Analgesic effects of breast-feeding or pacifier use with maternal holding in term infants

Objectives.-First, to compare analgesic effects of breast-feeding versus pacifier use in newborn infants undergoing blood collection via heel sticks. Second, to compare analgesic effects of pacifier use with maternal holding versus nonmaternal holding. Design.-A prospective, randomized, controlled trial. Setting.-Normal newborn nursery at academic teaching hospital. Participants.-Full-term breast-feeding infants scheduled for routine newborn screening blood test via heel stick (n=96). Interventions.-Infants randomized to 3 groups for analgesia: 1) breast-feeding, 2) pacifier use while held by mothers, 3) pacifier use while held by research assistants (nonmothers). Outcome Measures.-Primary outcome was crying (percent of infants who cried during the procedure and mean percent of procedure time that infants cried). Secondary outcomes were physiologic measures. Results.-Fewer breast-feeding infants cried than infants using a pacifier while held by nonmothers both during the procedure (69% vs 100%, P <.01) and after the procedure (28% vs 60%, P=.03). Those infants crying during the procedure cried for less time if held by their mothers either breast-feeding (33%, P <.01) or using a pacifier (45%, P=.03) than those using a pacifier while being held by nonmothers (66%). Conclusion.-Breast-feeding is more analgesic than pacifier use with nonmaternal holding. Maternal holding with either breast-feeding or pacifier use is more analgesic than nonmaternal holding with pacifier use, suggesting that maternal holding itself has an analgesic effect. Breast-feeding and maternal holding should be considered as pain-control measures for the neonate during heel-stick procedures.