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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 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. Oral sucrose administration is clinically indicated for the reduction of procedural pain and distress in infants 0-18 months at RCH.
To provide information for the safe and effective administration of oral sucrose to neonates and infants, prior to painful procedures. Supporting optimal procedural pain management, oral sucrose is to be administered with supportive interventions outlined in this guideline. Staff administering oral sucrose must follow the recommendations for patient groups, identify risks and complications.
Oral sucrose is a mild analgesic and should only be used clinically for the reduction of pain during minor procedures. 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.
Oral sucrose is most effective for preterm and term neonates (less than 28 days old). 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.
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.
Procedures 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.
Oral 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 administration.
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 infants.
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.
sweet to babies video
As the oral sucrose effects are short term (5-8 minutes) procedural pain management requires additional supportive measures:
Oral 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 order sucrose at RCH. Documentation of pain scores prior to and following administration of oral sucrose is recommended to evaluate effectiveness.
Storage and Availability
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
Sucrose (oral) for procedural pain management in neonates and infants evidence table.
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The development of this nursing guideline was coordinated by Alison Kendrick, Clinical Nurse Educator, Butterfly Ward, and approved by the Nursing Clinical Effectiveness Committee. Updated July 2018.