Assessment of Parents’ Knowledge of Their Infants’ Pain Experience in the NICU
DOI:
https://doi.org/10.54112/bcsrj.v6i8.1943Keywords:
Parental knowledge, neonatal pain, NICU, pain assessment, PakistanAbstract
Parental involvement in the assessment and management of neonatal pain in the Neonatal Intensive Care Unit (NICU) is essential for improving infant comfort and outcomes. However, gaps persist in parental knowledge, use of pain assessment tools, and engagement in clinical decision-making. Limited evidence exists from the Pakistani context, where resource constraints may further impact parental participation. Objective: To assess the knowledge and involvement of parents in evaluating their infants' pain experiences in the NICU of a tertiary care hospital in Lahore, Pakistan. Methods: A descriptive cross-sectional study was conducted from July 2024 to March 2025 at a tertiary care hospital NICU in Lahore. Using non-probability convenience sampling, 153 parents of neonates aged less than one month were recruited. Data were collected through a structured, validated questionnaire that covered demographic characteristics, parental knowledge of pain assessment, and their involvement in the assessment process. Descriptive statistics, including frequencies and percentages, were analyzed using SPSS version 21. Results: More than half of the infants (52.9%) were aged 0–7 days, with a slight female predominance (52.3%). Preterm births accounted for 32.7% of cases, and 64.7% of infants had a birthweight below 2500 grams. Most deliveries were by cesarean section (60.1%). The leading causes for NICU admission were shortness of breath (34.0%) and jaundice (24.8%). Regarding parental involvement, 56.2% reported that their expertise was considered in pain assessments; however, only 41.8% were informed about pain scales, and 26.8% were asked to use standardized tools. Nearly half (49.0%) could identify the type of pain, but many parents were uncertain about assessing its duration and location. Conclusion: While over half of the parents felt included in their infants' pain assessment, significant knowledge gaps remain, particularly in understanding and applying standardized pain assessment tools. These findings highlight the need for targeted educational interventions to improve parental engagement in neonatal pain management.
Downloads
References
Khalil A., Fathi A., & Halim A. Effect of tactile stimulation on neonatal stress during invasive procedures at neonatal intensive care units of Port Said. Port Said Scientific Journal of Nursing, 2020; 7(4): 1-20. https://doi.org/10.21608/pssjn.2020.123864
Muteteli C., Tengera O., & Gowan M. Neonatal pain management among nurses and midwives at two Kigali hospitals. Rwanda Journal of Medicine and Health Sciences 2019;2(2):138. https://doi.org/10.4314/rjmhs.v2i2.9
Perry M., Tan Z., Chen J., Weidig T., Xu W., & Cong X.. Neonatal pain. Critical Care Nursing Clinics of North America 2018;30(4):549-561. https://doi.org/10.1016/j.cnc.2018.07.013
Logashkin A., Silaeva V., Mamleev A., Шумкова В., Sitdikova V., Popova Y.et al.. Dexmedetomidine as a short-term analgesic for the immature nervous system. International Journal of Molecular Sciences 2024;25(12):6385. https://doi.org/10.3390/ijms25126385
Taksande A., Chaudhary S., Panwar A., Jhamb A., Rao R., Jameel P.et al.. Effect of vibratory therapy in decreasing the vaccination-induced pain in infants: randomized controlled study. Journal of Pharmaceutical Research International 2021:9-18. https://doi.org/10.9734/jpri/2021/v33i31a31659
Shah S., Mascarenhas D., Goyal M., Subadarsini S., Nanavati R., & Ananthan A. Routine use of analgesia for venipuncture in a tertiary level neonatal intensive care setting: a quality improvement study. Biomedicine Hub 2025;10(1):116-123. https://doi.org/10.1159/000545874
Mala O., Forster E., & Kain V. "Thai nurses' and midwives' perceptions regarding barriers, facilitators, and competence in neonatal pain management". Advances in Neonatal Care 2023;24(2): E26-E38. https://doi.org/10.1097/anc.0000000000001128
Mala O., Forster E., & Kain V. Neonatal nurse and midwife competence regarding pain management in neonates. Advances in Neonatal Care 2021;22(2): E34-E42. https://doi.org/10.1097/anc.0000000000000911
Bueno M., Costa R., Camargo P., Costa T., & Harrison D. Evaluation of a parent‐targeted video in Portuguese to improve pain management practices in neonates. Journal of Clinical Nursing 2018;27(5-6):1153-1159. https://doi.org/10.1111/jocn.14147
Cândido L., Harrison D., Veríssimo M., & Bueno M. Effectiveness of a parent‐targeted video on neonatal pain management: nonrandomized pragmatic trial. Paediatric and Neonatal Pain 2020;2(3):74-81. https://doi.org/10.1002/pne2.12023
Olsson E., Misic M., Andersen R., Ericson J., Eriksson M., Blomqvist Y.et al.. Study protocol: Parents as Pain Management in Swedish Neonatal Care – SWEPAP, a Multicenter Randomized Controlled Trial. BMC Pediatrics 2020;20(1). https://doi.org/10.1186/s12887-020-02356-7
Bonacaro A., Granata C., Canini C., Anderle L., Ambrosi F., Bassi M.et al.. Evaluation of pain in the pediatric patient admitted to sub-intensive care: what is the evidence? A scoping review. Epidemiologia 2025;6(1):9. https://doi.org/10.3390/epidemiologia6010009
Wari G., Wordofa B., Alemu W., & Habte T. Knowledge and practice of nurses and associated factors in managing neonatal pain at selected public hospitals in Addis Ababa, Ethiopia, 2020. Journal of Multidisciplinary Healthcare 2021; Volume 14:2275-2286. https://doi.org/10.2147/jmdh.s322903
Agakidou E., Tsoni K., Stathopoulou T., Thomaidou A., Farini M., Kontou A.et al.. Changes in physicians' perceptions and practices on neonatal pain management over the past 20 years. A survey was conducted at two time points. Frontiers in Pediatrics 2021;9. https://doi.org/10.3389/fped.2021.667806
Nugraha P., Fitri S., & Maryam N.. Description of perceptions of neonatology nurses in the implementation of assessment and management of pain in neonates. Indonesian Journal of Global Health Research, 2024; 6(1): 33-42. https://doi.org/10.37287/ijghr.v6i1.2615
Popowicz H., Mędrzycka‐Dąbrowska W., Kwiecień-Jaguś K., & Kamedulska A. Knowledge and practices in neonatal pain management of nurses employed in hospitals with different levels of referral—multicenter study. Healthcare 2021;9(1):48. https://doi.org/10.3390/healthcare9010048
Roma T., Lamy Z., Marques A., Pereira M., Mota E., & Filho F. Perception and attitude of parents towards newborn pain in neonatal unit / percepção e atitude de pais diante da dor do filho recém-nascido internado em unidade neonatal. Revista De Pesquisa Cuidado É Fundamental Online 2021;13:1234-1241. https://doi.org/10.9789/2175-5361.rpcfo.v13.9298
McNair C., Chirinian N., Uleryk E., Stevens B., McAllister M., Franck L.et al.. Effectiveness of parental education about pain in the neonatal period on knowledge, attitudes, and practices: a systematic review and meta-analysis. Paediatrics & Child Health 2022;27(8):454-463. https://doi.org/10.1093/pch/pxac050
Filippa M., Monaci M., Spagnuolo C., Benedetto M., Serravalle P., & Grandjean D. Oxytocin levels increase and anxiety decreases in mothers who sing and talk to their premature infants during a painful procedure. Children 2023;10(2):334. https://doi.org/10.3390/children10020334
Palomaa A., Hakala M., & Pölkki T. Parents' perceptions of their child's pain assessment in hospital care: a cross-sectional study. Journal of Pediatric Nursing 2023;71:79-87. https://doi.org/10.1016/j.pedn.2023.03.012
Despriee Å., Mägi C., Småstuen M., Glavin K., Nordhagen L., Jonassen C.et al.. Prevalence and perinatal risk factors of parent‐reported colic, abdominal pain, and other pain or discomforts in infants until 3 months of age ‐ a prospective cohort study in the Netherlands. Journal of Clinical Nursing 2021;31(19-20):2784-2796. https://doi.org/10.1111/jocn.16097
Hoti K., Chivers P., & Hughes J. Assessing procedural pain in infants: a feasibility study evaluating a point-of-care mobile solution based on automated facial analysis. The Lancet Digital Health 2021;3(10):e623-e634. https://doi.org/10.1016/s2589-7500(21)00129-1
Badovinac S., Gennis H., Riddell R., Garfield H., & Greenberg S.. Understanding the relative contributions of sensitive and insensitive parent behaviors on infant vaccination pain. Children 2018;5(6):80. https://doi.org/10.3390/children5060080
Makeen M., Farrell L., LaSorda K., Deng Y., Altamirano V., Jarvis O.et al.. Associations between postpartum pain, mood, and maternal–infant attachment and parenting outcomes. Scientific Reports 2022;12(1). https://doi.org/10.1038/s41598-022-21793-1
Despriee Å., Småstuen M., Glavin K., Carlsen K., Magi C., Söderhäll C.et al.. Infant colic and abdominal pain; associations with infant multimorbidity and maternal perceived stress up to 3 months postpartum—a cross‐sectional/cohort study in the Preventall study. Journal of Clinical Nursing 2023;32(19-20):7605-7617. https://doi.org/10.1111/jocn.16825
Olsson E., Pettersson M., Eriksson M., & Ohlin A. Oral sweet solution to prevent pain during neonatal hip examination: a randomised controlled trial. Acta Paediatrica 2018;108(4):626-629. https://doi.org/10.1111/apa.14588
Filippa M., Monaci M., Spagnuolo C., Serravalle P., Daniele R., & Grandjean D. Maternal speech decreases pain scores and increases oxytocin levels in preterm infants during painful procedures. Scientific Reports 2021;11(1). https://doi.org/10.1038/s41598-021-96840-4
Anderson N., Graham S., Prime H., Jenkins J., & Madigan S.. Linking quality and quantity of parental linguistic input to child language skills: a meta‐analysis. Child Development 2021;92(2):484-501. https://doi.org/10.1111/cdev.13508
Taddio A., Shah V., Bucci L., MacDonald N., Wong H., & Stephens D. Effectiveness of a hospital-based postnatal parent education intervention about pain management during infant vaccination: a randomized controlled trial. Canadian Medical Association Journal 2018;190(42): E1245-E1252. https://doi.org/10.1503/cmaj.180175
Hughes B., Benoit B., Rutledge K., Dol J., Martin‐Misener R., Latimer M.et al.. Impact of parent-targeted ehealth educational interventions on infant procedural pain management: a systematic review. Jbi Evidence Synthesis 2023;21(4):669-712. https://doi.org/10.11124/jbies-21-00435
Richardson B., Dol J., Rutledge K., Monaghan J., Orovec A., Howie K.et al.. Evaluation of mobile apps targeted to parents of infants in the neonatal intensive care unit: systematic app review. Jmir Mhealth and Uhealth 2019;7(4):e11620. https://doi.org/10.2196/11620
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Asma Ashraf, Syeda Mah Fatima, Syeda Tasneem Kauser, Kousar Perveen

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.