After completing this article, readers should be able to:

Pain perception is an inherent quality of life that appears early in development.

—K.J.S. Anand and K.D. Craig, 1999

Term and preterm neonates admitted to today’s NICUs often are exposed to pain, discomfort, or noxious stimulation from a variety of sources. These include major procedural pain, such as surgery to repair a volvulus or ligate a patent ductus arteriosus, as well as “minor” acute pain, including heel sticks, venipunctures, and lumbar punctures. They are exposed to chronic pain as might be expected from necrotizing enterocolitis or prolonged ventilation. Even routine care such as diaper changes, daily weighing, removal of adhesive tape, and rectal stimulation are not “gestationally appropriate” in the preterm infants and cause noxious stimulation. Finally, stress results from all of these events and leads to its own adverse effects in this vulnerable population. All of these stimuli, either individually...

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