Table of Contents Author Guidelines Submit a Manuscript
International Journal of Pediatrics
Volume 2010, Article ID 474838, 11 pages
http://dx.doi.org/10.1155/2010/474838
Review Article

Pain in Children: Assessment and Nonpharmacological Management

Division of Paediatric Emergency Medicine, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, Canada M5G 1X8

Received 30 January 2010; Accepted 4 May 2010

Academic Editor: Keira Mason

Copyright © 2010 Rasha Srouji et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Linked References

  1. N. S. Morton, “Pain assessment in children,” Paediatric Anaesthesia, vol. 7, no. 4, pp. 267–272, 1997. View at Google Scholar · View at Scopus
  2. P. J. McGrath and G. Frager, “Psychological barriers to optimal pain management in infants and children,” The Clinical Journal of Pain, vol. 12, no. 2, pp. 135–141, 1996. View at Publisher · View at Google Scholar · View at Scopus
  3. J. F. Hagan Jr., W. L. Coleman, J. M. Foy et al., “The assessment and management of acute pain in infants, children, and adolescents,” Pediatrics, vol. 108, no. 3, pp. 793–797, 2001. View at Publisher · View at Google Scholar · View at Scopus
  4. H. H. Abu-Saad and J. P. H. Hamers, “Decision-making and paediatric pain: a review,” Journal of Advanced Nursing, vol. 26, no. 5, pp. 946–952, 1997. View at Google Scholar · View at Scopus
  5. P. J. McGrath and A. M. Unruh, “Measurement and assessment of paediatric pain,” in Textbook of Pain, P. D. Wall and R. Melzack, Eds., pp. 371–384, Churchill Livingstone, New York, NY, USA, 4th edition, 1999. View at Google Scholar
  6. G. D. Champion, B. Goodenough, C. Von Baeyer, and W. Thomas, “Measurement of pain by self report,” in Measurement of Pain in Infants and Children, G. A. Finley and P. J. McGrath, Eds., pp. 123–160, IASP Press, Seattle, Wash, USA, 1998. View at Google Scholar
  7. P. J. McGrath, “Behavioural measures of pain,” in Measurement of Pain in Infants and Children, G. A. Finley and P. J. McGrath, Eds., pp. 83–102, IASP Press, Seattle, Wash, USA, 1998. View at Google Scholar
  8. S. D. Sweet and P. J. McGrath, “Physiological measures of pain,” in Measurement of Pain in Infants and Children, G. A. Finley and P. J. McGrath, Eds., pp. 59–81, IASP Press, Seattle, Wash, USA, 1998. View at Google Scholar
  9. M. Fitzgerald and S. Beggs, “The neurobiology of pain: developmental aspects,” Neuroscientist, vol. 7, no. 3, pp. 246–257, 2001. View at Google Scholar · View at Scopus
  10. R. V. E. Grunau and K. D. Craig, “Pain expression in neonates: facial action and cry,” Pain, vol. 28, no. 3, pp. 395–410, 1987. View at Google Scholar · View at Scopus
  11. J. Alexander and M. Manno, “Underuse of analgesia in very young pediatric patients with isolated painful injuries,” Annals of Emergency Medicine, vol. 41, no. 5, pp. 617–622, 2003. View at Publisher · View at Google Scholar · View at Scopus
  12. B. J. Stevens, C. C. Johnston, and L. Horton, “Multidimensional pain assessment in premature neonates: a pilot study,” Journal of Obstetric, Gynecologic, and Neonatal Nursing, vol. 22, no. 6, pp. 531–541, 1993. View at Google Scholar · View at Scopus
  13. H. D. Hadjistavropoulos, K. D. Craig, R. V. E. Grunau, and C. C. Johnston, “Judging pain in newborns: facial and cry determinants,” Journal of Pediatric Psychology, vol. 19, no. 4, pp. 485–491, 1994. View at Google Scholar
  14. B. Stevens, C. Johnston, P. Petryshen, and A. Taddio, “Premature infant pain profile: development and initial validation,” The Clinical Journal of Pain, vol. 12, no. 1, pp. 13–22, 1996. View at Publisher · View at Google Scholar · View at Scopus
  15. S. W. Krechel and J. Bildner, “CRIES: a new neonatal postoperative pain measurement score. Initial testing of validity and reliability,” Paediatric Anaesthesia, vol. 5, no. 1, pp. 53–61, 1995. View at Google Scholar · View at Scopus
  16. C. E. Izard, The Maximally Discriminative Facial Movement Coding System (MAX)-Manual, University of Delaware Resource Centre, Newark, NJ, USA, 1979.
  17. R. V. E. Grunau and K. D. Craig, “Facial activity as a measure of neonatal pain expression,” in Advances in Pain Research and Therapy, D. C. Tyler and E. J. Krane, Eds., vol. 15, pp. 147–155, Raven Press, New York, NY, USA, 1990. View at Google Scholar
  18. R. E. Grunau, T. Oberlander, L. Holsti, and M. F. Whitfield, “Bedside application of the neonatal facial coding system in pain assessment of premature neonates,” Pain, vol. 76, no. 3, pp. 277–286, 1998. View at Publisher · View at Google Scholar · View at Scopus
  19. S. A. Kohut and R. P. Riddell, “Does the neonatal facial coding system differentiate between infants experiencing pain-related and non-pain-related distress?” Journal of Pain, vol. 10, no. 2, pp. 214–220, 2009. View at Publisher · View at Google Scholar · View at Scopus
  20. J. Lawrence, D. Alcock, P. McGrath, J. Kay, S. B. MacMurray, and C. Dulberg, “The development of a tool to assess neonatal pain,” Neonatal Network, vol. 12, no. 6, pp. 59–66, 1993. View at Google Scholar · View at Scopus
  21. M. Ballantyne, B. Stevens, M. McAllister, K. Dionne, and A. Jack, “Validation of the premature infant pain profile in the clinical setting,” The Clinical Journal of Pain, vol. 15, no. 4, pp. 297–303, 1999. View at Publisher · View at Google Scholar · View at Scopus
  22. R. J. Moore and J. A. Paice, Behavioural Approaches to Pain, Springer, New York, NY, USA, 2009.
  23. C. E. Izard, The Maximally Discriminative Facial Movement Coding System, Academic Computing Services and University Media Services, University of Delaware, Newark, Canada, Revised edition, 1983.
  24. A. J. Fridlund, Human Facial Expression: An Evolutionary View, Academic Press, San Diego, Calif, USA, 1994.
  25. J. A. Russell, “Is there universal recognition of emotion from facial expression? A review of the cross-cultural studies,” Psychological Bulletin, vol. 115, no. 1, pp. 102–141, 1994. View at Google Scholar · View at Scopus
  26. D. O'Rourke, “The measurement of pain in infants, children, and adolescents: from policy to practice,” Physical Therapy, vol. 84, no. 6, pp. 560–570, 2004. View at Google Scholar · View at Scopus
  27. J. E. Beyer and N. Wells, “The assessment of pain in children,” Pediatric Clinics of North America, vol. 36, no. 4, pp. 837–854, 1989. View at Google Scholar · View at Scopus
  28. P. J. McGrath, G. Johnston, and J. T. Goodman, “CHEOPS: a behavioral scale for rating postoperative pain in children,” in Proceeding of the 4th World Congress on Pain: Advances in Pain Research and Therapy, H. L. Fields, R. Dubner, and F. Cervero, Eds., vol. 9, pp. 395–401, Raven Press, New York, NY, USA, 1985.
  29. S. I. Merkel, T. Voepel-Lewis, J. R. Shayevitz, and S. Malviya, “The FLACC: a behavioral scale for scoring postoperative pain in young children,” Pediatric Nursing, vol. 23, no. 3, pp. 293–297, 1997. View at Google Scholar · View at Scopus
  30. S. Merkel, T. Voepel-Lewis, and S. Malviya, “Pain assessment in infants and young children: the FLACC scalex,” American Journal of Nursing, vol. 102, no. 10, pp. 55–68, 2002. View at Google Scholar · View at Scopus
  31. B. Ambuel, K. W. Hamlett, C. M. Marx, and J. L. Blumer, “Assessing distress in pediatric intensive care environments: the COMFORT scale,” Journal of Pediatric Psychology, vol. 17, no. 1, pp. 95–109, 1992. View at Google Scholar · View at Scopus
  32. J. M. Wielenga, R. De Vos, R. de Leeuw, and R. J. De Haan, “COMFORT scale: a reliable and valid method to measure the amount of stress of ventilated preterm infants,” Neonatal Network, vol. 23, no. 2, pp. 39–44, 2004. View at Google Scholar · View at Scopus
  33. S. W. Powers, “Empirically supported treatments in pediatric psychology: procedure- related pain,” Journal of Pediatric Psychology, vol. 24, no. 2, pp. 131–145, 1999. View at Publisher · View at Google Scholar · View at Scopus
  34. C. H. Elliot, S. M. Jay, and P. Woody, “An observational scale for measuring children's distress during medical procedures,” Journal of Pediatric Psychology, vol. 12, no. 4, pp. 543–551, 1987. View at Google Scholar
  35. C. L. Tucker, K. J. Slifer, and L. M. Dahlquist, “Reliability and validity of the brief behavioral distress scale: a measure of children's distress during invasive medical procedures,” Journal of Pediatric Psychology, vol. 26, no. 8, pp. 513–523, 2001. View at Publisher · View at Google Scholar · View at Scopus
  36. R. L. Blount, J. W. Sturges, and S. W. Powers, “Analysis of child and adult behavioral variations by phase of medical procedure,” Behavior Therapy, vol. 21, no. 1, pp. 33–48, 1990. View at Google Scholar · View at Scopus
  37. K. Hesselgard, S. Larsson, B. Romner, L.-G. Strömblad, and P. Reinstrup, “Validity and reliability of the behavioural observational pain scale for postoperative pain measurement in children 1–7 years of age,” Pediatric Critical Care Medicine, vol. 8, no. 2, pp. 102–108, 2007. View at Publisher · View at Google Scholar · View at Scopus
  38. W. J. C. Boelen-van der Loo, E. Scheffer, R. J. De Haan, and C. J. De Groot, “Clinimetric evaluation of the pain observation scale for young children in children aged between 1 and 4 years after ear, nose, and throat surgery,” Journal of Developmental and Behavioral Pediatrics, vol. 20, no. 4, pp. 222–227, 1999. View at Google Scholar · View at Scopus
  39. A. E. E. De Jong, M. Bremer, M. Schouten, W. E. Tuinebreijer, and A. W. Faber, “Reliability and validity of the pain observation scale for young children and the visual analogue scale in children with burns,” Burns, vol. 31, no. 2, pp. 198–204, 2005. View at Publisher · View at Google Scholar · View at Scopus
  40. S. E. Tarbell, I. T. Cohen, and J. L. Marsh, “The toddler-preschooler postoperative pain scale: an observational scale for measuring postoperative pain in children aged 1–5. Preliminary report,” Pain, vol. 50, no. 3, pp. 273–280, 1992. View at Publisher · View at Google Scholar · View at Scopus
  41. S. E. Tarbell, J. L. March, and I. T. C. Cohen, “Reliability and validity of the pain assessment scale for measuring postoperative pain in young children,” Journal of Pain and Symptom Management, vol. 6, p. 196, 1991. View at Google Scholar
  42. S. Suraseranivongse, U. Santawat, K. Kraiprasit, S. Petcharatana, S. Prakkamodom, and N. Muntraporn, “Cross-validation of a composite pain scale for preschool children within 24 hours of surgery,” British Journal of Anaesthesia, vol. 87, no. 3, pp. 400–405, 2001. View at Publisher · View at Google Scholar · View at Scopus
  43. B. Goodenough, L. Addicoat, and G. D. Champion, “Pain in 4–6 year old children receiving muscular injections: a comparesion of the faces pain scale with other self report and behavioural measures,” The Clinical Journal of Pain, vol. 13, pp. 60–73, 1997. View at Google Scholar
  44. T. St-Laurent-Gagnon, A. C. Bernard-Bonnin, and E. Villeneuve, “Pain evaluation in preschool children and their parents,” Acta Paediatrica, vol. 88, no. 4, pp. 422–427, 1999. View at Publisher · View at Google Scholar · View at Scopus
  45. C. L. Hicks, C. L. Von Baeyer, P. A. Spafford, I. Van Korlaar, and B. Goodenough, “The faces pain scale revised: toward a common metric in pediatric pain measure,” Pain, vol. 93, no. 2, pp. 173–183, 2001. View at Publisher · View at Google Scholar · View at Scopus
  46. C. T. Chambers, K. L. Cassidy, and P. J. McGrath, Child Facial Coding System: A Manual, Dalhousie University, Halifax, Canada; University of British Columbia, Vancouver, Canada, 1996.
  47. C. A. Gilbert, C. M. Lilley, K. D. Craig et al., “Postoperative pain expression in preschool children: validation of the child facial coding system,” The Clinical Journal of Pain, vol. 15, no. 3, pp. 192–200, 1999. View at Publisher · View at Google Scholar · View at Scopus
  48. N. K. Hester, “The preoperational child's reaction to immunization,” Nursing Research, vol. 28, no. 4, pp. 250–255, 1979. View at Google Scholar · View at Scopus
  49. N. O. Hester, R. L. Foster, and K. Kristensen, “Measurement of pain in children: generalizability and validity of the pain ladder and poker chip tool,” in Advances in Pain Research and Therapy, Volume 15: Pediatric Plan, D. C. Tyler and E. J. Krane, Eds., pp. 79–84, Raven Press, New York, NY, USA, 1990. View at Google Scholar
  50. N. O. Hester and R. L. Foster, “Scrutiny of the protocol for administration of the poker chip tool: phase I. Research study partially funded by RR03503,” National Institutes of Health, 1991-1992.
  51. D. L. Wong and C. M. Baker, “Pain in children: comparison of assessment scales,” Pediatric Nursing, vol. 14, no. 1, pp. 9–17, 1988. View at Google Scholar · View at Scopus
  52. C. T. Chambers and K. D. Craig, “An intrusive impact of anchors in children's faces pain scales,” Pain, vol. 78, no. 1, pp. 27–37, 1998. View at Publisher · View at Google Scholar · View at Scopus
  53. “The Oucher!TM A user's manual and technical report,” January 2010, http://www.oucher.org/index.html.
  54. J. E. Beyer and C. R. Aradine, “Content validity of an instrument to measure young children's perceptions of the intensity of their pain,” Journal of Pediatric Nursing, vol. 1, no. 6, pp. 386–395, 1986. View at Google Scholar · View at Scopus
  55. C. R. Aradine, J. E. Beyer, and J. M. Tompkins, “Children's pain perception before and after analgesia: a study of instrument construct validity and related issues,” Journal of Pediatric Nursing, vol. 3, no. 1, pp. 11–23, 1988. View at Google Scholar
  56. J. E. Beyer, M. J. Denyes, and A. M. Villarruel, “The creation, validation, and continuing development of the oucher: a measure of pain intensity in children,” Journal of Pediatric Nursing, vol. 7, no. 5, pp. 335–346, 1992. View at Google Scholar · View at Scopus
  57. P. A. McGrath and J. Gillsepie, “Pain assessment in children and adolescents,” in Handbook of Pain Assessment, D. C. Turk and R. Melzack, Eds., pp. 97–118, Gilford Press, New York, NY, USA, 2nd edition, 2001. View at Google Scholar
  58. J. W. Varni, K. L. Thompson, and V. Hanson, “The Varni/Thompson pediatric pain questionnaire. I. Chronic musculoskeletal pain in juvenile rheumatoid arthritis,” Pain, vol. 28, no. 1, pp. 27–38, 1987. View at Google Scholar · View at Scopus
  59. M. C. Savedra, M. D. Tesler, W. L. Holzemer, and J. A. Ward, Adolescent Pediatric Pain Tool (APPT): Preliminary User's Manual, University of California, San Francisco, Calif, USA, 1989.
  60. M. E. Wewers and N. K. Lowe, “A critical review of visual analogue scales in the measurement of clinical phenomena,” Research in Nursing & Health, vol. 13, no. 4, pp. 227–236, 1990. View at Google Scholar · View at Scopus
  61. D. Brinmaumer, “Colour analogue scale, a reliable measure of pain in children,” Journal of Academic Emergency Medicine, vol. 16, p. 465, 2009. View at Google Scholar
  62. M. A. Rapoff, “Pediatric measures of pain: the pain behavior observation method, pain coping questionnaire, and pediatric pain questionnaire,” Arthritis Care and Research, vol. 49, no. S5, pp. S90–S95, 2003. View at Google Scholar
  63. M. Crandall and M. Savedra, “Multidimensional assessment using the adolescent pediatric pain tool: a case report,” Journal for Specialists in Pediatric Nursing, vol. 10, no. 3, pp. 115–123, 2005. View at Google Scholar · View at Scopus
  64. M. C. Savedra, M. D. Tesler, W. L. Holzemer, D. J. Wilkie, and J. A. Ward, “Pain location: validity and reliability of body outline markings by hospitalized children and adolescents,” Research in Nursing & Health, vol. 12, no. 5, pp. 307–314, 1989. View at Google Scholar · View at Scopus
  65. M. C. Savedra, M. D. Tesler, W. L. Holzemer, D. J. Wilkie, and J. A. Ward, “Testing a tool to assess postoperative pediatric and adolescent pain,” in Advances in Pain Research and Therapy, Volume 15: Pediatric Pain, D. C. Tyler and E. J. Krane, Eds., pp. 85–94, Raven, New York, NY, USA, 1990. View at Google Scholar
  66. M. C. Savedra, W. L. Holzemer, M. D. Tesler, and D. J. Wilkie, “Assessment of postoperation pain in children and adolescents using the adolescent pediatric pain tool,” Nursing Research, vol. 42, no. 1, pp. 5–9, 1993. View at Google Scholar · View at Scopus
  67. R. Melzack and W. S. Torgerson, “On the language of pain,” Anesthesiology, vol. 34, no. 1, pp. 50–59, 1971. View at Google Scholar · View at Scopus
  68. R. Melzack, “The McGill pain questionnaire: major properties and scoring methods,” Pain, vol. 1, no. 3, pp. 277–299, 1975. View at Publisher · View at Google Scholar · View at Scopus
  69. R. Melzack, “The short-form McGill pain questionnaire,” Pain, vol. 30, no. 2, pp. 191–197, 1987. View at Google Scholar · View at Scopus
  70. Royal Australasian college of physicians, “Management of procedure related pain in children and adolescents. Guideline statement: paediatric and health division,” Journal of Paediatric and Child Health, vol. 42, pp. 51–529, 2006. View at Google Scholar
  71. J. A. Vessey, K. L. Carlson, and J. McGill, “Use of distraction with children during an acute pain experience,” Nursing Research, vol. 43, no. 6, pp. 369–372, 1994. View at Google Scholar · View at Scopus
  72. D. DeLoach Walworth, “Procedural-support music therapy in the healthcare setting: a cost-effectiveness analysis,” Journal of Pediatric Nursing, vol. 20, no. 4, pp. 276–284, 2005. View at Publisher · View at Google Scholar · View at Scopus
  73. L. L. Cohen, R. L. Blount, R. J. Cohen, E. R. Schaen, and J. F. Zaff, “Comparative study of distraction versus topical anesthesia for pediatric pain management during immunizations,” Health Psychology, vol. 18, no. 6, pp. 591–598, 1999. View at Publisher · View at Google Scholar · View at Scopus
  74. R. Goldman, D. Koller, T. Wan, S. Bever, and S. Stuart, “Passive versus active distraction for intravenous catheterization in the emergency department,” in Paediatric Research in Emergency Therapeutics (PRETx), Toronto, Canada, 2008, CPS Abstracts. View at Google Scholar
  75. D. Barlow and V. Durand, Abnormal Psychology: An Integrative Approach, Wadsworth Publishing, Pacific Grove, Calif, USA, 2nd edition, 1999.
  76. L. S. Uman, C. T. Chambers, P. J. McGrath, and S. Kisely, “Psychological interventions for needle-related procedural pain and distress in children and adolescents,” Cochrane Database of Systematic Reviews, no. 4, Article ID CD005179, 2006. View at Google Scholar · View at Scopus
  77. L. L. Cohen, R. L. Blount, and G. Panopoulos, “Nurse coaching and cartoon distraction: an effective and practical intervention to reduce child, parent, and nurse distress during immunizations,” Journal of Pediatric Psychology, vol. 22, no. 3, pp. 355–370, 1997. View at Publisher · View at Google Scholar · View at Scopus
  78. A. Harrison, “Preparing children for venous blood sampling,” Pain, vol. 45, no. 3, pp. 299–306, 1991. View at Publisher · View at Google Scholar · View at Scopus
  79. J. H. Tak and W. H. J. van Bon, “Pain- and distress-reducing interventions for venepuncture in children,” Child: Care, Health & Development, vol. 32, no. 3, pp. 257–268, 2006. View at Publisher · View at Google Scholar · View at Scopus
  80. R. L. Blount, P. J. Bachanas, S. W. Powers et al., “Training children to cope and parents to coach them during routine immunizations: effects on child, parent, and staff behaviors,” Behavior Therapy, vol. 23, no. 4, pp. 689–705, 1992. View at Publisher · View at Google Scholar · View at Scopus
  81. S. Sander Wint, D. Eshelman, J. Steele, and C. E. Guzzetta, “Effects of distraction using virtual reality glasses during lumbar punctures in adolescents with cancer,” Oncology Nursing Forum, vol. 29, no. 1, pp. E8–E15, 2002. View at Google Scholar · View at Scopus
  82. G. M. French, E. C. Painter, and D. L. Coury, “Blowing away shot pain: a technique for pain management during immunization,” Pediatrics, vol. 93, no. 3, pp. 384–388, 1994. View at Google Scholar · View at Scopus
  83. M. A. Zabin, The modification of children's behavior during blood work procedures, Doctoral dissertation, West Virginia University, 1982.
  84. K. Posner, A pharmacological behavioral intervention to reduce child cancer distress, Doctoral dissertation, Ferkauf Graduate School of Psychology, Yeshiva University, 1998.
  85. C. C. Johnston and B. J. Stevens, “Experience in a neonatal intensive care unit affects pain response,” Pediatrics, vol. 98, no. 5, pp. 925–930, 1996. View at Google Scholar · View at Scopus
  86. B. Stevens, P. Petryshen, J. Hawkins, B. Smith, and P. Taylor, “Developmental versus conventional care: a comparison of clinical outcomes for very low birth weight infants,” Canadian Journal of Nursing Research, vol. 28, no. 4, pp. 97–113, 1996. View at Google Scholar · View at Scopus
  87. L. L. Cohen, “Reducing infant immunization distress through distraction,” Health Psychology, vol. 21, no. 2, pp. 207–211, 2002. View at Publisher · View at Google Scholar · View at Scopus
  88. L. K. Bo and P. Callaghan, “Soothing pain-elicited distress in Chinese neonates,” Pediatrics, vol. 105, no. 4, p. E49, 2000. View at Google Scholar · View at Scopus
  89. L. Hartling, M. S. Shaik, L. Tjosvold, R. Leicht, Y. Liang, and M. Kumar, “Music for medical indications in the neonatal period: a systematic review of randomised controlled trials,” Archives of Disease in Childhood: Fetal and Neonatal Edition, vol. 94, no. 5, pp. F349–F354, 2009. View at Publisher · View at Google Scholar · View at Scopus
  90. R. Pillai Riddell, A. Gerwitz, L. Uman, and B. Stevens, “Nonpharmacological interventions for needle-related procedural pain and post-operative pain in neonates and infants,” Cochrane Database of Systematic Reviews, no. 4, Article ID CD006275, 2006. View at Publisher · View at Google Scholar · View at Scopus
  91. I. Fearon, B. S. Kisilevsky, S. M. J. Hains, D. W. Muir, and J. Tranmer, “Swaddling after heel lance: age-specific effects on behavioral recovery in preterm infants,” Journal of Developmental and Behavioral Pediatrics, vol. 18, no. 4, pp. 222–232, 1997. View at Google Scholar · View at Scopus
  92. B. Stevens, C. Johnston, L. Franck, P. Petryshen, A. Jack, and G. Foster, “The efficacy of developmentally sensitive interventions and sucrose for relieving procedural pain in very low birth weight neonates,” Nursing Research, vol. 48, no. 1, pp. 35–43, 1999. View at Google Scholar · View at Scopus
  93. B. Stevens, C. Johnston, L. Franck, P. Petryshen, A. Jack, and G. Foster, “The efficacy of developmentally sensitive interventions and sucrose for relieving procedural pain in very low birth weight neonates,” Nursing Research, vol. 48, no. 1, pp. 35–43, 1999. View at Google Scholar · View at Scopus
  94. C. C. Johnston, B. Stevens, J. Pinelli et al., “Kangaroo care is effective in diminishing pain response in preterm neonates,” Archives of Pediatrics and Adolescent Medicine, vol. 157, no. 11, pp. 1084–1088, 2003. View at Publisher · View at Google Scholar · View at Scopus
  95. R. G. Campos, “Rocking and pacifiers: two comforting interventions for heelstick pain,” Research in Nursing & Health, vol. 17, no. 5, pp. 321–331, 1994. View at Google Scholar · View at Scopus