Does Recognition Lead to Relief? Healthcare Workers’ Knowledge, Perception, Attitudes and Practices in Neonatal Pain Management in Northeast Nigeria

Newborns cannot speak. They cannot point to a sore spot or tell a nurse that a procedure hurts. For decades, this silence led many to believe that babies, especially those born prematurely, did not feel pain the way adults do. Modern science has since overturned that idea. We now know that the biological pathways required to feel pain are active before a baby is even born. When a newborn undergoes a medical procedure, their body reacts with measurable changes: their heart rate speeds up, their blood pressure rises, and their facial muscles tighten. These are not just reflexes; they are signals of distress. Because these infants are in a critical period of brain development, repeated exposure to untreated pain can alter how their nervous systems grow, potentially affecting their ability to handle stress and process sensations later in life. Recognizing this, medical professionals have long agreed that managing pain is not just a kindness but a fundamental part of safe care. Yet, knowing a baby is in pain and actually doing something to stop it are two very different things.

In a hospital in Northeast Nigeria, a team of researchers set out to investigate this gap between knowing and doing. They focused on the Special Care Baby Unit at Abubakar Tafawa Balewa University Teaching Hospital in Bauchi, a major center for newborn care in the region. The team wanted to understand what the doctors, nurses, and midwives working there actually knew about neonatal pain, how they felt about treating it, and what they actually did when a baby needed relief. They did not just ask the staff what they thought; they also watched them work to see if their actions matched their words. The study involved fifty healthcare workers who cared for newborns in the unit. The researchers gave them a questionnaire to test their factual knowledge, asked them to rate how painful they thought common procedures were, and recorded their attitudes toward pain management. Crucially, they also observed the staff in action, checking whether they used standard tools to measure pain, whether they documented their findings, and whether they gave medicine to ease the suffering of the infants.

The results painted a picture of a workforce that cares deeply but lacks the tools and training to act on that care. The healthcare workers showed a strong understanding that pain is real. When asked to rate the pain level of various procedures, they correctly identified the most invasive ones, such as chest tube insertions and circumcisions, as extremely painful. Their attitudes were equally positive; the vast majority agreed that pain management is a priority and that newborns have a right to relief. However, when the researchers looked at the facts, the picture became more complicated. Only about half of the staff knew the correct details about how pain works in a newborn's body. Many held onto the mistaken belief that babies could easily become addicted to strong pain medicines, a fear that often leads to withholding necessary treatment. While most staff could identify pain by looking at a baby's crying or facial expression, fewer than one in three used a standardized scale to measure the intensity of that pain.

The disconnect between belief and action was most visible in the daily routine of the unit. The staff reported that they often assessed pain and used comfort measures like breastfeeding or skin-to-skin contact. Yet, when the researchers watched them work, the use of standardized assessment tools dropped significantly. In the observed cases, pain scales were used in only a quarter of the instances where they should have been. Documentation was even worse; pain scores were rarely written down in the medical charts. The use of medicine to stop pain followed a pattern of inconsistency. For major, invasive surgeries, the staff frequently used pain relief. But for common, routine procedures like inserting a tube through the nose into the stomach or drawing blood from a vein, pain relief was often skipped. The staff cited several reasons for this: the procedures were too quick, the medicines were not available, or there was no clear rule in the hospital telling them to use them.

Interestingly, the study found that simply having a training session or a written guideline did not automatically fix these problems. The researchers looked closely to see if staff who had received training or had access to hospital protocols performed better. They found no statistical link between having these resources and actually using them in practice. This suggests that the issue is not just a lack of information or a missing piece of paper. Instead, the problem appears to be systemic. Even when staff knew what to do and wanted to do it, the environment made it difficult. Without reliable access to medicines, clear step-by-step instructions for every procedure, and a culture that demands documentation, good intentions often fade into the background of a busy workday. The study concluded that to truly improve care for these vulnerable infants, hospitals need more than just education. They need a complete system overhaul that includes validated tools, specific rules for every procedure, reliable supplies of medicine, and regular checks to ensure that the care being planned is the care that is actually delivered.