Clinical Practice Update – Paediatrics
Oral sucrose for pain management in the paediatric emergency department; a review

https://doi.org/10.1016/j.aenj.2008.02.004Get rights and content

Summary

Provision of effective analgesia for infants and children is important during painful procedures performed in emergency departments. Although small volumes of sweet-tasting solutions have been extensively shown to be analgesic during minor painful procedures in newborn infants, there have been fewer studies of sucrose use in infants beyond the neonatal period, and in children. This review of sucrose effectiveness in infants beyond the neonatal period highlights that sucrose continues to provide some analgesia, resulting in procedural pain reduction, however the effects may be less marked. There is inadequate evidence to support the use of sucrose during painful procedures in school-aged children. Oral sucrose should be included in paediatric emergency department pain management guidelines as one of the possible strategies to utilise for infants during minor painful procedures. Careful assessment of pain and distress during procedures is required to evaluate the effectiveness of sucrose analgesia. Appropriate comfort measures should always be used, and adjunct analgesics should be utilised as required.

Section snippets

Historical perspective

It has been almost 20 years since the first study demonstrating calming effects of sweet-tasting solutions in human infants was published. In a landmark study in 1989, Blass and colleagues demonstrated that crying infants given two 0.2 mL doses of 12% sucrose orally, rapidly became calm, with the calming effects persisting up to 5 min.9 In addition, Blass and colleagues were the first to publish results of blinded, randomised, controlled trials demonstrating the efficacy of small volumes of

Sucrose analgesia beyond the newborn period

Studies of sucrose-induced analgesia beyond the neonatal period have primarily been conducted during scheduled childhood immunisation in infants ranging from 2 to 18 months of age.18, 19, 20, 21, 22, 23 The majority of these studies were randomised, controlled trials evaluating the efficacy of either oral sucrose or glucose during a single episode of routine vaccination, which may have included either a single injection, or multiple injections. Two studies however, were longitudinal randomised,

Conclusion

Sucrose is a short-acting, mild analgesic, which may be a useful strategy in the ED for management of minor painful procedures in infants up to 18 months of age. Pain needs to be carefully evaluated and both appropriate comfort measures and adjunct analgesia needs to be considered, especially if the procedure becomes prolonged. As some of the evidence of sucrose effectiveness in infants beyond the neonatal period is conflicting, further studies are warranted to determine the degree of

Competing Interests

None declared by author.

Funding Interests

None declared by author.

References (39)

  • B. Stevens et al.

    Sucrose for analgesia in newborn infants undergoing painful procedures (Cochrane Review)

    The Cochrane library, 3

    (2004)
  • American Academy of Pediatrics Committee on Psychosocial Aspects of Child Family Health Task Force on Pain in Infants Children Adolescents

    The assessment and management of acute pain in infants, children, and adolescents

    Pediatrics

    (2001)
  • K.J. Anand

    International Evidence-Based Group for Neonatal Pain. Consensus statement for the prevention and management of pain in the newborn

    Arch Pediatr Adolesc Med

    (2001)
  • Royal Australasian College of Physicians

    Guideline statement: management of procedure-related pain in neonates

    (2005)
  • D. Harrison

    Australian College of Neonatal Nurses. Management of pain in sick hospitalised infants

    Neonat Paediatr Child Health Nurs

    (2006)
  • E.M. Blass et al.

    Sensorimotor and motivational determinants of hand-mouth coordination in 1–3-day-old human infants

    Dev Psychol

    (1989)
  • E.M. Blass et al.

    Sucrose as an analgesic for newborn infants

    Pediatrics

    (1991)
  • E. Blass et al.

    A new look at some old mechanisms in human newborns

    Monogr Soc Res Child Dev

    (1994)
  • E.M. Blass et al.

    Differential effects of sucrose, fructose, glucose, and lactose on crying in 1- to 3-day-old human infants: qualitative and quantitative considerations

    Dev Psychol

    (1992)
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