The recognition of facial expression of pain in full-term newborns by parents and health professionals

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Balda, Rita de Cássia Xavier [UNIFESP]
Guinsburg, Ruth [UNIFESP]
Almeida, Maria Fernanda Branco de [UNIFESP]
Peres, Clovis de Araujo [UNIFESP]
Miyoshi, Milton Harumi [UNIFESP]
Kopelman, Benjamin Israel [UNIFESP]
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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 Sao 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.
Archives Of Pediatrics & Adolescent Medicine. Chicago: Amer Medical Assoc, v. 154, n. 10, p. 1009-1016, 2000.