In this section
Definition of Terms
Oral sucrose is safe and effective for
reducing procedural pain from a single event. Oral sucrose is a mild analgesic
which is effective in decreasing short-term pain and distress during minor
procedures. Small amounts of sweet solutions (oral sucrose) are placed on the
infant's tongue to reduce procedural pain. The mechanism is an orally mediated
increase in endogenous opioid. The
analgesic effect lasts 5-8 minutes making it an ideal strategy for the
management of short term pain. There is no analgesic effect if sucrose is given
directly into the stomach via a nasogastric tube. Oral sucrose is more effective if given
with a dummy as this promotes Non-Nutritional Sucking (NNS) which contributes
to calming. There is no evidence to show that oral sucrose used for
procedural pain management (PPM) affects future teeth development or that it
has any long-term adverse effects. However, dose recommendations and maximum
volumes should be strictly adhered to. The sweetness of breast milk has proven
to be as effective as a pain relieving strategy. Breast milk and Breastfeeding
(providing comfort, diversion and maternal contact) should be used where
available to relieve procedural pain. The application of supportive measures
such as; kangaroo care, facilitated tucking, swaddling, warmth, NNS and
distraction (in older infants), should occur prior to oral sucrose
administration. While oral sucrose is most effective in the neonatal
population, benefits are demonstrated in older infants with an increased dose. The
evidence and efficacy of using oral sucrose in the term neonate to 12 months of
age has been demonstrated. Patient groups such as neonates < 32 weeks and
infants > 12 months require further investigation. Evidence suggests that
oral sucrose given to Infants > 12 months may continue provide some analgesia
and a calming effect. Oral sucrose is recommended at RCH to infants up to 18
months of age, supporting PPM for older infants.
This guideline provides information for the safe and effective
administration of oral sucrose to neonates and infants, prior to painful
sucrose administration is clinically indicated for the reduction of procedural
pain and distress in infants 0-18 months at RCH. Supporting optimal procedural
pain management oral sucrose is to be administered with the supportive
interventions outlined in this guideline. Staff administering oral sucrose must
follow the recommendations for patient groups, identify risk and
Oral sucrose is a mild analgesic and
should only be used clinically for the reduction of pain during minor
procedures. Oral sucrose is most effective for preterm and term neonates (less
than 28 days old). It has also been reported to have some analgesic and calming
effects up to 18 months of life. Assessment of the effectiveness of oral
sucrose using an appropriate RCH pain assessment tool is also recommended. RCH Clinical Practice Guideline: neonatal pain assessment.
which are known to cause pain and/ or distress in infants may include:
Oral sucrose may be considered as an
adjunct to strong analgesic and topical local anaesthetic during invasive or
distressing procedures such as chest drain insertion, laser therapy, ROP
examination and circumcision.
sucrose is not appropriate for the management of continuing pain or distress.
It may be used as a bridge for infants in distress to be examined and to assess
the cause of inconsolability. However, support measures should precede oral sucrose
All Nursing, Medical, Allied Health Staff, Technicians and
Pathologists may give oral sucrose. If the infant is an inpatient discuss with
the bedside nurse if the procedure is necessary, if oral sucrose is appropriate
and who will observe and support the infant. Consultation in areas such as NICU
and PICU is essential due to the population of premature and critically ill
*10ml of 33% oral sucrose equates to 66ml of 5% glucose
solution. 5% Glucose is the standard oral rehydration solution at RCH. An
infant routinely drinks 70-180ml of this concentration for a feed.
are based on an inpatient infant requiring no more than five painful procedures
/ day, unless critically ill and receiving appropriate strong analgesia. There
is no evidence to provide the exact dose or the maximum amount to be given in a
24 hour period. Research supports small volumes, dose to effect and repeat
only as required.
an infant requires more than the recommended
maximum in 24 hours discuss with the nursing and medical team re:
additional oral sucrose or alternative pain management options.
dosing requires application of oral sucrose to the
infants tongue using a mouth swab.
As the oral sucrose effects are short term
(5-8 minutes) procedural pain management requires additional supportive
sucrose administration requires documentation to prevent exceeding the maximum
recommended dose in 24 hours. The following
staff: Nursing, Medical, Allied Health, Technicians and Pathologists may sign
for sucrose at RCH.
Documentation of pain scores prior to and following administration of oral
sucrose is recommended to evaluate effectiveness.
documentation - Record in a log book or in the
notes (Patient name, DOB, procedure and amount of oral sucrose given)
documentation - Record in the as required PRN
section of the Medication chart.
oral sucrose percentage (TootSweetTM 24% or RCH supplied 33%),
patient group e.g. 0-1 month, dose, maximum in 24 hours and the indication.
the order with any change in patient age or NBM status
There is no evidence to suggest that
oral sucrose from a sealed bottle, stored in a temperature regulated refrigerator
leads to bacterial growth. The oral sucrose dose should be administered as
recommended and the syringe discarded immediately. For areas without
refrigeration order TootSweetTM
bottled oral sucrose is obtained from the RCH pharmacy and stored in the refrigerator (which must
be temperature regulated and monitored). RCH oral sucrose has a one month
sucrose at RCH - TootSweetTM is stored at room temperature and
expires after 2 years. To order pre-packaged sucrose TootSweetTM send a
Purchase Requisition Form to Material Resources with the item number
1040027-100, Supplier name: JLM Acute Health Care. (100 vials per box).
Sucrose (oral) for procedural pain management in neonates and infants evidence table.
Please remember to read the disclaimer
The development of this clinical guideline was revised by Kate Austin, Clinical Nurse Consultant, Comfort Kids Program. Approved by the Clinical Effectiveness Committee. Authorised by Bernadette Twomey, Executive Director Nursing Services. Revised November 2015.