Which Gentle Comfort Methods Ease a Newborn's Heel-Prick Pain?

What a large 2025 research review found when it compared six drug-free ways to soothe babies during blood tests

Newborn babies need small blood tests in their first days, and the most common one is the "heel prick" — a quick lance to the heel to collect a few drops of blood. It is brief, but it does hurt. A 2025 research review gathered the best trials on drug-free ways to comfort babies during this procedure and compared six of them side by side. The headline finding is encouraging: several simple, everyday measures genuinely reduce a baby's pain, and a mother's own breast milk came out on top.

That review, led by Lingxue Xu and colleagues and published in the journal Frontiers in Pediatrics, did not test babies itself [1]. Instead it pooled the results of many earlier trials into one big analysis. This matters because most individual studies are small, and parents and nurses have long lacked a clear answer to a very practical question: of all the soothing methods people use, which ones work best? The review set out to rank them.

Why Comforting a Newborn Matters

It may seem obvious that we should ease a baby's pain, but for much of the last century doctors assumed newborns barely felt pain and could not remember it, so procedures were often done with nothing to comfort the infant. That thinking changed in 1987, when a landmark medical paper by Anand and Hickey showed that newborns are fully wired to sense pain and respond to it with real, measurable stress [2]. Later research raised the stakes further: in the most fragile, premature babies, repeated untreated pain during a hospital stay has been linked to differences in how the brain develops and how the child handles stress and pain later on [3]. In other words, comforting a baby during a needle is not just kindness in the moment — it may matter for the longer term. Today the American Academy of Pediatrics asks every hospital that cares for newborns to routinely check for pain and to have a plan to prevent and treat it, using gentle non-drug methods first for quick procedures [4].

Doctors and nurses do not simply guess whether a baby is in pain. They use a scorecard called the Neonatal Infant Pain Scale, or NIPS, which rates things anyone can watch for — the baby's facial expression, whether and how it cries, how it moves its arms and legs, how awake and agitated it is, and its breathing [5]. A higher score means more distress. Every result in this review is measured in NIPS points, so a bigger drop in the score means a calmer, more comfortable baby.

What the Review Compared

The researchers searched four large medical databases for all the trials that used the NIPS score during a heel prick in healthy newborns [1]. Many soothing methods had only been tested once or twice, which is too little to trust, so the team kept only those backed by at least three studies. That left a solid core of 13 studies covering 1,141 babies and six methods, each compared against giving no comfort at all:

  • Breast milk — a little of the mother's milk given around the time of the prick.
  • Sweet taste — a few drops of a sugar (sucrose or glucose) solution on the tongue.
  • Yakson touch — a gentle technique from Korea in which a caregiver rests a warm, still hand on the baby and softly caresses it.
  • Swaddling — snugly wrapping the baby.
  • Heel warming — warming the heel before the prick.
  • A pacifier to suck on (without any milk or sugar), known as non-nutritive sucking.

What Worked Best

Five of the six methods clearly reduced babies' pain scores compared with doing nothing [1]. Breast milk had the biggest effect, lowering the NIPS score by about 1.7 points on average. Close behind were Yakson touch (about 1.4 points) and sweet taste (about 1.4 points as well). Swaddling and heel warming helped too, though by a smaller amount (roughly half a point each). When the researchers put them in order overall, the top three were breast milk, Yakson touch, and sweet taste.

There was one surprise. A pacifier on its own — with nothing sweet on it — did not significantly reduce pain in this analysis, and it ranked at the bottom of the active methods. That does not mean pacifiers are useless; it means that, by itself, a plain pacifier was not enough. As the wider research shows, comfort methods often work best when layered together, so a pacifier can still play a supporting role alongside something sweet or a mother's milk [6].

Two honest cautions come with these numbers. First, the score measures how distressed a baby looks and acts. One careful study using brain-activity recordings found that a sweet solution lowered the outward signs of pain without clearly changing the pain signals in the brain, so soothing a baby's behaviour is not exactly the same as switching off the pain [7]. Second, the trials in this review differed a great deal from one another, so the authors were careful to call their work a "comparison of effectiveness" rather than a final, fixed ranking. The overall message is a direction to head in, not a rulebook.

Why the Breast-Milk Result Is Reassuring

The finding that breast milk ranked first fits neatly with what was already known and is genuinely good news for families. Sweet solutions are among the most thoroughly proven comfort measures in all of newborn care, backed by large reviews of both sucrose [8] and other sugars such as glucose [9] — which is why the study grouped them together as "sweet taste." Breast milk, which is naturally a little sweet and comes with the comfort of feeding and a mother's familiar smell and closeness, has its own strong evidence for easing pain during heel pricks and blood draws [10]. Best of all, it is something a mother can offer herself, turning a stressful moment into one where the family actively helps.

What This Means for Your Baby

If your newborn needs a heel prick or similar quick test, it is reasonable to ask the nurse whether your baby can breastfeed or be given a little expressed breast milk, or a few drops of a sugar solution, just before the procedure — these were the most effective options here. Gentle touch, snug swaddling, and warming the heel can all help as well, and for babies who need many tests or who are very premature, skin-to-skin "kangaroo" care — holding your baby bare-chest against you — has its own strong track record for comfort and is worth asking about [11]. Combining measures is often better than relying on any single one — for example, offering breast milk or a sweet solution together with snug swaddling and a calm, gentle touch. It also helps to know what the numbers mean in everyday terms: the pain scorecard used in this research runs from 0 to 7, so breast milk's average drop of about 1.7 points is a meaningful shift toward a calmer baby, while warming the heel or swaddling nudges the score down by a smaller amount and works best as an extra layer of comfort rather than the only step. None of these methods erases pain completely, but together they can take the sharp edge off a routine that your baby will go through more than once. You are not being fussy by asking; routine pain relief is exactly what modern guidelines expect [4].

What Researchers Are Working On Next

This review pulled together many small studies, and its main limitation is that those studies varied widely and were often modest in size, so the certainty of the evidence ranged from moderate to low. The authors say the next step is larger, more carefully run trials across multiple hospitals that can pin down which babies benefit most from which method [1]. Future work is also likely to pair the watch-and-score approach with measurements of brain activity, so researchers can tell how much a method eases what the baby actually feels, not just how the baby looks [7]. For now, the practical takeaway is warm and simple: a baby's pain during routine blood tests is real, it can be eased, and some of the most effective tools — a mother's milk, a touch of sweetness, gentle hands, and closeness — are already within easy reach.

References

  1. Xu L, Xiang L, Pan L, Xue P, Li J, He Y, Liu H, Hu Y, Zheng B. A Bayesian network meta-analysis of non-pharmacological interventions for neonatal pain management: a clinical effectiveness comparison. Front Pediatr. 2025;13:1547308. doi:10.3389/fped.2025.1547308 ↩
  2. Anand KJS, Hickey PR. Pain and its effects in the human neonate and fetus. N Engl J Med. 1987;317(21):1321–1329. doi:10.1056/NEJM198711193172105 ↩
  3. Grunau RE. Neonatal pain in very preterm infants: long-term effects on brain, neurodevelopment and pain reactivity. Rambam Maimonides Med J. 2013;4(4):e0025. doi:10.5041/RMMJ.10132 ↩
  4. Committee on Fetus and Newborn and Section on Anesthesiology and Pain Medicine. Prevention and management of procedural pain in the neonate: an update. Pediatrics. 2016;137(2):e20154271. doi:10.1542/peds.2015-4271 ↩
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  7. Slater R, Cornelissen L, Fabrizi L, et al. Oral sucrose as an analgesic drug for procedural pain in newborn infants: a randomised controlled trial. Lancet. 2010;376(9748):1225–1232. doi:10.1016/S0140-6736(10)61303-761303-7) ↩
  8. Stevens B, Yamada J, Ohlsson A, Haliburton S, Shorkey A. Sucrose for analgesia in newborn infants undergoing painful procedures. Cochrane Database Syst Rev. 2016;(7):CD001069. doi:10.1002/14651858.CD001069.pub5 ↩
  9. Bueno M, Yamada J, Harrison D, et al. A systematic review and meta-analyses of nonsucrose sweet solutions for pain relief in neonates. Pain Res Manag. 2013;18(3):153–161. doi:10.1155/2013/956549 ↩
  10. Shah PS, Herbozo C, Aliwalas LL, Shah VS. Breastfeeding or breast milk for procedural pain in neonates. Cochrane Database Syst Rev. 2012;(12):CD004950. doi:10.1002/14651858.CD004950.pub3 ↩
  11. Johnston C, Campbell-Yeo M, Disher T, et al. Skin-to-skin care for procedural pain in neonates. Cochrane Database Syst Rev. 2017;(2):CD008435. doi:10.1002/14651858.CD008435.pub3 ↩