Facilitated tucking to reduce pain in neonates: evidence for best practice

Abstract

Background: Increasing survival rates of preterm infants and a greater understanding of the long-term consequences of early exposure to pain have generated a greater need for nonpharmacologic pain management strategies in the neonatal intensive care unit (NICU) setting. Facilitated tucking supports the preterm infant and is a valuable strategy to manage neonatal pain. Alternative nonpharmacologic approaches to pain management in neonates include nonnutritive sucking and kangaroo care.

Clinical question: In premature and critically ill infants, what is the effect of facilitated tucking on pain behaviors in those who received the intervention compared with those who did not, and what alternative interventions for nonpharmacologic pain reduction are supported by strong research evidence?

Search strategy: Studies were identified in the PubMed database using the search terms: facilitated tucking, NICU, pain management, preterm infant, and nonpharmacologic. Studies were included if they were peer reviewed, were published in the last 5 years (or considered classic), and if they used experimental study designs.

Results: The studies identified demonstrate that facilitated tucking reduces the expression of pain in premature infants. As a whole, existing research supports the use of facilitated tucking for infants as early as 23 weeks' gestational age, during painful procedures including: heel stick, endotracheal suctioning, and venipuncture.

Implications for practice and research: Pain management interventions are necessary to decrease the potentially unfavorable consequences of early exposure to pain and to promote positive outcomes. Additional research is indicated to discover the effects of nonpharmacologic interventions in neonates with severe illness, congenital abnormalities, and/or assisted breathing.