Babies Don't Feel Pain: A Century of Denial in Medicine
During the 20th century when medicine rose to dominate childbirth in the United States, it brought with it a denial of infant pain based on ancient prejudices and scientific dogmas no longer supportable. The painful collision of babies with doctors is seen in neonatal intensive care, infant surgery without anesthesia, painful obstetric routines, and genital mutilation of newborn males. This presentation includes a historical review of experiments on infant reactions to pain, the persistence of medical practices causing pain, and speculation about the reasons for professional indifference. (110 citations)
Als, Heidelise, Lester, Barry M. and Tronick, Edward Z. (1982), Manual for the Assessment of Preterm Infants' Behavior. In Hiram E. Fitzgerald, Barry M. Lester, and M. W. Yogman (Eds.) Theory and Research in Behavioral Pediatrics (pp. 65-132). New York: Plenum.
Als, H., Lawhon, G., Duffy, F. H. McAnulty, G. B. Gibes-Grossman, R. and Blickman, J.G. (1994), Individualized Developmental Care for the Very Low Birthweight Preterm Infant: Medical and Neurofunctional Effects. J. American Medical Association, 272(11): 853-858.
Anand, K. J. S. and Aynsley-Green, A.(1985), Metabolic and Endocrine Effects of Surgical Ligation of Patent Ductus Arteriosus in the Preterm Neonate: Are There Implications for Further Improvement in Postoperative Outcome? Modern Problems in Paediatrics, 23:143-157.
Anand, K. J. S. (1986), Hormonal and Metabolic Functions of Neonates and Infants Undergoing Surgery. Current Opinion in Cardiology, 7:681-689.
Anand, K. J. S. and Hickey, P. R. (1987), Pain and It's Effects in the Human Neonate and Fetus. New England J. Medicine, 317 (21): 1321-1329.
Bauchner, H., May, A. and Coates, E. (1992), Use of Analgesic Agents for Invasive Medical Procedures in Pediatric and Neonatal Intensive Care Units. J. of Pediatrics, 121(4), 647-649.
Berry, Frederic A. and Gregory, George A. (1987), Do Premature Infants Require Anesthesia for Surgery? Anesthesiology, 67(3): 291-293.
Bigelow, Henry J. (1893) , Transactions of the American Medical Association, 1:211. Cited by Pernick (1985).
Bigelow, Jim (1992), The Joy of Uncircumcising! Aptos, CA: Hour Glass Publishers.
Blanton, Mary G. (1917), The Behavior of the Human Infant in the First 30 Days of Life. Psychological Review, 24(6): 456-483.
Boyd, Billy Ray (1990), Circumcision: What it Does. San Francisco: Taterhill Press.
Brackbill, Yvonne, McManus, Karen and Woodward, Lynn (1985), Medication in Maternity: Infant Exposure and Maternal Information. Ann Arbor, MI: University of Michigan Press.
Campbell, N. (1989), Infants, Pain, and What Health Care Professionals Want To Know-A Response To Cunningham-Butler. Bioethks, 3(3): 200-210.
Chamberlain, David B.(1992), Babies Are Not What We Thought: Call For A New Paradigm. International J. Of Prenatal and Perinatal Psychology and Medicine, 4(3/4), 161-177.
Chamberlain, D. B. (1998) The Mind of Your Newborn Baby. Berkeley, CA: North Atlantic Books.
Chamberlain, D. B. (1999) Prenatal Body Language: A New Perspective On Ourselves, Journal of Prenatal and Perinatal Psychology and Health, 14 (1 and 2). 145-168.
Clifford, M. (1893), Circumcision: It's Advantages and How to Perform It. London: Churchill.
Crudden, Charles H. (1937), Reactions of Newborn Infants To Thermal Stimuli Under Constant Tactual Conditions. J. of Experimental Psychology, 20: 350-370.
Cunningham-Butler, Nance (1989), Infants, Pain, And What Health Professionals Should Want To Know: An Issue In Epistemology and Ethics. Bioethics, 3(3): 181-209.
Cunningham, Nance, (1990), Ethical Perspectives on the Perception and Treatment of Neonatal Pain. J. Perinatal and Neonatal Nursing, 4(1): 75-83.
DeMause, Lloyd (1991), The Universality of Incest. J. of Psychohistory, 9(2): 123-164.
Dixon, Suzanne, Snyder, Joel, Holve, Richard., and Bromberger, Patricia (1984), Behavioral Effects of Circumcision With and Without Anesthesia. Developmental and Behavioral Pediatrics, 5(5): 246-250.
Emde, Robert N., Harmon, Robert J., Metcalf, David, Koenig, Kenneth, and Wagonfeld, Samuel (1971), Stress and Neonatal Sleep. Psychosomatic Medicine, 33: 491-497.
Field, Tiffany (1990), Alleviating Stress in Newborn Infants in the Intensive Care Unit. Clinics in Perinatology, 17(1): 1-9.
Field, T. (1992), Interventions in Early Infancy. Infant Mental Health Journal, 13(4): 329-336,
Fitzgerald, Maria and Millard, Catherine (1988), Hyperalgesia in Premature Infants. (Letters). The Lancet, (Feb. 6): 292.
Flavell, John H. (1977), Cognitive Development. Englewood, New Jersey: Prentice-Hall.
Franke, Linda, Lund, C. and Fanaroff, A. (1986), A National Survey of the Assessment and Treatment of Pain in the Newborn Intensive Care Unit. Pediatric Research, 20: 347A, #1123.
Gairdner, Douglas (1949), The Fate of the Foreskin. British Medical Journal, 2, 1433-1437.
Gardner, A. K. (1872) Cited in Pernick (1985), A Calculus of Suffering: Pain Professionalism and Anesthesia in 19th Century America. New York: Columbia University Press, p. 47.
Giannakoulopoulos, X., Sepulveda, W., Kourtis, P. Glover, V. and Fisk, N. M. (1994), Fetal Plasma Cortisol and B-Endorphin Response to Intrauterine Needling. The Lancet, 344, 77-81.
Gottfried, Allen W. and Gaiter, J. L. (Eds.) (1985), Infant Stress Under Intensive Care: Environmental Neonatology. Baltimore, MD: University Park Press.
Graham, D. A. (1919), Intrauterine Crying. British Medical Journal, 1 (May 31): 675.
Grimes, David A. (1978), Routine Circumcision of the Newborn Infant: A Reappraisal. American J. Obstetrics and Gynecology, 130: 125-129.
Grunau, R. V. E. and Craig, K. D. (1987), Pain Expression in Neonates: Facial Action and Cry. Pain, 28: 395-410.
Guillemin, Jeanne H. and Holmstrom, Lynda. L. (1986), Mixed Blessings: Intensive care for Newborns. New York: Oxford University Press.
Gunnar, Megan. R., Fisch, Robert O., Korsvik, S. and Donhowe, J. M., (1981), The Effects of Circumcision on Serum Cortisol and Behavior. Psyckoneuroendocrinolgy, 6(3): 269-275.
Gunnar, Megan R., Fisch, Robert O., and Malone. Steve (1984), The Effect of a Pacifying Stimulus on Behavioral and Adrenocortical Responses to Circumcision. J. American Academy of Child Psychiatry, 23(1): 34-38.
Gunnar, Megan R., Malone, Steve, Vance, G., and Fisch, Robert O. (1985), Quiet Sleep and Levels of Plasma Cortisol During Recovery from Circumcisions in Newborns. Child Development, 56, 824-834.
Gustaitis, R. and Young, E. W. D. (1986), A Time to be Born, A Time to Die: Conflicts and Ethics in an Intensive Care Unit. Reading, MA: Addison-Wesley.
Harrison, Helen (1986), Letter. Birth, 13(2): 36-11. Harrison (1987), Pain Relief for Premature Infants. Twins (July/August): p.10 ff. Harrison (1990), Television Interview. The Dark Side of a Miracle. ABC's 20/20 (Feb. 2).
Herrera, Alfredo J., Hsu, A. S., Salcedo, U. T. and Ruiz, M. P. (1982), The Role of Parental Information on the Incidence of Circumcision. Pediatrics, 70: 597-598.
Holve, Richard, Bromberger, Patricia, Groveman, Howard, Klauber, M., Dixon, S. and Snyder, J. (1984), Regional Anesthesia During Newborn Circumcision. Clinical Pediatrics, 22: 813-818.
Illingworth, Ronald S. (1980) The Development of Communication in the First Year and Factors Which Affect It. In T. Murry and J. Murry (Eds.), Infant Communication (pp. 4-19). Houston: College Hill Press.
Janov, Arthur (1983), Imprints: The Life-long Effects of the Birth Experience. New York: Coward-McCann.
Kagen, Jerome (1981), The Second Year: The Emergence of Self-awareness. Cambridge, MA: Harvard University Press.
Kaye, Herbert and Lipsitt, Lewis (1964), Relation of Electrostatic Threshold to Basal Skin Conductance. Child Development, 35: 1307-1312.
Kellman, Neil (1980), Risks in the Design of the Modern Neonatal Intensive Care Unit. Birth 7(4): 243-248.
Kirya, Christopher and Werthmann, Milton W. (1978), Neonatal Circumcision and Penile Dorsal Nerve Block: A Painless Procedure. J. of Pediatrics, 92(6): 998-1000.
Klaus, Marshall and Kennell, John (1976), Maternal-Infant Bonding: the Impact of Early Separation or Loss on Family Development. St. Louis, MO: C. V. Mosby.
Klaus, Marshall, Kennell, John, and Klaus, Phyllis (1995), Bonding: Building the Foundation for Secure Attachment and Independence. Reading, MA: Addison-Wesley.
Lawson, Jill (1986a) Letter. Birth, 13(2): 125. [1986b) Letter. Perinatal Press, 9: 141-142. (1988a) Letter. New England J. of Medicine,(May 26): 1198. (1988b) Letter. Birth, 15(1): 36. (1990) The Politics of Newborn Pain. Mothering, (Fall): 41-47.
Leboyer, Frederick (1975), Birth Without Violence. New York: Alfred Knopf.
Lester, Barry M. and Boukydis, C. F. Zachariah (Eds.) (1985), Infant Crying: Theoretical and Research Perspectives. New York: Plenum.
Lightfoot-Klein, Hanny (1989), Prisoners of Ritual: An Odyssey into Female Genital Circumcision in Africa. New York and London: Harrington Park Press.
Lind, John (ed.) (1965), Newborn Infant Cry. Acta Paediactrica Scandinavica Supplement 163.
Lipsitt, Lewis P. and Levy, N. (1959), Electrostatic Threshold in the Neonate. Child Development, 30: 547-554.
Ludington-Hoe, Susan and Golant, Susan K. (1993), Kangaroo Care: The Best You Can Do to Help Your Preterm Infant. New York: Bantam.
Marshall, Richard E. (1989), Neonatal Pain Associated with Caregiving Procedures. Pediatric Clinics of North America, 36(4): 885-903.
Masciello, Anthony L. (1990), Anesthesia for Neonatal Circumcision: Local anesthesia is better than dorsal penile nerve block. Obstetrics and Gynecology, 75(5): 834-838.
Maurer, Daphne and Maurer, Charles (1988), The World of the Newborn. New York: Basic Books.
McGrath, Patrick J. and Unruh, A. M. (1987), Pain in Children and Adolescents. New York: Elsevier.
McGraw, Myrtle (1941), Neural Maturation as Exemplified in the Changing Reactions of the Infant to Pin Prick. Child Development, 12(1): 31-42.
Miller, Alice (1983), For Your Own Good: Hidden Cruelty in Childrearing and the Roots of Violence Translated by Hildegarde and Hunter Hannum. New York: Farrar, Straus, and Giroux.
Mirmiran, M. and Swaab, D. P. (1993) Effects of Perinatal Medication on the Developing Brain.: In Jan G. Nijuis (Ed.), Fetal Behavior, pp. 112-125. London and New York: Oxford University Press.
Owens, Mark E. and Todt, Ellen H. (1984), Pain in Infancy: Neonatal Reaction to a Heel Lance. Pain, 20(1): 77-86.
Patel, D. A. (1982) Factors Effecting the Practice of Circumcision. American J. of the Diseases of Children, 136(7): 634.
Patel, H. (1966) The Problem of Routine Circumcision. Canadian Medical Association, 95: 576.
Peabody, J. L. and Lewis, K. (1985), Consequences of Newborn Intensive Care. In A. W. Gottfried and J. L. Gaiter (Eds.), Infant Stress Under Intensive Care: Environmental Neonatohgy, (pp. 199-226). Baltimore: University Park Press.
Pelosi, Marco A. and Apuzzio, Joseph A. (1985) Making Circumcision a Painless Event. Contemporary Pediatrics,(January), 85-88.
Perlman, Jeffrey M. and Volpe, Joseph (1983), Suctioning in the Preterm Infant: Effects On Cerebral Blood Flow Velocity, Intracranial Pressure, and Arterial Blood Pressure. Pediatrics, 72(3): 329-334.
Pernick, Martin S. (1985), A Calculus of Suffering: Pain Professionalism and Anesthesia in 19th Century America. New York: Columbia University Press.
Pierson, A. (1852), In American Journal of Medical Science, 24, 576. Cited in Pernick (1985).
Pillai, Mary and James, David (1990) Are the Behavioral States of the Newborn Comparable to Those of the Fetus? Early Human Development, 22(1): 39-49.
Poland, Ronald L., Roberts, R. J., Gutierrez-Mazorra, J. F. and Fonkalsrud, E. W. (1987), Neonatal Anesthesia. Pediatrics, 80(3): 446.
Poland, Ronald L. (1990), The Question of Routine Neonatal Circumcision. New England J. of Medicine, 322(18), 1312-1315.
Porter, Fran L., Miller, Richard H., and Marshall, Richard E. (1986), Neonatal Pain Cries: Effect of Circumcision on Acoustic Features and Perceived Urgency. Child Development, 57: 790-802.
Pratt, K. C., Nelson, A. K. and Sun, K. H. (1930) The Behavior of the Newborn Infant. Ohio State University Student Contributions to Psychology, 10.
Purcell-Jones, Gari, Dormon, Frances, and Sumner, Edward (1988), Pediatric Anesthetists' Perception of Neonatal and Infant Pain. Pain, 33(2): 181-187.
Rabinowitz, Ronald, and Hulbert, William C. (1995) Newborn Circumcision Should Not Be Performed Without Anesthesia. Birth, 22(1), 45-46.
Rana, Sohail R. (1987), Pain: A Subject Ignored. Pediatrics, 79: 309-310.
Rawlings, D. J., Miller, P. A., and Engle, R. R. (1980), The Effect of Circumcision on Transcutaneous pO2 in Term Infants. American J. Diseases of Children, 134: 676-678.
Remondino, P. C. (1891), History of Circumcision. Philadelphia and London: F. A. Davis.
Rice, Ruth D. (1977), Neurophysiological Development in Premature Infants Following Stimulation. Developmental Psychology, 13(1): 69-76.
Rich, Eugene C., Marshall, Richard E. and Volpe, Joseph J. (1974), The Normal Neonatal Response to Pin-Prick. Developmental Medicine and Child Neurology, 16: 432-434.
Ritter, Thomas (1992), Soy No to Circumcision! Forty Compelling Reasons Why You Should Leave Your Son Whole. Aptos, CA: Hourglass Publishing.
Russell, P. M. G. (1957), Vagitus Uterinus: Crying in Utero. The Lancet, 1: 137-138.
Ryder, George H. (1943) Vagitus Uterinus. American J. of Obstetrics and Gynecology, 46: 867-872.
Scanlon, John W. (1985), Barbarism. Perinatal Press, 9: 103-104.
Schoen, Edgar J. and Committee (1989), Report of the Task Force on Circumcision. Pediatrics, 84(2): 388-391.
Schoen, Edgar J. (1990), The Status of Circumcision of Newborns. (Sounding Board) New England J. of Medicine, 322(18): 1308-1312.
Sexon, William R., Schneider, Pam, Chamberlin, J. L., Hicks, M. K. and Sexon, Sandra B. (1986), Auditory Conditioning in the Critically 111 Neonate to Enhance Interpersonal Relationships. J. of Perinatology, 6: 20-23.
Sherman, Mandel and Sherman, Irene C. (1925), Sensorimotor Responses in Infants. J. of Comparative Psychology, 5: 53-68.
Sherman, Mandel (1927), The Differentiation of Emotional Responses in Infants. I. Judgments of Emotional Responses From Motion Picture Views and From Actual Observations. Journal Comparative Psychology, 7(4): 265-284.
Sherman, Mandel, Sherman, Irene, and Flory, C. (1936), Infant Behavior. Comparative Psychology Monographs, 12 (4): 1-107.
Speert, Harold (1953), Circumcision of the Newborn: An Appraisal of It's Present Status. Obstetrics and Gynecology, 2: 164-172.
Stang, Howard J., Gunnar, Megan R., Snellman, Leonard, and Kostenbaum, Roberta (1988), Local Anesthesia for Neonatal Circumcision: Effects on Distress and Cortisol. (Response.), Journal of the American Medical Association, 259(10): 1507-1511.
Sugarman, Muriel (1977), Paranatal Influences on Maternal-Infant Attachment. American J. Orthopsychiatry, 47(3): 407-421.
Taddio, Anna, Goldbach, Morton, Ipp, Moshe, Stevens, Bonnie and Koren, Gideon (1995), Effect of Neonatal Circumcision on Pain Responses During Vaccination of Boys. The Lancet, 345 (Feb. 4) 291-292.
Talbert, Luther M., Kraybill, Ernest N. and Potter, H. D. (1975) Adrenal Cortical Response to Circumcision in the Neonate. Obstetrics and Gynecology, 48: 208-210.
Thiery, M., Ye Lo Sian, A. Vrijens, M. and Janssens, D. (1973), Vagitus Uterinus, J. of Obstetrics and Gynecology of the British Commonwealth, 80: 183-185.
Thoden, Carl Johan and Koivisto, Maila (1980), Acoustic Analysis of the Normal Pain Cry. In T. Murray and J. Murray (Eds.), Infant Communication: Cry and Early Speech (pp. 124-151). Houston, TX: College Hill Press.
Tohill, Jane and McMorrow, Olive (1990), Pain Relief in Neonatal Intensive Care. The Lancet, 336: 569.
Van der Kolk, Bessel T. (1987), Psychological Trauma. Washington D.C.: American Psychiatric Press.
Wallerstein, Edward (1985), Circumcision: The Uniquely American Medical Enigma. Urologic Clinics of North America, 12(1): 123-132.
Wellington, Nancy and Rieder, Michael J. (1993), Attitudes and Practices Regarding Analgesia for Newborn Circumcision. Pediatrics, 92(4), 541-543.
Wesson, Sara C. (1982), Ligation of the Ductus Arteriosus: Anesthesia Management of the Tiny Premature Infant. J. American Association of Nurse Anesthetists, 50: 579-582.
Whitelaw, Andrew (1990), Kangaroo Baby Care: Just a Nice Experience Or An Important Advance for Preterm Infants? Pediatrics, 85(4): 604-605.
Williamson, Paul and Williamson, Marvel (1983), Physiologic Stress Reduction By a Local Anesthetic During Newborn Circumcision. Pediatrics, 71(1): 36-40.
Winberg, Jan, Bollgren, Ingela, Gothefors, Leif, Herthelius, Maria, and Tullus, Kjell. (1989), The Prepuce: A Mistake of Nature? The Lancet, (March 18): 598-589.
Yeoman, P. M. Cooke, R. and Hain, W. R. (1983), Penile Block for Circumcision: A Comparison with Caudal Blockade. Anesthesia, 38(9): 862-866.