Mother's hand tool as a skin-to-skin contact simulation instrument decreases pain levels in newborns

Main Article Content

Yesim Ceylantekin
Nuriye Buyukkayaci Duman
Dilek Ocalan
Senay Topuz
Betul Yildiz Ucar


Sensory stimulation activates the gate control mechanism, raises the level of beta endorphins, and the secretion of beta endorphins increases the pain threshold, reducing or eliminating the feeling of pain. It has been reported that skin-to-skin contact or sensual stimulation reduces stress, pain and crying time in newborns. The present study aimed to examine the effect of the mother’s hand tool (MHT) - developed by the researchers for three purposes: touch, positioning and vibration - on pain levels in newborns.

A quasi-experimental study was conducted involving 52 newborns aged 0-15 days who were being treated in the neonatal intensive care unit. The MHT was applied to support the newborn and was applied 8 times in 24 hours for 3 minutes in total. Demographic data collection form (DDCF), neonatal evaluation form (NEF) to assess the respiratory rate, pulse rate, SPO2 and CO2 level, and neonatal infant pain scale (NIPS) were used to collect data. The Wilcoxon signed rank test was applied to analyse the data. A p value of <0.05 was considered to be statistically significant.

After the MHT application, it was revealed that there was a significant difference in pulse rate (p=0.000), SPO2 level (p=0.029), CO2 level (p=0.000) and NIPS pain scores (hour 6,9,12,15,18, and 24) and total NIPS (p=0.000) pain scores, before and after MHT practice.

This study demonstrated that MHT application to the newborns had a decreasing effect on pain level, heart rate, CO2 level, and an increasing effect on SPO2 level.

Article Details

How to Cite
Ceylantekin, Y., Duman, N. B. ., Ocalan, D. ., Topuz, S. ., & Ucar, B. Y. (2021). Mother’s hand tool as a skin-to-skin contact simulation instrument decreases pain levels in newborns. Universa Medicina, 40(2), 87–95.
Original Articles


Boles J. Non-pharmacological strategies for addressing infant pain. Pediatr Nurs 2017;43:98-100.

Erodlu A, Arslan S. Perception, evaluation and management of pain in the newborn. Duzce University J Inst Health Sci 2018;8:52-60.

Polkki T, Korhonen A, Laukkale H. Nurses’ perceptions of pain assessment and management practices in neonates: a cross-sectional survey. Scand J Caring Sci 2018;32:725-33. doi: 10.1111/scs.12503.

Field T. Preterm newborn pain research review. Infant Behav Dev 2017;49:141-50. doi: 10.1016/j.infbeh.2017.09.002.

Efe E, Dikmen S, Altas N, Boneval C. Turkish pediatric surgical nurses’ knowledge and attitudes regarding pain assessment and nonpharmacological and environmental methods in newborns’ pain relief. Pain Manag Nurs 2013;14:343-50. doi: 10.1016/j.pmn.2011.08. 003.

Bucsea O, Riddell RP. Non-pharmacological pain management in the neonatal intensive care unit: managing neonatal pain without drugs. Semin Fetal Neonatal Med 2019;24:101017. doi: 10.1016/j.siny.2019.05.009.

Williams N, Mac Lean K, Guan L, Collet JP, Holsti L. Pilot testing a robot for reducing pain in hospitalized preterm infants. OTJR Occup Participation Health 2019;39:108-15.

Akcan E, Yiðit R. Related approaches to pain management of neonatal nurses and physicians in the neonatal clinic in Turkey. ACU Health Sci J 2016;3:147-53.

De Clifford-Faugere G, Aita M, Le May S. Nurses’ practices regarding procedural pain management of preterm infants. Appl Nurs Res 2019;45:52-4.

Yavuz DE, Alpar PE. Interventional pain and non-pharmacological management in newborns and infants. Zeynep Kamil Med Bull 2018;49:169-78.

Rivas-Fernandez M, Roque I Figuls M, Diez-Izquierdo A, Escribano J, Balaguer A. Infant position in neonates receiving mechanical ventilation. Cochrane Database Syst Rev 2016;11: CD003668. doi:10.1002/14651858.CD003668.pub4

Campbell-Yeo M, Johnston CC, Benoit B, et al. Sustained efficacy of kangaroo care for repeated painful procedures over neonatal intensive care unit hospitalization: a single-blind randomized controlled trial. Pain 2019;160:2580-8. doi: 10.1097/j.pain.0000000000001646.

Pagni AM, Kellar S, Rood M. Effects of Kangaroo care on procedural pain in preterm infants: a systematic review. Honors Research Projects 2017;441.

Benoit B, Campbell-Yeo M, Johnston C, Latimer M, Caddell K, Orr T. Staff nurse utilization of Kangaroo Care as an intervention for procedural pain in preterm infants. Adv Neonatal Care 2016; 16:229-38. doi: 10.1097/ANC.0000000000000262.

Zampino C, Ficacci R, Checcacci M, Catacuzzeno L. Pain control by proprioceptive and exteroceptive stimulation at the trigeminal level. Front Physiol 2018;9:1037. doi:10.3389/fphys. 2018.01037.

Herrington CJ, Chiodo LM. Human touch effectively and safely reduces pain in the newborn intensive care unit. Pain Manag Nurs 2014;15:107-15. doi: 10.1016/j.pmn.2012.06.007.

McGinnis K, Murray E, Cherven B, McCracken C, Travers C. Effect of vibration on pain response to heel lance: a pilot randomized controltrial. Adv Neonatal Care 2016;16:439-48. doi: 10.1097/ANC. 0000000000000 315.

Ueki S, Yamagami Y, Makimoto K. Effectiveness of vibratory stimulation on needle-related procedural pain in children: a systematic review. JBI Database System Rev Implement Rep 2019; 17:1428-63. doi: 10.11124/JBISRIR-2017-003890.

Dolu Kaya FN, Karakoc A. Efficacy of mechanical vibration of heel stick pain in neonates. Clin Exp Health Sci 2018;8:122-7.

Abdallah B, Badr LK, Hawwari M. The efficacy of massage on short and long term outcomes in preterm infants. Infant Behav Dev 2013;36:662-9.

Lawrence J, Alcock D, McGrath P, Kay J, MacMurray SB, Dulberg C. The development of a tool to assess neonatal pain. Neonatal Netw 1993;12:59-66.

Akdovan T, Yyldyrym Z. Assessment of pain in healthy neonates, investigation of the effects of pacifying and holding in arms. J Perinatal Med 2001;29:43.

Çaðlayan N, Balcy S. An effective pain reduction in preterm newborns method: fetal position. Florence Nightingale J Nurs 2014;22:63-8.

Chidambaram AG, Manjula S, Adhisivam B, Bhat BV. Effect of kangaroo mothercare in reducing pain due to heel prick among preterm neonates: a cross-over trial. J Matern Fetal Neonatal Med 2014;27:488-90. doi: 10.3109/14767058.2013. 818974.

Sen E, Manav G. Effect of Kangaroo care and oral sucrose on pain in premature infants: a randomized controlled trial. Pain Manag Nurs 2020;21:556-64. doi: 10.1016/j.pmn.2020.05.003.

Karimi F, Abolhassani M, Ghasempour Z, Gholami A, Rabiee N. Comparing the effect of kangaroo mother care and massage on preterm infant pain score, stress, anxiety, depression, and stress coping strategies of their mothers. Int J Pediatr 2020. doi:10.22038/IJP.2020.50006.3990.