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October 2000

The Recognition of Facial Expression of Pain in Full-Term Newborns by Parents and Health Professionals

Author Affiliations

From the Neonatal Division, Departments of Neonatal Medicine (Dr Xavier Balda), Pediatrics (Drs Xavier Balda, Guinsburg, Almeida, Miyoshi, and Kopelman), and Epidemiology (Dr Peres), Federal University of São Paulo–Escola Paulista de Medicina, São Paulo, Brazil.

Arch Pediatr Adolesc Med. 2000;154(10):1009-1016. doi:10.1001/archpedi.154.10.1009

Objective  To determine whether adults can recognize neonatal facial expression of pain.

Design  A cross-sectional study.

Setting  Neonatal intensive care unit, nursery, and outpatient clinic of one university hospital and one private hospital in São Paulo, Brazil.

Patients  Four hundred five adults divided into 2 groups: health and nonhealth professionals.

Intervention  The faces of 3 healthy full-term newborns who needed glucose screening were photographed at rest and during light exposure, heel rubbing, and heel puncture. A series of adults answered a questionnaire on personal and professional data and then they analyzed for 1 minute each of the 3 sets of pictures to answer the following question: "In which picture of this set do you think that the baby is feeling pain?"

Main Outcome Measure  Number of correct answers for the 3 sets of photographs shown to the adults.

Results  Seventy-four percent of the health professionals and 86% of the nonhealth professionals indicated correctly the picture with facial expressions of pain in at least 2 of the 3 sets. Regarding which picture was picked out by the interviewee, 94% of the health professionals and 92% of the nonhealth professionals indicated the picture taken during the heel puncture in set 1. The same observation was made by 53% and 54% of the health professional and by 68% and 66% of the nonhealth professional interviewees for sets 2 and 3, respectively.

Conclusions  Facial expression of pain represents an effective neonatal communication tool. However, the health professional group achieved a lower level of recognition of neonatal facial expressions of pain. Factors related to the personal and professional characteristics of the adults interviewed probably contributed to this result.