To provide an updated synthesis of the current state of the evidence for the effectiveness of breast-feeding and expressed breast milk feeding in reducing procedural pain in preterm and full-term born infants. A systematic search of key electronic databases (PubMed, CINAHL, EMBASE) was completed. Of the 1032 abstracts screened, 21 were found eligible for inclusion. Fifteen studies reported on the use of breast-feeding or expressed breast milk in full-term infants and 6 reported on preterm infants. Direct breast-feeding was more effective than maternal holding, maternal skin-to-skin contact, topical anesthetics, and music therapy, and was as or more effective than sweet tasting solutions in full-term infants. Expressed breast milk was not consistently found to reduce pain response in full-term or preterm infants. Studies generally had moderate to high risk of bias. There is sufficient evidence to recommend direct breast-feeding for procedural pain management in full-term infants. Based on current evidence, expressed breast milk alone should not be considered an adequate intervention.
School of Nursing (Ms Benoit and Drs Martin-Misener, Latimer, and Campbell-Yeo) and Departments of Psychology & Neuroscience (Dr Campbell-Yeo) and Pain, Anesthesia and Perioperative Medicine, Faculty of Medicine (Dr Latimer), Dalhousie University, Halifax, Nova Scotia, Canada; and Centre for Pediatric Pain Research (Ms Benoit and Drs Latimer and Campbell-Yeo), Maternal Newborn Program (Ms Benoit), and Department of Pediatrics (Dr Campbell-Yeo), IWK Health Centre, Halifax, Nova Scotia, Canada.
Corresponding Author: Britney Benoit, MSc(A)N, RN, School of Nursing, Dalhousie University, 5869 University Ave, PO Box 15000, Halifax, Nova Scotia, B3H 4R2, Canada (britney.benoit@dal.ca).
Britney Benoit is a Canadian Institutes of Health Research (CIHR) Vanier Canada Graduate Scholar and Canadian Child Health Clinician Scientist Program (CCHCSP) Career Enhancement Program Trainee and is a trainee member of Pain in Child Health: A CIHR Strategic Training Initiative and Transdisciplinary Understanding and Training on Research in Primary Health Care. She has also received doctoral funding support from the Nova Scotia Health Research Foundation Scotia Scholars Program, the Nova Scotia Research and Innovation Graduate Scholarship, the Dalhousie University School of Nursing Doctoral Scholarship and Helen Watson Memorial Award, and the IWK Health Centre Ruby Blois Scholarship. Marsha Campbell-Yeo is a CIHR New Investigator and is additionally funded by a CCHCSP Career Development Award. The authors thank Leah Boulos (MLIS, Evidence Synthesis Coordinator, Maritime Strategy for Patient Oriented Research [SPOR] Support Unit) for her assistance with developing and running the search strategy for this review.
Author contribution: B.B. and M.C.Y. are responsible for conceptualization of this review topic and B.B. was responsible for completing the literature search and screening, data extraction, and writing of the manuscript in its entirety. R.M.M., M.L., and M.C.Y. provided feedback and editing of the content of the manuscript.
Disclosure: The authors have no conflicts of interest to declare.
Submitted for publication: October 31, 2016; accepted for publication: February 18, 2017.
