Developmentally appropriate care is a central feature of rehabilitation in the pediatric intensive care unit (PICU), but the hospital environment often fails to meet the specific needs of infants, impacting the quality of care that they receive. The infant rehabilitation team at Oregon Health and Science University Doembecher Children’s Hospital collaborated with student researchers to identify the most effective nonpharmacological pain strategies in order to communicate these strategies to other allied health professionals. The final practice question was “What are the most effective nonpharmacological pain management practices for optimal developmental outcomes for infants 12 months old and younger in the PICU?” The literature review resulted in 28 articles providing moderate to strong evidence on effective nonpharmacological pain management strategies, including breastfeeding, positioning, infant massage, sensory-based, non-nutritive sucking, and a combination of approaches. Based on the strength of the evidence, it is recommended that practitioners prioritize the use of these effective nonpharmacological pain management strategies to provide developmentally appropriate care to infants in the PICU.

The findings from the literature were translated into a caregiver and health professional resources binder, an infant pain management checklist, and an inservice presentation to orient the collaborating practitioners to the findings and products. Pre- and post-surveys were provided during the inservice. Overall trends showed that rehabilitation professionals believe that the nonpharmacological strategies will be feasible to implement and effective in reducing infant pain. The evidence based resources will also increase legitimacy of the use of these strategies in practice. The outcomes of this evidence project suggest that nonpharmacological strategies are a feasible, effective method of pain management for infants in the PICU that would benefit from further research in regards to their effectiveness in comparison to pharmacological strategies, as well as the potential long term implications of extended stays in the PICU on infant neurodevelopment.

Publication Place

Tacoma, Washington


University of Puget Sound

Project Chairperson

Jennifer Pitonyak, PhD, OTR/L, SCFES

Publication Date



Capstone Project





Degree Program

Occupational Therapy

Degree Level

Master of Science


Occupational Therapy


University of Puget Sound