What parents need to know about pain in newborns

Claire McCarthy, MD
Claire McCarthy, MD, Faculty Editor, Harvard Health Publications

Just because newborn babies can’t tell you they feel pain doesn’t mean they don’t feel pain. They do. And parents can help.

We tend to think that newborns are too little to really experience pain, and that if they do experience it, they soon forget it. However, research has shown that, indeed, babies do experience pain — and that repeated painful experiences in the newborn period can lead to both short- and long-term problems with development, emotions, and responses to stress.

This is particularly a problem for babies who need many medical procedures after they are born, such as premature babies, babies with certain birth defects, and those who have birth complications or get sick shortly after birth. But even perfectly healthy babies may have some painful procedures, such as heel sticks for newborn screening tests, immunizations, or circumcisions.

That’s why the American Academy of Pediatrics (AAP) recently released an updated policy statement on the prevention and management of procedural pain in newborns: to lessen the pain newborns experience. While the policy statement is written for health care providers, it’s important for the parents of newborns to be aware of it too.

We certainly need to avoid doing painful procedures in the first place. The policy statement does say that we should be very thoughtful and careful when it comes to choosing to do painful things to babies. But some of the painful things we do are either necessary or very helpful to the health of babies now and in the future.

Luckily, there are things health care providers — and parents — can do.

It turns out that even something as simple as holding a baby during a procedure can make a difference. Swaddling the baby, or just holding him or her in a bent position with the arms tight against the body, has been shown to lessen pain. So has breastfeeding during the procedure — or giving expressed breast milk. It also can help to simply look at and gently talk to the baby, while stroking the face or back. If a child is very sick or the procedure is complicated, it may not be practical to hold, nurse, or stroke and talk to a baby during a procedure, but it certainly could be done during a heel stick or immunization.

Another simple way to help is by giving babies sucrose, or sugar. It’s not fully clear how sucrose helps, but it does (glucose, which is similar to sucrose, can work too). It may be that the sweet taste activates natural pain-killing chemicals in the body. It’s best to give it about 2 minutes before the procedure, and the effects last about 4 minutes; for longer procedures such as circumcision, a few doses may be needed. If you talk to and massage the baby along with giving the sucrose, the effects may be even stronger.

For more painful procedures, there are medications (such as opioids, like morphine) that can be used. These medications have side effects, and must be used very carefully, but the AAP urges doctors to always think about using them.

So, parents, if you are told that your baby is going to have a procedure, ask questions. Ask if the procedure is necessary. If it is, ask what can be done to prevent or lessen pain. Ask if you can hold, or caress and talk to, your baby. Ask about using sucrose or glucose. Ask if there are other medications that might help.

Hopefully you won’t need to; hopefully, your doctor or nurse will suggest something before you even have a chance to say anything. But if they don’t, do what your baby can’t do: speak up.


  1. Craig Adams

    The euphemism you refer to is Male Genital Mutilation. Male (and intersex) children are human beings deserving of the same human and constitutional rights as females to bodily and hence genital integrity, to be free from harm, to protection from injury and assault. Instead of directing parents to ask if a procedure is necessary or painful, why don’t medical, and health professionals who know better, do better? They can start by telling their unethical and brutal colleagues to stop cutting the normal, natural genitals of children for profit and/or compulsion to repeat the trauma.

  2. Sanford (Sandy) D'Esopo

    I cannot understand why the results of Danish researcher Morten Frisch have not been acknowledged by AAP, NIH, CDC or to my knowledge any other major health care organization. His findings that both male and female partners fail to experience successful sex are bad enough. But ignoring his study of 334,000 boys, which found a 46% higher incidence of Autism Spectrum Disorder, is not only malpractice, it is criminal

  3. ajay shah

    in india the hindu ism practicing population generally never circumcise
    the penis unless medically necessary in rear cases.
    i am very gratefull that my parents never curcumcised me.i cannot imagine me having a circumcised penis. of course i have to wash and keep it clean but the sexual pleasure i have had with a full penis is very pleasurable and i am always confident that the foreskin will protect my forehead of the penis so much so that if the foreskin ever fails to go back covering the whole penis i physically roll it back to stop the forehead from getting sexually excited when it rubs against the underwear.
    many hindus look with utter contempt muslims and christians who circumcise their boys which is called sunnat in hindi and urdu.

  4. Deborah S.

    It’s time for the United States to join the rest of the civilized world! Routine, circumcision of baby boys violates every necessary ethical principle required for surgery on a minor. The degree of cultural bias, denial and misinformation that exists is mind-numbing. Leave baby boys intact, the way nature intended. Stop this barbaric, primitive, practice of genital mutilation. Help educate the public. Once one sees what an actual “circumcision” entails, there is no turning back. The number of people who still believe it is a “snip” of redundant tissue is astounding. At least the myth that infants don’t feel pain is now out there. Long overdue!

  5. Kevin

    Author is afraid to call circumcision for what it is, barbaric genital mutilation carried out on a baby while awake, without any way to give proper pain relief. Grouping infant genital mutilation together with things like a heel prick is laughable. The cognitive dissonance on this issue from the US medical establishment is appalling but predictable.

  6. Adeline

    I think it’s telling that the editors selected a photo of a baby girl for this article. As one of the other readers commented, circumcision is the elephant in the hospital!

  7. Hans Castorp

    Dr. McCarthy,

    You have a platform to speak the truth regarding the harm of routine infant circumcision, and to make a real difference.

    For the love of G-d, please don’t let this precious opportunity slip through your fingers.

  8. Donald

    The american medical establishment has lost all credibility. They have become the laughing stock of the world. They are an embarrassment to themselves and the rest of us. They promote archaic medical practices and their recommendations are driven by sexism and political correctness. They are so proud of themselves but they are nothing more than a symptom of what is wrong with the larger society.

  9. Karen

    After watching with tears streaming down my face as my first two babies endured the heel prick (they screamed the entire time – unwrapped, laying on a bed, arms flailing), I determined to not put a baby through that again. With my next baby I asked the nurse if I could nurse my daughter during the procedure. At first the nurse balked but at my insistence for at least trying, she agreed. All my baby did was wince once, then she fell back asleep. I did not unwrap my baby save for one foot, I held her close to me. The nurse could not believe what she was seeing and called other nurses over to watch. With each baby after that I did the same thing and each time the nurses were astonished at how my babies didn’t so much as whimper. My babies don’t fuss when they are vaccinated for the same reason – they are still mostly wrapped, held close to me, and often nursing. Only one time did a nurse refuse to go along with my request to hold/wrap/nurse my baby. I walked out and went to another lab where the nurse worked with me.

  10. stephanie smith

    I’m wondering where the references for this blog post are? I don’t believe sucrose/glucose is at all effective for pain reduction-it may confuse the infant, cause the infant to focus temporarily on the strange sweetness/texture, etc. — but distraction and pain reduction are not equivalent (similarly-an infant so shut down from pain/stimuli/lack of attention/too much crying may appear asleep and possibly calm but most current evidence suggests elevated cortisol, breathing irregularities and heart rate decrease would suggest shut down/’close to death’ rather than sleeping).

  11. William

    Or here’s a concept, don’t mutilate the genitals of children you fucking idiots.

  12. David Biviano

    Once again, a highly respected medical publication and author lay out the parameters for pain prevention for infants, and classify circumcision as unnecessary : “But even perfectly healthy babies may have some painful procedures, such as heel sticks for newborn screening tests, immunizations, or circumcisions” – without questioning why a healthy baby would be having one of the most painful surgeries there is – the non-anesthetized amputation of highly enervated tissue from the boy’s genitals. (Even so-called anesthetization is ineffective and/or dangerous). I look for the day when such an article refers to medical ethics, to the Hippocratic Oath, to the violation of human rights to an intact body, and stop glossing over this “elephant in the hospital”!

    • stephanie smith

      This article only mentions a few doses of sucrose/glucose may be necessary for something like circumcision — right: penile/foreskin amputation with just a few sips of sugar. Sick society we live in.

  13. James Mac

    Given that America:-
    1. has been routinely circumcising males for generations for health reasons.
    2. has the worst sexual health of any developed nation, including the highest rate of HIV/AIDS.
    3. remains the only country where doctors circumcise baby boys in hospitals.
    4. is the only country who’s failed to sign-up to UN Convention on the Rights of the Child, with circumcision being a clear violation of a child’s physical integrity.

    One has to ask; why is this practice tolerated at all, let alone promoted (but not recommended) by the AAP?

  14. David Atkinson

    In the case of foreskin amputation, the question is not whether a child feels pain, but whether it is acceptable to steal sexually important body parts from healthy children.

    Even if the penis could be probed, clamped, sliced into, and partially amputated without torturing the baby, it would still be a human rights violation, since everyone deserves the opportunity to keep their whole body.

  15. Mare

    “Do what your baby can’t do……. Speak up!”……. Exactly right…… Speak up against medically unnecessary painful procedures like circumcision! If it’s not medically necessary why do it? Now we are all in agreement that early pain is not in the best interest of babies……. So eliminating unnecessary surgery/procedures seems like the next step. Why not start with eliminating circumcision?

  16. kelly

    I’m confused, because I thought sugar was long since proven to be ineffective pain relief, though it may reduce crying.

  17. Marc

    The author has come right up to the point of saying don’t circumcise your baby. Why not go all the way and just say it, people need to hear it. It is irresponsible to put an infant through an unnecessary cosmetic surgery of the genitals. Even if you don’t understand or believe in the functions of the foreskin in adult sexuality (which is crazy, they are real and documented), even if you don’t believe in a person’s right to an unaltered body (without medical necessity), even if you don’t believe in equal protection for boys and girls, certainly the known dangers of pain and complications of any surgery should be enough to end this ancient barbaric practice. Doctors should be practicing medicine, not superstition.

  18. Tara Shipley

    It is incredibly irresponsible to suggest that sucrose or glucose is even remotely effective for circumcision pain.
    “Compared head to head, DPNB is substantially more effective than EMLA cream. Ring block and lidocaine creams other than EMLA also reduced pain but did not eliminate it. ****Trials of oral acetaminophen, sugar solutions, pacifiers, music, and other environmental modifications to reduce circumcision pain did not prove them effective. ****”
    Brady-Fryer B, Wiebe N, Lander JA. Pain relief for neonatal circumcision. Cochrane Database of Systematic Reviews 2004, Issue 4. Art. No.: CD004217. DOI: 10.1002/14651858.CD004217.pub2

  19. Hope Savage

    Then why does the AAP endorse routine circumcision? I really want to know

    • Desiree

      They don’t. The closest they come is to say that the benefits *may* outweigh the risks, but not enough to recommend routine infant circumcision. What they also don’t say is the the “risk” is already comically low to begin with; we’re talking a drop from .04% to .03%. Hygiene and safe sex prevents problems, not cutting off body parts.

      • Marc

        Do you mean the ‘benefits’ are comically low? They are. There might not be any benefits at all when viewed through a realistic, unbiased lens. The ACA doesn’t recommend it to prevent penile cancer, UTI’s are more properly treated with antibiotics, There’s a vaccine for HPV now, it’s never been proven to reduce HIV risk, there’s more evidence to the contrary. But the risks are actually quite high: Much more serious disfigurement than anyone knows (victims of ‘botched circumcisions’ often never show or speak about their damage), various forms of sexual dysfunction, lack of natural mechanics in sex, loss of specialized nerve endings, brain damage, loss of entire penis, and death. All to make him look like daddy (or insert other lame excuse here).

    • Mare

      The AAP doesn’t endorse infant circumcision……. They advocate getting paid to do it……. It’s a trade organization…

  20. Wren

    Sugar water isn’t going to minimize the pain of having the most sensitive part of your genitals ripped, crushed, and violently cut away from your body while you’re strapped to a plastic board.