Australasian Emergency Nursing Journal (2008) 11, 72—79

available at www.sciencedirect.com

journal homepage: www.elsevier.com/locate/aenj

CLINICAL PRACTICE UPDATE — PAEDIATRICS

Oral sucrose for pain management in the paediatric

emergency department; a review
Denise Margaret Harrison, RN, RM, PhD a,b,∗

a
School of Nursing, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Level 1, 723 Swanston
Street, Carlton Vic. 3053, Australia
b
Department of Neonatology, Royal Children’s Hospital, Flemington Road, Parkville Vic. 3052, Australia

Received 21 January 2008; accepted 5 February 2008

KEYWORDS Summary Provision of effective analgesia for infants and children is important during painful
Sucrose; procedures performed in emergency departments. Although small volumes of sweet-tasting
Pain; solutions have been extensively shown to be analgesic during minor painful procedures in new-
Analgesia; born infants, there have been fewer studies of sucrose use in infants beyond the neonatal period,
Infant; and in children. This review of sucrose effectiveness in infants beyond the neonatal period high-
Emergency service; lights that sucrose continues to provide some analgesia, resulting in procedural pain reduction,
Hospital 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.
© 2008 College of Emergency Nursing Australasia Ltd. Published by Elsevier Ltd.
All rights reserved.

Painful procedures are commonly performed in paediatric
emergency departments (ED). A recent study reported that
18% of paediatric patients experienced one or more painful
procedures during their ED visit, with 21% of these patients
being infants younger than 12 months of age.1 Effective
pain management during painful procedures in paediatric
∗ Correspondence address: Nursing and Social Work, The Univer-
sity of Melbourne, Level 5, 234 Queensberry St., Carlton, Victoria
3053, Australia. Tel.: +61 3 9345 5000/8344 0800;
fax: +61 3 9345 5067/9347 4172.
E-mail address: denise.harrison@rch.org.au.
patients is recognised as vital, yet pain management in pae-
diatric patients presenting to the ED has been reported as
less than optimal.1—3 For example, Maclean et al. reported
that, during venepuncture, the most frequently performed
painful procedure in a paediatric ED, pain relief was used in
less than 1% of procedures.1 Infants younger than 4 months
of age were least likely to have pain management docu-
mented during their ED presentation.
Oral sucrose has been shown in a large number of studies
to be an effective analgesic during minor painful proce-
dures in neonates,4 and is now widely recommended by
national and international bodies concerned with neonatal
pain management.5—8 As the large majority of the evi-

1574-6267/$ — see front matter © 2008 College of Emergency Nursing Australasia Ltd. Published by Elsevier Ltd.All rights reserved.
doi:10.1016/j.aenj.2008.02.004
Oral sucrose for pain management
dence has arisen from trials including neonates only, the
use of sucrose in settings outside the neonatal intensive
care unit (NICU), such as paediatric ED settings, has not
been widely practiced. The aim of this paper is therefore
to review sucrose efficacy beyond the neonatal period to
enable informed recommendations regarding sucrose use
during minor painful procedures in the paediatric population
presenting to the ED to be made.
Historical perspective
It has been almost 20 years since the first study demon-
strating 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 addi-
tion, Blass and colleagues were the first to publish results
of blinded, randomised, controlled trials demonstrating the
efficacy of small volumes of sucrose in the reduction of
procedure-related pain. In a trial including 24 healthy new-
born infants, infants randomised to receive 2.0 mL of a 12%
sucrose solution, cried for a significantly shorter time dur-
ing heel lancing compared to infants in the control group
who received water.10 Analgesic effects of oral sucrose in
infants undergoing circumcision were also demonstrated,
with infants randomised to receive 24% sucrose on a paci-
fier crying significantly less throughout the procedure than
infants sucking on a pacifier with water.10 The underlying
mechanism is considered to be an orally mediated release
of endogenous opioids,11 with sweeter sugars of sucrose and
fructose being more effective than the less sweet sugars
of glucose and lactose. Calming effects are reported to be
independent of volume, with small volumes of 0.2 mL being
equally as effective as larger volumes of 0.6 and 1.0 mL.12
The analgesic effects are sweet taste-mediated, as demon-
strated by the lack of effect if sucrose is given directly into
the stomach via a nasogastric tube.13
Since these early studies, over 45 trials have been pub-
lished confirming the analgesic efficacy of oral sucrose or
other sweet tasting solutions in infants, 21 of which are
included in a systematic review of sucrose for analgesia in
newborn infants undergoing painful procedures.4 The major-
ity of sucrose studies have been conducted during the first 28
days of life, and mostly during the procedures of heel lancing
and venepuncture. The evidence from these studies have,
however, been extrapolated to include other painful proce-
dures, with pain management guidelines from the Melbourne
Royal Children’s Hospital, and national and international
organisations recommending oral sucrose for procedures
such as eye examination, arterial line insertion, intramuscu-
lar or subcutaneous injections, and lumbar puncture.6,7,14—17
Sucrose analgesia beyond the newborn period
Studies of sucrose-induced analgesia beyond the neona-
tal period have primarily been conducted during scheduled
childhood immunisation in infants ranging from 2 to 18
months of age.18—23 The majority of these studies were ran-
domised, controlled trials evaluating the efficacy of either
oral sucrose or glucose during a single episode of routine vac-
73
cination, which may have included either a single injection,
or multiple injections. Two studies however, were longitu-
dinal randomised, controlled trials, in a cohort of infants
receiving routine vaccinations at two and three time points,
respectively.20,23 Results of all immunisation studies were
that the sweet tasting solutions of sucrose or glucose were
effective in reducing pain, based on the various pain mea-
surement outcomes utilised, however in most studies the
effects were more moderate than reported for infants dur-
ing the neonatal period.4 In addition, two studies used
higher volumes or concentrations of sucrose compared to
the doses used in most studies involving newborn infants.
For example, in a trial which included 107 healthy infants
aged 2, 4 or 6 months, conducted in an immunisation clinic
in a Children’s Hospital in Australia, infants in the treat-
ment group received 2.0 mL of a concentrated 75% sucrose
solution.19 The authors reported that this high concentra-
tion of sucrose solution was chosen following a pilot study
where 50% sucrose resulted in no clinically observable pain
reduction. In another study, including infants aged 2 months
undergoing routine immunisation comprising four injections,
10 mL of a 25% sucrose solution was administered.22 This
volume of sucrose far exceeds the small volumes of 2.0 mL
or less administered in other studies, and far exceeds the
sucrose volume recommended for effective pain manage-
ment in newborn infants.4
A combination of strategies rather than oral sucrose alone
has also been used in some studies; consequently any anal-
gesic effects demonstrated cannot necessarily be attributed
to sucrose alone. For example, a combination of oral glucose
and topical anaesthetic cream was compared to oral water
and topical placebo cream in one study,21 and in another,
the intervention group were encouraged to suck on a paci-
fier or a bottle to elicit non-nutritive sucking (NNS) following
sucrose administration, and in addition, were held by their
parent during the injections.22 In contrast, the control group
of infants were vaccinated whilst lying on the examination
table, with no specific comfort measures provided during
the procedure.
There have been four other randomised, controlled tri-
als of sucrose analgesia, which have included infants beyond
the neonatal period, two of which were conducted in an
ED.24,25 The painful procedures studied were: urethral blad-
der catheterisation,25 venepuncture,24 heel lancing,26,27 and
repeated subcutaneous injections over a six week period.28
The study of sucrose analgesia in infants undergoing ure-
thral bladder catheterisation in an ED included infants up
to 90 days of age.25 Results showed that 2.0 mL of 24%
sucrose, given 2 min before commencement of the proce-
dure, failed to reduce behavioural signs of pain. Effective
sucrose analgesia was, in fact, evident only in a subgroup of
infants aged less than 30 days, whilst for the infants older
than 30 days of age, sucrose was reported to be no more
effective than water. Similarly, the second study undertaken
in an ED also showed reduced efficacy of oral sucrose in
infants beyond the neonatal period.24 The painful proce-
dure observed in this study was venepuncture, and included
infants ranging in age from newborn to 6 months. Infants
were randomised to one of four groups; 44% sucrose with
or without a pacifier, or water with and without a paci-
fier. Results showed that sucrose combined with a pacifier
resulted in the shortest duration of crying, but only in the
 74
Table 1 Randomised, controlled trials of sucrose or glucose analgesia in infants beyond the neonatal period
Study Participants Procedure Interventions Outcomes Results
Barr (1995)20 57 healthy term infants. Age: Immunisation (single 2 groups: Cry duration Sucrose group: reduction in crying
2 and 4 months injection) 3 doses at 30 s intervals: time in the post injection period at
0.25 mL 50% sucrose or both 2 and 4 months. No differences
0.25 mL water 2 min prior to in cry duration during injection
immunisation Longitudinal study: Infants remained
in same group for both time periods

Allen (1996)18 285 healthy term infants. Age:
2 weeks to 18 months
Immunisation (1, 2 or 3
injections)
3 groups: Cry duration Sucrose no more effective than sterile
2.0 mL 12% sucrose or water but more effective than no
2.0 mL water 2 min prior to intervention during a single injection.
immunisation or No differences in groups for multiple
nil injections
12% sucrose considered not sweet
enough for effective analgesia

Lewindon (1998)19 107 healthy infants (2 infants
born at 34 weeks). Age: 2, 4
and 6 months
Immunisation (2 injections)
2 groups:
2.0 mL 75% sucrose or
2.0 mL water 2 min prior to
immunisation
Cry duration Sucrose group: Reduction in cry
Oucher score34 duration and Oucher score. No
Visual analogue scale (VAS) from 0 to reduction in parental VAS
100, scored by parent 75% sucrose chosen, due to nil
observable effects of 50% sucrose
used in pilot study

Reis (2003)22 116 healthy term infants. Age: Immunisation (4 injections) 2 groups:
2 months Combination of: 10 mL 25%
sucrose, 2 min prior to
injections + NNS + parental
holding or
Standard care
Cry duration
Heart rate
Vaccination duration
Parental preference for future pain
management (VAS 0—100)
Nurses’ score; ease of administration
(VAS 0—100)
Combination of sucrose, NNS and
holding resulted in significant
reduction in cry duration
Combination of sucrose, NNS and
holding resulted in parents reporting
significantly higher preference for
pain management compared to
parents in standard care group
No difference in heart rate response
No difference in vaccination time or
ease of administration of vaccination

D.M. Harrison

Table 1 (Continued )
Study Participants
Lindh (2003)21 70 healthy term infants. Age:
3 months
Harrison (2003)26,27 128 sick infants in a NICU (NB;
30 infants beyond neonatal
period)
Mucignat (2004)28 33 premature infants (<33/40)
Rogers (2006)25 80 infants presenting to ED.
Age: newborn to 90 days
Procedure Interventions
Immunisation (1 injection) 2 groups:
1.0 mL 30% glucose, 2 min
prior to injection and EMLA®
or
1.0 mL water 2 min prior to
injection and topical placebo
Heel lance 2 groups:
1.0 mL 33% sucrose or
1.0 mL water, 2 min prior to
procedure
Multiple subcutaneous 4 groups:
injections over 6 weeks 0.2-0.5 mL 30% sucrose and
NNS or
NNS alone or
EMLA® and NNS or
Combination of all 3
strategies
Urethral catheterisation 2 groups:
2.0 mL 24% sucrose or
2.0 mL water, 2 min prior to
procedure
Oral sucrose for pain management
Outcomes Results
VAS (0—10) of infant’s pain (parents Combination of glucose and EMLA®
and investigator) resulted in significant reduction in
Heart rate nurse and parent VAS, MBPS, presence
Heart rate variability (HRV) of cry and latency to cry
Presence of crying No difference in total crying time
Cry duration No difference in heart rate or HRV
Modified behavioural pain scale
(MBPS)35
Four point subset of neonatal facial Sucrose group: significant reduction in
coding system (NFCS)36 facial scores immediately upon heel
Presence of cry lance and following completion of
Cry duration procedure. Reduction in presence of
Heart rate cry and duration following completion
Oxygen saturation of procedure
No difference in physiological
outcomes
Douleur Aiguë Nouveau-né (DAN) Sucrose and NNS: more effective than
scale37 (0—10) NNS alone, and NNS and EMLA® in
NFCS38 reducing DAN scores and NFCS
Cry duration Combination of all 3 strategies most
Heart rate effective
Respiratory rate No differences in physiological
Oxygen saturation parameters between groups
DAN scale No difference in any outcome
Presence of cry measures
Time to return to baseline Subgroup analysis: sucrose more
behavioural state effective than placebo in youngest
group of infants (1—30 days of age)
75
76
Sucrose group: significant reduction in
duration in younger infants aged 0—3
Longitudinal study: infants remained
to placebo, and NNS compared to no
No difference in cry intensity at any
Adjusted effects: sucrose compared
in same group for all 3 time periods
immunisation, but not at 3 months
No effect on FLACC or heart rate
cry duration at 5 and 12 months
NNS resulted in reduction in cry
measures between four groups
No difference in any outcome
time point
months
consolability pain scale (FLACC)39
Face, legs, activity, cry and
Cry intensity score
Cry duration
Cry duration
Heart rate
2.0 mL water with and without
NNS, 2 min prior to procedure
2.0 mL 44% sucrose with and
2.0 mL water, 2 min prior to
2.0 mL 30% glucose or
without NNS or
procedure
2 groups:
4 groups:
Immunisation (single
Venepuncture
injection)
110 healthy term infants. Age:
84 term infants. Age: 0—6
3, 5 and 12 months
months
Table 1 (Continued )
Curtis (2007)24
Thyr (2007)23
D.M. Harrison
youngest infants. The differences in crying duration were no
longer statistically significant in infants aged 3—6 months.
Although the authors of both studies acknowledged that the
numbers of infants may have been too small to detect dif-
ferences in outcomes within subgroups of infants,24,25 the
results do contribute to the evidence that oral sucrose may
be less effective in infants beyond the neonatal period. Sim-
ilarly, a blinded, randomised, controlled trial of 1.0 mL 33%
sucrose solution compared to water during heel lancing,
which included 30 infants older than 28 days of life, showed
that sucrose, compared to water, was effective in reduc-
ing pain, however the analgesic effects were reported to be
more modest than that observed in younger infants.26,27 One
factor that may have contributed to these results was that
a single dose of sucrose only was given 2 min prior to the
commencement of the procedures.24—27 Although the 2 min
time period is when the sweet taste-mediated analgesic
effects are reported to peak,29 repeated doses administered
on commencement of the procedure and 2 min throughout
the procedure are recommended for optimising the anal-
gesic effects and providing ongoing analgesia, especially
since many painful procedures last more than 2 min.30
In contrast, results of a longitudinal, randomised, con-
trolled trial comparing sucrose, topical anaesthetic cream,
NNS, or a combination of the four strategies, in premature
infants over a 6-week period during repeated subcutaneous
injections, showed oral sucrose to be more effective than
the other strategies, although the combination of all four
strategies was the most effective.28 Table 1 summarises the
results of ten published, randomised, controlled trials of
sucrose or glucose analgesia, which have included infants
beyond the neonatal period of 28 days of life.
The next question to be asked concerns the analgesic
effects of sweet taste in children. Only three published
studies were identified which evaluated sucrose analgesia
in children during painful procedures. As summarised in
Table 2, these studies were conducted during the following
procedures:
• Arm immersion in cold water (cold pressor test),31
• Scheduled immunisation for Hepatitis B,32
• Venepuncture.32
In the cold pressor test study, 42 children, aged between
8 and 11 years, who had volunteered to participate, were
included.31 The children were tested two days apart, during
two different conditions; whilst holding 20 mL 24% sucrose or
20 mL water in their mouths. Findings were that oral sucrose
resulted in a 35% increase in the time at which the children’s
arm first started to hurt (cold threshold), but did not alter
the time children held their arms in the cold water (cold
tolerance), or the self-report of pain on a visual analogue
scale. In over half of the observations (57%), children kept
their arms in the cold water for the maximum time allowed
(4 min), which occurred more frequently on the second day
of testing and in the younger children. The majority of data
for cold tolerance was therefore unavailable. In addition,
the majority of children failed to record their pain rating
scores at the required time intervals, further limiting the
available data required to confirm findings.
Lewkowski et al. conducted two studies to ascertain if
sweet taste and/or chewing gum resulted in a reduction in
 Oral sucrose for pain management
Table 2 Randomised, controlled trials of sucrose or glucose analgesia in children

Study Participants Procedure Interventions Outcomes Results

31 ◦
Miller (1994) 42 healthy children. Age: Cold pressor test (10 C) 2 conditions: (cross-over Self-report: Sucrose condition: 35%
8—11 years study over 2 days) Tolerance (time arm prolongation in pain threshold
20 mL 24% sucrose or kept in water) Complete VAS only available
20 mL water, held in Threshold (time at for 17 children: no differences
mouth during testing which arm first started in scores between sucrose or
to hurt) water conditions
Insufficient date for tolerance,
as 57% of children kept their
arms in cold water for full
4 min of testing
Lewkowski, (2003)32 Study 1: Venepuncture 4 groups: Self-report: No significant differences
Venepuncture: 99 Sweet chewing gum Pain intensity: colored between groups.
children in paediatric (∼15—30% sucrose) or analogue scale (CAS)
pathology outpatients. Unsweetened chewing 0—10
Age: 7—12 years gum prior to procedure Unpleasantness: faces
only or pain scale (FPS) 1—7
Study 2: Immunisation Sweet or No significant differences
Immunisation: 115 Unsweetened chewing between groups.
children receiving gum continuing
Hepatitis B immunisation throughout procedure
at school. Age: 7—12
years

77
78
pain scores in school-aged children aged 7—12 years. The
children were either undergoing immunisation for Hepati-
tis B in a school setting (N = 115), or venepuncture in a
paediatric pathology outpatients setting (N = 99).32 The chil-
dren were randomised to one of four groups: sweetened
chewing gum (approximating 15—30% sucrose solution) or
unsweetened chewing gum prior to the procedure only, or
sweet or unsweetened chewing gum continuing throughout
the procedures. Results of both studies showed no differ-
ences between the four groups in the children’s self-ratings
of pain, confirming a lack of observable analgesic effect of
sweet taste in children.
In summary, sucrose analgesia beyond the first month
of life, although obviously present throughout infancy, is
less evident than that observed in the neonatal period.
Higher volumes or concentrations may be required to elicit
the same profound sweet taste-mediated analgesic effect
as seen in newborn infants. As some of the evidence is
conflicting, further well-conducted, randomised, controlled
trials including infants beyond the neonatal period are war-
ranted. There is currently minimal evidence of effective
sweet taste-induced analgesia in school-aged children.
Evidence-based recommendations for sucrose use for
neonates presenting to the ED have been made previously.33
However, guidelines for sucrose use for infants beyond the
first 28 days of life presenting to the ED should include the
following points:
• Sucrose is effective for minor painful procedures
• For optimal analgesic effects, small volumes of sucrose
should be administered 2 min prior to the procedure,
immediately upon commencement of the procedure, and
every 2 min whilst the procedure is in progress
• The addition of a pacifier if this is a normal part of the
infants’ care, as well as holding and comforting by a par-
ent or familiar care-giver may give additional comfort and
reduce distress
• Sucrose effectiveness should be carefully evaluated, and
appropriate comfort measures as well as adjunct anal-
gesics with or without appropriate sedatives should be
considered, especially if the infant is distressed or the
procedure is prolonged.
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 appropri-
ate 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 sucrose-induced anal-
gesia beyond the neonatal period, and throughout infancy.
Competing Interests
None declared by author.
D.M. Harrison
Funding Interests
None declared by author.
References
1. MacLean S, Obispo J, Young KD. The gap between pediatric
emergency department procedural pain management treat-
ments available and actual practice. Pediatr Emerg Care
2007;23(2):87—93.
2. Alexander J, Manno M. Underuse of analgesia in very young
pediatric patients with isolated painful injuries. Ann Emerg
Med 2003;41(5):617—22.
3. Petrack EM, Christopher NC, Kriwinsky J. Pain management in
the emergency department: patterns of analgesic utilization.
Pediatrics 1997;99(5):711—4.
4. Stevens B, Yamada J, Ohlsson A. Sucrose for analgesia in new-
born infants undergoing painful procedures (Cochrane Review).
In: The Cochrane library, 3. Chichester, UK: John Wiley & Sons,
Ltd.; 2004.
5. 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;108(3):793—7.
6. Anand KJ. International Evidence-Based Group for Neonatal
Pain. Consensus statement for the prevention and manage-
ment of pain in the newborn. Arch Pediatr Adolesc Med
2001;155(2):173—80.
7. Royal Australasian College of Physicians. Guideline statement:
management of procedure-related pain in neonates. Sydney:
Paediatrics & Child Health Division, The Royal Australasian Col-
lege of Physicians; 2005.
8. Harrison D. Australian College of Neonatal Nurses. Manage-
ment of pain in sick hospitalised infants. Neonat Paediatr Child
Health Nurs 2006;9(1):27—9.
9. Blass EM, Fillion TJ, Rochat P, Hoffmeyer LB, Rochat P, Metzger
MA. Sensorimotor and motivational determinants of hand-
mouth coordination in 1—3-day-old human infants. Dev Psychol
1989;25:963—75.
10. Blass EM, Hoffmeyer LB. Sucrose as an analgesic for newborn
infants. Pediatrics 1991;87(2):215—8.
11. Blass E, Ciaramitaro V. A new look at some old mecha-
nisms in human newborns. Monogr Soc Res Child Dev 1994;
59(1).
12. Blass EM, Smith BA. Differential effects of sucrose, fruc-
tose, glucose, and lactose on crying in 1- to 3-day-old human
infants: qualitative and quantitative considerations. Dev Psy-
chol 1992;28(5):804—10.
13. Ramenghi LA, Evans DJ, Levene MI. ‘‘Sucrose analgesia’’:
absorptive mechanism or taste perception? Arch Dis Child Fetal
Neonat Ed 1999;80(2):F146—7.
14. American Academy of Pediatrics Canadian Paediatric Society.
Prevention and management of pain and stress in the neonate.
Pediatrics 2000;105(2):454—61.
15. Australian College of Neonatal Nurses. Position statement
number 2003/2, management of pain in sick hospitalised
infants; 2004 [available at: www.acnn.org.au, accessed Jan-
uary 10, 2008].
16. Royal Children’s Hospital. Clinical guidelines (hospital)
oral sucrose for procedural pain management in infants.
Royal Children’s Hospital Clinical Guidelines; 2005 [available
at: http://www.rch.org.au/rchcpg/index.cfm?doc id=8590,
accessed January 7, 2008].
17. Henderson D. Australian & New Zealand neonatal network.
Evidence uptake using networks—–newborn pain project. Syd-
Oral sucrose for pain management
ney: National Institute of Clinical Studies, National Health and
Medical Research Council; 2007.
18. Allen KD, White DD, Walburn JN. Sucrose as an analgesic agent
for infants during immunization injections. Arch Pediatr Ado-
lesc Med 1996;150(3):270—4.
19. Lewindon PJ, Harkness L, Lewindon N. Randomised controlled
trial of sucrose by mouth for the relief of infant crying after
immunisation. Arch Dis Child 1998;78(5):453—6.
20. Barr RG, Young SN, Wright JH, Cassidy KL, Hendricks L, Bedard
Y, et al. Sucrose analgesia’’ and diphtheria—tetanus—pertussis
immunizations at 2 and 4 months. J Dev Behav Pediatr
1995;16(4):220—5.
21. Lindh V, Wiklund U, Blomquist HK, Hakansson S. EMLA cream
and oral glucose for immunization pain in 3-month-old infants.
Pain 2003;104(1/2):381—8.
22. Reis EC, Roth EK, Syphan JL, Tarbell SE, Holubkov R. Effec-
tive pain reduction for multiple immunization injections
in young infants. Arch Pediatr Adolesc Med 2003;157(11):
1115—20.
23. Thyr M, Sundholm A, Teeland L, Rahm VA. Oral glucose
as an analgesic to reduce infant distress following immu-
nization at the age of 3, 5 and 12 months. Acta Paediatr
2007;96(2):233—6.
24. Curtis SJ, Jou H, Ali S, Vandermeer B, Klassen T. A random-
ized controlled trial of sucrose and/or pacifier as analgesia
for infants receiving venipuncture in a pediatric emergency
department. BMC Pediatr 2007;7(27).
25. Rogers AJ, Greenwald MH, Deguzman MA, Kelley ME, Simon HK.
A randomized, controlled trial of sucrose analgesia in infants
younger than 90 days of age who require bladder catheteriza-
tion in the pediatric emergency department. Acad Emerg Med
2006;13(6):617—22.
26. Harrison D, Johnston L, Loughnan P, Manias E. Erratum: re:
oral sucrose for procedural pain in sick hospitalized infants:
a randomized-controlled trial (J. Paediatr. Child Health 2003;
39: 5917). J Paediatr Child Health 2005;41(9/10):535.
27. Harrison D, Johnston L, Loughnan P. Oral sucrose for procedural
pain in sick hospitalized infants: a randomized-controlled trial.
J Paediatr Child Health 2003;39(8):591—7.
79
28. Mucignat V, Ducrocq S, Lebas F, Mochel F, Baudon JJ, Gold F.
Analgesic effects of EMLA cream and saccharose solution for
subcutaneous injections in preterm newborns: a prospective
study of 265 injections. Arch de Pediatr 2004;11(8):921—5.
29. Blass EM, Shah A. Pain-reducing properties of sucrose in human
newborns. Chem Senses 1995;20(1):29—35.
30. Johnston CC, Stremler R, Horton L, Friedman A. Effect of
repeated doses of sucrose during heel stick procedure in
preterm neonates. Biol Neonat 1999;75(3):160—6.
31. Miller A, Barr RG, Young SN. The cold pressor test in children:
methodological aspects and the analgesic effect of intraoral
sucrose. Pain 1994;56(2):175—83.
32. Lewkowski MD, Barr RG, Sherrard A, Lessard J, Harris AR, Young
SN. Effects of chewing gum on responses to routine painful
procedures in children. Physiol Behav 2003;79(2):257—65.
33. Zempsky WT, Cravero JP. American Academy of Pediatrics
Committee on Pediatric Emergency Medicine, Section on
Anesthesiology, Pain Medicine. Relief of pain and anxiety in
pediatric patients in emergency medical systems. Pediatrics
2004;114(5):1348—56.
34. Beyer JE, Denyes MJ, Villarruel AM. The creation, validation,
and continuing development of the Oucher: a measure of pain
intensity in children. J Pediatr Nurs 1992;7(5):335—46.
35. Taddio A, Nulman I, Koren BS, Stevens B, Koren G. A revised
measure of acute pain in infants. J Pain Symptom Manage
1995;10(6):456—63.
36. Harrison D, Johnston L, Loughnan P, Evans C. Bedside assess-
ment of heel lance pain in the hospitalized infant. J Obstet
Gynecol Neonat Nurs 2002;31(5):411—7.
37. Carbajal R, Paupe A, Hoenn E, Lenclen R, Olivier-Martin M.
DAN: une échelle comportementale d’évaluation de la douleur
aiguë du nouveau-né APN: a behavioral acute pain rating scale
for neonates. Arch Pediatr 1997;4(7):623—8.
38. Grunau RE, Craig KD. Pain expression in neonates: facial action
and cry. Pain 1987;28(3):395—410.
39. Merkel SI, Voepel-Lewis T, Shayevitz JR, Malviya S. Practice
applications of research. The FLACC: a behavioral scale for
scoring postoperative pain in young children. Pediatr Nurs
1997;23(3):293—7.