Sucrose for pain management in infants
Sucrose is used in infants to modify responses to some painful procedures (eg heel lance, venepuncture, intramuscular injection). Its sweet taste is thought to evoke a fast-onset analgesic effect that is mediated by endogenous opioids—breast milk is an alternative. The effect peaks at 2 minutes and lasts for up to 10 minutes. Sucrose has been shown to reduce surrogate measures of infant pain (eg crying, grimacing, elevated heart rate, carer-reported pain scores).
Seek specialist advice before using sucrose to manage pain in neonates younger than 32 weeks gestational age1 or who weigh less than 1000 g.
Evidence suggests that sucrose efficacy begins to wane between 4 and 6 months of age and there is inadequate clinical evidence to support its use in infants older than 12 months. Consider the need for additional analgesics in infants older than 4 months.
Use the minimum effective sucrose dose and combine with age-appropriate nonpharmacological comfort measures (eg skin-to-skin contact, swaddling, breastfeeding). Also consider the need for other analgesics as appropriate for the child, procedure and anticipated pain level (eg sucrose should not be used alone to manage pain from circumcision).
Sucrose must not be used by parents to manage day-to-day infant distress because the long-term effects of frequent dosing is unknown.
If sucrose is indicated in infants 32 weeks gestational age or older who weigh more than 1000 g, use:
sucrose 25% solution2 pain sucrose
infants aged 32 to 36 weeks gestational age1: 0.2 to 0.5 mL orally, administered 2 minutes before the procedure. Use a dummy or oral syringe to administer the solution directly onto the tongue or buccal mucosa. Do not give more than 1.5 mL of sucrose solution in 24 hours. Seek advice from a neonatologist or paediatrician if higher doses are required
infants aged 37 weeks gestational age to 1 month1: 0.5 to 1 mL orally, administered 2 minutes before the procedure. Use a dummy or oral syringe to administer the solution directly onto the tongue or buccal mucosa. Do not give more than 3 mL in 24 hours. Seek advice from a neonatologist or paediatrician if higher doses are required
child aged 1 month to 12 months3: 1 to 2 mL orally, administered 2 minutes before the procedure. Use a dummy or oral syringe to administer the solution directly onto the tongue or buccal mucosa. Do not give more than 6 mL in 24 hours. Seek advice from a paediatrician if higher doses are required.