Helping Infants Suffering From Pain

This is part three of our special series, "Easing the Pain." CBS News contributor Sanjay Gupta reports that some doctors disagree over how to treat pain in infants - and sometimes, whether to treat it at all.

In three short weeks of life, Josie Toland has undergone a lifetime's worth of medical procedures. She was born two months premature and developed serious lung problems, Gupta reports.

She's had tubes inserted to breathe and to eat, and constant sticks in her heels to draw blood.

"Babies have an average of 10-to-15 painful procedures per day in this unit if they're under 30 weeks gestation, or if they're really sick like Josie was," said Dr. Whit Hall.

Besides fighting for her survival, doctors have been wrestling with another issue: With everything that's been done to her, how much pain is Josie feeling?

As recently as 15 years ago, it was thought that newborns were not developed enough to feel or remember pain. Amazingly, newborns often received little or no anesthesia for most medical procedures - even surgery.

"The folklore became babies don't feel pain, anesthesia is bad for them, let's not give anything," said Dr. K.J.S. Anand.

Gupta said: "What you're describing must have been torture for these babies."

Anand is a leading researcher on how to detect pain in these tiny patients who can't speak and spend most of their time sleeping.

Doctors monitor some of the physical signs of pain, like blood pressure and heart rate, and the obvious behavioral signs like crying and facial expressions. But how do you know the difference between a cry of pain or a cry for hunger?

"You just can't stand over an infant 24-7 and watch them. And that's why I thought a machine system would be pretty good at handling some of these problems," said computer scientist Sheryl Brahnam.

Brahnam works with facial recognition technology to identify key spots in a baby's face that signal pain.

"It's wrong to think that every time a baby experiences pain, they'll cry. They're not. Sometimes all you see is a bulging forehead," Brahnam said.

She's working with facial recognition technology to identify key spots in a baby's face that signal pain. The hope is that one day a camera would constantly monitor the faces of newborns and alert doctors to even the subtle signs that something is wrong.

"It gives the infant a voice, it lets the infant cry out, 'I'm in pain,'" Brahnam said.

Detecting pain in newborns is one thing. Treating it is another.

Unfortunately, the drugs to treat babies' pain are meant for adults. Like morphine and methadone. Even today there is reluctance by doctors and parents to use them.

"Yes, I think there are still medical physicians, nurses, who hold out that babies probably don't feel pain," Anand said.

Some of the techniques to calm babies are tried and true: creating a quiet atmosphere with low lights and swaddling them for comfort.

It's all working for Josie.

"Can you say without a doubt, that Josie is not in pain right now?" Gupta asked Hall.

"I can. I'm basing that on she seems comfortable, she's not crying, she seems to be happy," Hall said.

Evidence that years later, children and adults remember the pain they suffered as babies. Studies show they're more pain sensitive and can have higher rates of ADD.



Doctors at Arkansas Children's Hospital say little Josie's feeding tube has now been removed and she's due to have the first breast feeding of her life. She should be going home in just a few days.