developed, and it can be dangerous to give pain/opioid medications especially on an out patient basis to neonates. That doesn't mean that local anesthetic couldn't/shouldn't be used or other forms of analgesia, but there is more to think about when seeing an infant upset/crying during a procedure which is probably more from being held down than anything else.

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I think this topic has been covered in depth on here before. Infants nervous systems are not fully developed, and it can be dangerous to give pain/opioid medications especially on an out patient basis to neonates. That doesn't mean that local anesthetic couldn't/shouldn't be used or other forms of analgesia, but there is more to think about when seeing an infant upset/crying during a procedure which is probably more from being held down than anything else.

Actually he wasn't crying at all before the procedure began, he was sucking on the techs finger and as calm as he could be. When he was first put on the board sure he was fussy, but he calmed within a couple of minutes. When the cutting started he cried like I had never heard before, and I really want to never hear again. It was obvious that he was in EXTREME pain and it made me feel very sick.

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Our babies are medicated with xylocaine and also given sweetease. Some of the doctors are really great about the medicating and give it ample time to kick in, but some of the others rush so fast you know it doesn't do them any good.

It makes me glad that my husband and I are opposed to circumcision unless medically necessary. Saves us from all the hassle of finding a doctor who does the procedure humanely.

ETA the xylocaine is given through local injection and as wtbcrna said, the babies tend to get upset anytime they're restrained like that and that is definitely part of it. The part where I know it's legitimately because of the pain is when they're totally fine with the sweetease and whatnot and then at a point of the procedure where it's obvious there would be pain they start crying hard.

Yeah, this baby was calm before the procedure began, content with sucking the sweetease. It's good to know that some doctors are moving into the future. 97% of the training programs that teach circumcision now train doctors in anesthesia/analgesia use, I just wish it would become standard practice in the field. Seems like progress is always so slow . There is a lot of research coming down the pipes concerning short-term and long-term consequences of painful experiences such as this, some of it is even being done by the NINR. Maybe this will help move things along.

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Specializes in Anesthesia.
Yeah, this baby was calm before the procedure began, content with sucking the sweetease. It's good to know that some doctors are moving into the future. 97% of the training programs that teach circumcision now train doctors in anesthesia/analgesia use, I just wish it would become standard practice in the field. Seems like progress is always so slow . There is a lot of research coming down the pipes concerning short-term and long-term consequences of painful experiences such as this, some of it is even being done by the NINR. Maybe this will help move things along.

Keeping in mind Circs have been done for over a thousand years without analgesia what long term consquences are there to infants that recieve circs without analgesia?

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Specializes in Pediatric/Adolescent, Med-Surg.
Keeping in mind Circs have been done for over a thousand years without analgesia what long term consquences are there to infants that recieve circs without analgesia?

I don't think the OP is arguing there are long term consequences, but instead that for this being the 21st century there should be a better way to minimize the pain.

I am a peds nurse and recently was taking care of a 6 week old male who, do to health problems following birth, was just now getting circ'ed. Per the attending, a penile block was going to be used as well as a topical lidocaine. I didn't get to see the actual procedure, but it did seem like my docs were trying their best to minimize the pain factor.

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Specializes in Anesthesia.
I don't think the OP is arguing there are long term consequences, but instead that for this being the 21st century there should be a better way to minimize the pain.

I am a peds nurse and recently was taking care of a 6 week old male who, do to health problems following birth, was just now getting circ'ed. Per the attending, a penile block was going to be used as well as a topical lidocaine. I didn't get to see the actual procedure, but it did seem like my docs were trying their best to minimize the pain factor.

I am not saying it shouldn't be done or that I haven't done penile blocks for circs myself. I just think something that has been done for over a thousand years without analgesia and is still done all the time by Rabbis the world over without analgesia is that we might be over thinking this just a tad.

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Specializes in Pediatric/Adolescent, Med-Surg.
I am not saying it shouldn't be done or that I haven't done penile blocks for circs myself. I just think something that has been done for over a thousand years without analgesia and is still done all the time by Rabbis the world over without analgesia is that we might be over thinking this just a tad.

While I am aware that Jewish Rabbis and other religious figures performed circumcisions for thousands of years. We also used to use leaches and tied women down for childbirth. Obviously we don't do those things anymore. I personally see circumcisions as archaic and torturous. I have not had children yet, but when I do, I have no intention of circumcising my sons unless it's absolutely medically necessary.

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Keeping in mind Circs have been done for over a thousand years without analgesia what long term consquences are there to infants that recieve circs without analgesia?

Would you want your foreskin removed without pain control? The argument that neonates have less pain response is ridiculous! Yes, I will agree that holding infants down is a cause for sig. irritation but pain is pain and it hurts when their foreskin is cut off.

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We premedicate with acetaminophen. The MD uses a local anesthetic immediately prior to the procedure. We use sweeties during the procedure. After procedure, we medicate with around-the-clock dosing of acetaminophen for a couple of days. Typically, the only crying is during the administration of the local anesthetic, if even then.

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Specializes in NICU, PICU, educator.

Check the OB board..there is a thread there. We premed with Tylenol, use lidocaine or emla cream depending on gestation age and weight, tylenol q6 for 24hrs after.

No excuse to not use pain measures in this day and age.

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