1. Merisa Akuszewski Azusa Pacific University

2. The Importance of Managing Neonatal Pain Infants encounter painful stimuli as a result of routine medical procedures Because of their undeveloped pain-inhibiting pathways, infants experience more pain during painful procedures than children and adults do Unrelieved pain in infants can lead to decreased pain tolerance in adulthood (Cong et al., 2012; Esfahani et al., 2013)

3. The Importance of Managing Neonatal Pain Many medications are useful in treating pain, but are associated with adverse side effects It is important to determine non- pharmacological interventions

4. Skin-to-Skin Contact Skin-to-skin contact (SSC) is achieved when an unclothed infant is placed on its mother's bare chest Benefits of SSC: Accelerates brain development Improves oxygenation Temperature regulation Stimulates digestion and weight gain Strengthens bond between parent and infant Davidson, London, & Ladewig, 2012; Phillips, 2013)

5. Skin-to-Skin Contact Useful for minimizing infants’ pain during Immunizations Heel lances

6. Skin-to-Skin Contact Reduces Infants’ Autonomic Pain Responses Infants' who received SSC had: More stable heart rates throughout the procedures Cried for shorter periods of time Lower mean pain scores (Chermont, et al., 2009; Cong et al., 2012; Esfahani et al., 2013; Kostandy, Anderson, & Good, 2013; Razek & El-Dein, 2009)

7. Skin-to-Skin Contact is More Effective than Other Interventions SSC is superior to other non-pharmacological interventions at reducing neonatal pain Infants who received SSC reached relaxed behavioral states more quickly compared to infants who received no intervention, massage therapy or an oral sweetener. (Chermont, et al., 2009; Esfahani et al., 2013; Kostandy et al., 2013)

8. Breastfeeding Breastfeeding reduced infants' pain, cry time, and increased heart rate stability. (Esfahani et al., 2013; Razek & El-Dein, 2009)

9. Implementing Skin-to-Skin Contact into Nursing Practice SSC should be implemented into nursing practice as a standard hospital protocol for labor and delivery and neonatal intensive care units (NICU). Breastfeeding should be used as the primary intervention for infants undergoing painful procedures Basic SSC should be used as a secondary or replacement therapy (Chermont, et al., 2009; Cong et al., 2012; Esfahani et al., 2013; Kostandy et al., 2013; Razek & El-Dein, 2009)

10. Implementing Skin-to-Skin Contact into Nursing Practice Educate and motivate nursing staff Educate parents/families Provide privacy and space

11. Using Breastfeeding to Reduce Infants’ Pain During Immunization https://www.youtube.com/watch?v=8Wzjxvrl91U (Children’s Hospital of Eastern Ontario, 2013)

12. References Chermont, A.G., Falcão, L., Silva, E., Balda, R., & Guinsburg, R. (2009). Skin-to-skin contact and/or 25% oral dextrose for procedural pain relief for term newborn infants. Pediatrics, 124(6), 1101-1107. doi: 10.1542/peds.2009-0993 Children’s Hospital of Eastern Ontario. [Cheovideos]. (2013, October 21). Baby vaccination; the secret to a calm and peaceful immunization [Video file]. Retrieved from https://www.youtube.com/watch?v=8Wzjxvrl91U Cong, X., Cusson, R. M., Walsh, S., Hussain, N., Ludington-Hoe, S. M., & Zhang, D. (2012). Effects of skin-to-skin contact on autonomic pain responses in preterm infants. The Journal of Pain, 13(7), 636-645. doi: 10.1016/j.jpain.201202008 Davidson, M., London, M., & Ladewig, P. (2012). Old's maternal-newborn nursing & women's health across the lifespan. Upper Saddle River, NJ: Pearson. Esfahani, M. S., Sheykhi, S., Abdeyazdan, Z., Jodakee, M., & Boroumandfar, K. (2013). A comparative study on vaccination pain in the methods of massage therapy and mothers' breast feeding during injection of infants referring to Navabsafavi Health Care Center in Isfahan. Iranian Journal of Nursing and Midwifery Research, 18(6), 494-498. Kostandy, R., Anderson, G. C., & Good, M. (2013) Skin-to-skin contact diminishes pain from hepatitis B vaccine injection in healthy full-term neonates. Neonatal Network: Journal of Neonatal Nursing, 32(4), 274-280. doi: 10.1891/0730-0832.32.4274 Phillips, R. (2013). Uninterrupted skin-to-skin contact immediately after birth. Newborn and Infant Nursing Reviews, 13 (2), 67-72. Razek, A. A., & El-Dein, N. A. Z. (2009). Effect of breast-feeding on pain relief during infant immunization injections. International Journal of Nursing Practice, 15, 99-104. doi: 10.1111/j.1440-172X.2009.01728.x