University Life: How we hope to reduce the pain that babies feel

Head of the Paediatric Infant Pain and Anaesthesia group and Associate Professor of Paediatric 
Neuro-imaging and Wellcome Trust Career Development Fellow at Oxford University

It is difficult to know whether a baby is experiencing pain.

In a recent study, adults were asked to listen to babies making different sounds during vaccinations, when hungry, after feeding or while playing.

While adults could tell when the babies were distressed, they couldn’t identify whether this was because they were in pain or due to other experiences such as hunger.

Most babies do not have many painful experiences while they are very young.

However, if babies are born early or are unwell, they may need to stay in hospital and often require invasive procedures to be performed as part of their essential medical care.

For example, estimates suggest that in the first two weeks of life, a baby who requires intensive care will experience eight to 12 painful procedures per day.

To limit the pain these babies experience and to prevent any negative long-term consequences, we need better ways to measure and treat pain in babies.

Babies cannot tell us when they are in pain, so one approach is to use brain-imaging techniques such as functional magnetic resonance imaging (fMRI) to observe what is happening in the brain when babies undergo procedures that adults describe as “mildly painful”.

These have been used extensively in adults and have shown that many different parts of the brain are active when adults experience pain.

For example, brain areas involved in both the emotional and sensory aspects of pain have been shown to be active in adults. Until relatively recently, fMRI had not been used in babies to investigate patterns of pain-related brain activity.

However, recent work performed at the University of Oxford by Sezgi Goksan, Caroline Hartley and other colleagues showed that the patterns of brain activity triggered when a baby experiences pain are extremely similar to those observed when adults experience pain.

These novel brain-imaging techniques are particularly useful in researching babies’ responses because they may be more sensitive compared to simple observations of infant behaviour.

One mother, Rachel Edwards, was inspired to allow her second son Alex to take part in one of Oxford University’s brain-imaging studies investigating infant pain following the birth of her first son Rhys, who was born four weeks early and needed to spend a short time in special care.

While he was there, he had over ten heel lances a day, where they cut the foot to take blood.

She said: “I was conscious that he was not given any pain medication.

“He also had to have a nasal-gastric tube put in and that was very stressful for me. It makes you feel helpless. It was a very difficult time.”

After that experience, she was keen to take part because she wanted to make a difference to how babies and parents in a similar position are treated in the future.

Having developed novel methods for measuring pain-related brain activity in babies, the research team now plans to use these methods to investigate whether medication effectively relieves pain in infants.

Sezgi Goksan and Caroline Hartley are part of the Paediatric and Infant Pain and Anaesthesia (PIPA) research group in the Department of Paediatrics at the University of Oxford.

The research team aims to understand how the human brain develops during early infancy and is funded by the Wellcome Trust, Medical Research Council and National Institute for Health Research.