Be Sweet to Babies during painful procedures – Showing the evidence

This month’s blog is brought to us by Dr Denise Harrison about why we need to be sweet to babies during painful procedures. Dr Harrison began her research career at the Royal Children’s Hospital, Melbourne and is currently the Children’s Hospital of Eastern Ontario (CHEO) Nursing Research Chair. Her program of research focuses on pain management in infants and young children and knowledge translation. She recently launched a YouTube video showing the three key effective pain management strategies for newborn infants during needle-related procedures. The video, targeted at parents, shows infants breastfeeding, held in skin-to-skin care, and being given sucrose during heel lancing or venepuncture.  Denise felt this could potentially be an effective knowledge translation tool, based on robust high quality evidence of the analgesic effects of these three strategies.

Reducing pain during painful procedures is important to all, but especially important to newborn and young infants. This fact has been well established, based on a growing number of reports highlighting negative sequela of repeated painful procedures in preterm and sick infants as well as a concerning number of children and adults who have developed a fear of needles. Such needle fears, more than likely, have developed from poorly treated procedural pain in infancy and early childhood. There is however, good news for infants. There are three effective pain management strategies, based on robust high quality synthesised evidence, which are simple to use, easily accessible and extremely cost effective. These strategies are breastfeeding (Shah et al. 2012), skin-to-skin care (Johnston et al. 2014), also referred to as kangaroo care, and small amounts of sweet solutions (Harrison et al. 2012), either sucrose (Stevens et al. 2013) or glucose (Bueno et al. 2013). Numerous published neonatal and infant pain guidelines exist (Lee et al. 2014), and include recommendations to use sweet solutions with or without non-nutritive sucking, breastfeeding and kangaroo care for painful procedures. These three strategies can be easily implemented for reducing pain during non-urgent short lasting procedures in newborn and young infants.

The bad news, is that despite the evidence, guidelines and pain management recommendations from national and international organisations, knowledge has not been translated into normalised care in diverse settings where painful procedures for infants take place. Study after study around the world continue to report sub-optimal pain management in tertiary and community settings. Even a review of posted YouTube videos of infants being immunised, show no use of these effective strategies. The problem is obviously not one of lack of evidence, but a failure to translate knowledge into practice. As health care researchers and clinicians, we need to explore more effective and efficient ways to disseminate and translate knowledge.

Social media currently plays a large role in the way people seek health information (Harrison et al. 2014; McMullan 2005) and researchers have been encouraged to use social media in their knowledge translation efforts (Kruse 2010). YouTube, a social media site founded in February 2005, allows people to post, watch and share originally-created videos (Oomman A et al. 2013). Video format is suggested to be an effective method of sharing knowledge, by showing evidence, to target users (Public Health Agency of Canada 2012), and YouTube, is the third most accessed social media internet site, with over 2 billion views daily (Oomman A et al. 2013; Nielsen 2012). Based on these facts, the Be Sweet to Babies team decided to use the social media platform of YouTube with the aim of showing parents ways to reduce needle-related pain in newborns and older infants, and disseminating this knowledge to a far and wide audience. We produced and posted two parent-targeted educational videos:

• showing analgesic effects of breastfeeding and sucrose during immunisation in infants

and

• breastfeeding, skin-to-skin care and sucrose for pain management during newborn screening

The neonatal pain video has been posted in English, French, Spanish and Portuguese and will soon be available in Mandarin, Arabic, Hindustani as well as Inuktitut, one of the principal Inuit languages of Canada.

It is not enough however, to simply post intervention videos and count the views. To evaluate effectiveness of using this potentially promising knowledge translation strategy, health researchers need to design innovative methods of evaluating reach and impact, as well as process and clinical outcomes of social media delivered interventions. This opens up a whole new spectrum of research for our multidisciplinary teams of pain researchers and trainees. I look forward to leading, participating in, supporting and reading results of social media-delivered intervention research in the years to come.

Denise Harrison (RN, PhD)
Chair in Nursing Care of Children, Youth and Families
Children’s Hospital of Eastern Ontario (CHEO) Research Institute & University of Ottawa
Murdoch Childrens Research Institute; Honorary Research Fellow
The University of Melbourne Faculty of Medicine, Dentistry & Health Sciences; Honorary Senior Fellow
Email: denise.harrison@uottawa.ca
Facebook: https://www.facebook.com/besweet.tobabies
Twitter: @dharrisonCHEO