Pain in infants and children—Physiological background and clinical aspects

Pain is a vital sign in infants and children and is essential for survival. Pain is subjective and it is only the individual who can describe the pain or the anticipation of pain. In infants, observation of behaviors that suggests pain, physiological and biological markers are used in the clinical assessment.It is well established that infants from the gestational age of about 20 weeks have a functional pain system, even if immature, which can perceive and respond to tissue injury. Prolonged or repetitive nociceptive input and stress is harmful to the nervous system especially in the neonatal period of life. The nervous system shows a high degree of plasticity and untreated pain can lead to long-term undesired changes. Preventing or treating pain is therefore a primary goal in infants and children.Over the last decades, the practice of pediatric pain management has advanced rapidly. Pain management includes analgesics as well as non-pharmacological approaches. A multimodal strategy is often advocated. Among the non-pharmacological methods medical acupuncture has emerged as an alternative in its own right in for example baby colic.