Background Gavage feeding is required in preterm infants who cannot feed by themselves. Insertion of the feeding tube is painful, however, and reducing the discomfort in these patients is considered important. The aim of this study was to assess pain and discomfort during insertion of a feeding tube, and to evaluate different measures for pain relief.

Material and Methods We included 24 preterm infants with postmenstrual age 28–32 weeks in stable clinical condition. Prior to nasal tube insertion, the infants were given a pacifier or not; and oral fluids (none, sterile water, or 30% sucrose) in a 2-by-3 factorial design. Each infant acted as his own control over a 3 week period. The order of interventions was randomised.

Pain and discomfort was assessed by at least two independent and experienced observers using the pain assessment tool “Premature infant pain profile” (PIPP, range: 1 to 21). Score >12 indicates moderate to strong discomfort.1

Results Mean PIPP score during the procedure was about 9 and gradually decreased towards the baseline score of 4 in about five minutes. Significantly best pain relief was achieved by combining a pacifier with oral sucrose. Sterile water without a pacifier seemed to increase discomfort.

Conclusion Insertion of a feeding tube in preterm infants causes pain and discomfort as measured by the PIPP pain assessment tool. Pain relief is best achieved by combining a pacifier with 30% sucrose.