Sunday, April 6, 2008

Do Babies Really Feel Pain?


Do babies feel pain? I certainly think they do, but, to find out, we should not have stuck them with pins. There are other objective indications of pain.
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1. Crying. It seems perfectly obvious now, but for a long time, experts were informing the public that infants cries were only "random" sounds, not genuine communications. It took a quarter century of cry research to prove otherwise.
Cries are not only meaningful signals, but often compelling ones. They increase in intensity with degrees of pain. Spectrographic studies that reduce sound to an elaborate visual portrait show just how varied and complex cry language is. Acoustic studies show that changes in pitch, temporal patterning, and harmonic structure also reflect the degree of pain and urgency. For example, in a thorough study of cries during circumcision, acoustic features precisely reflected the degree of invasiveness of the surgery.
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Parents present at circumcision (a rarity) have recalled how their babies cried. One father, present in the delivery room told me of his great surprise when the obstetrician proceeded to circumcise this boy at delivery. Having been quiet through the entire birth, the boy proceeded to protest loudly about the circumcision! A Jewish father, reflecting on this boy's circumcision on the eighth day, said it was the saddest occurrence of his babyhood: the boy cried more that afternoon, he said, than anytime in his whole first year.
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2. Facial expressions. Second, the pain that babies feel is clearly expressed on their faces. Brows bulge, crease, and furrow. Eyes squeeze shut: bulging of the fatty pads about the eyes is pronounced. There is a nasolabial furrow that runs down and outwards from the corners of the lip. Lips purse, the mouth opens wide, the tongue is taut, and the chin quivers. This look on a human face of any age communicates pain. Why do we doubt that it means the same on the face of a baby?
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3. Body movement. Body language in its larger motor dimensions is also a language that babies share with older humans. In response to pain, babies jerk, pull back, try to escape, swing their arms, use their hands to push away, and frantically scrape one leg against the other to dislodge an offending stimulus in that area. They strike out with their upper extremities and kick with the lower. Receiving routine heel lancing, a deep wound made in the heel to obtain blood samples. Using calibrated hairs, they gently stroked the corresponding areas in the injured and non-injured heel. Even premature infants showed the same well-defined hypersensitivity to tissue injury that is found in adults.

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4. Vital signs. Fourth, we can see how baby pain is revealed by changed in vital signs and blood chemistry. Pain causes increased respiration. Babies hold their breath and release it in piercing cries. Researchers have observed infant heart rates increase 50 beats per minute and peak above 180 beats per minute. In a study to compare behavioral states of the newborn to those of the fetus, Pillai and James discovered that the heart rate during newborn crying was unlike anything seen in prenatal life. This racing heartbeat was unstable, often reaching peaks in excess of 200 bpm, in spite of the fact that baseline heart rates after birth are generally 20-25 bpm lower than they are in utero. These extremely elevated heart rates signal a serious and urgent disturbance.
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Serum cortisol is a measure of stress. In painful conditions, adrenals may release cortisol three to four times the baseline. In one study, cortisol levels clearly differentiated between three different surgical techniques of circumcision.
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Under painful conditions, tissue and blood oxygen levels drop.
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5. Neurobehavioral assessments. Further consequences of infant pain can be seen in neurobehavioral assessments. Babies who have been subjected to pain may have difficulty quieting themselves. Following circumcision, the normal progression of sleep cycles is reversed with immediate and prolonged escape into Non-REM sleep. After circumcision, babies withdraw, change their social interactions with their mothers, and modify their motor behavior.

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