Judgment of pain in newborns: Facial activity and cry as determinants.

Abstract
The difficulties inherent in the task of assessing pain in infants and children highlight the subjective nature of pain assessment in general. In the present study, adult judgments of the sensory intensity and affective discomfort experienced by newborn infants subjected to heel lancing were examined. Video-recordings of 72 infant''s reactions were categorized as high or low in cry pitch and high or low in the involvement of facial activity. Forty-five parents of other children provided the ratings. Findings indicated that both cry and facial activity were determinants of the ratings, but variability in facial activity was more important than variaiton in cry pitch. Discrete facial actions, identified using the Neonatal Facial Coding System, were predictive and substantially correlated with the adult ratings. Thus, facial activity serves as a crucial determinant of adult judgments of infant pain.