Holding and swaddling newborn infants during heel lance procedures reduces pain

For newborn infants, being held and swaddled is a simple and effective way to reduce pain during routine blood sampling, reports a study in the November/December issue of MCN: The American Journal of Maternal/Child Nursing. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health, a leading provider of information and business intelligence for students, professionals, and institutions in medicine, nursing, allied health, and pharmacy.

"The technique of swaddling infants while holding them in an upright position was superior for pain relief during heel lance procedures when compared with a standard position technique," according to the study, led by Carla Morrow, DNP, CNM, RN, of Texas Health Harris Methodist Hospital Cleburne, Cleburne, Texas.

Simple Nursing Technique Reduces Pain Scores by Half
Heel lancing is a routine procedure for collecting blood samples from newborn infants. In the study, 42 newborns were randomly assigned to two groups. In one group, the procedure was performed the usual way, with the infant lying in a crib. In the other group, the infant was swaddled and held in an upright position during the procedure. Pain responses were assessed using a standard scale, based on observable behaviors (facial expressions, crying, etc).

Infants who were swaddled and held had significantly lower pain scores. On a 7-point scale, the average pain score was 1.3 for infants who were swaddled and held versus 2.7 for those who were not. Thus holding and swaddling reduced pain scores by about one-half.

The researchers thought that holding infants upright might also allow the blood sample to be collected more quickly and reduce the rate of inadequate blood samples. Although time to collect the samples was slightly shorter (by 30 seconds) for infants who were swaddled and held, the difference was not significant. Both techniques provided good blood samples for testing.

"It is important to evaluate and address pain issues experienced by neonates [newborns] during routine heel lancing, not only to increase the infants' comfort but also to decrease the negative consequences of excessive pain," Morrow and coauthors write. Especially in infants who require repeated blood sampling, an exaggerated pain response may develop. Studies have suggested longer-term developmental consequences as well.

Several nondrug procedures have been shown to reduce pain during heel lancing, such as a pacifier dipped in a sugar (sucrose) solution. However, many hospitals don't routinely offer any method of pain control—perhaps partly because doing so might require a formal change in "hospital policy."

"This is an important study for all nurses who work with mothers and infants because it shows that using a simple technique like swaddling can significantly reduce infant discomfort during heel sticks," comments Margaret Comerford Freda, EdD, RN, CHES, FAAN, Editor of MCN. "Nurses on any unit can implement this technique without any cost, and without time-consuming and confusing policy changes. Staff nurses and nurse managers can use this study as evidence for an important change in nursing practice."

"Evaluating nursing practice is essential in the development of evidence-based nursing interventions," Morrow and coauthors add. They call for further studies to evaluate non-drug methods for pain control in newborns undergoing heel lancing, as well as to see if swaddling can reduce pain in infants undergoing other painful procedures.