A Spoonful of Sugar

A recent report in the March/April 2010 edition of the journal Pediatric Dermatology reported the use of an oral sucrose solution for pain relief in infants who were undergoing steroid injections into vascular birthmarks called hemangiomas.


As a pediatric dermatologist, minimizing pain is extremely important to me. I choose painless treatment modalities whenever possible, and when a painful procedure is necessary I take whatever measures I can to make it as pleasant as possible for the patient. It has been suggested that this is especially important for infants, because pain control for early procedures affects how kids respond to pain when they are older. Oral sucrose solution is currently commonly used in neonatal intensive care units and for circumcisions, and is used by some pediatricians for immunizations.


This 24% solution of sucrose is administered 2 minutes prior to the procedure, either by placing it on the anterior tip of the tongue or by dipping a pacifier into the solution. How does sugar numb pain? Well, we aren’t exactly sure, but it may activate sites in the brain that decrease pain perception, or it may cause the release of chemicals which cause babies to have less feeling of pain.


In addition to hemangioma steroid injections, oral sucrose solution could be used by pediatric dermatologists for biopsies and laser treatments. One caveat: it is only useful for infants less than one year of age. For older children, I use topical anesthetics and distraction techniques such as a portable DVD player. For infants less than a year of age, however, oral sucrose solution may help an infant tolerate many dermatologic procedures… in a most delightful way!