Challenges of judging pain in vulnerable infants.

The inevitability of pain during infancy and its potential for destructive impact impose a burden on caregiving adults. An armamentarium of effective pharmacological, behavioral and environmental interventions is available if pain were recognized and accurately assessed. Infants have limited behavioral repertoires that make identification of specific needs difficult, mothers and other caregivers prone to high levels of protection and redundant care. But more specific care can best suit infant requirements. Certain behaviors are sensitive to states of distress, including pain, for example, cry and disruption of usual activities such as sleep. Others appear more specific, for example, facial activity. This paper proposes that effective care is best delivered to infants and children if we recognize the complexities of the sociocommunication process; subjective states are encoded in behavioral activity and caregivers must be able to recognize the meaning of these actions. The paper delineates some features of the process whereby caregivers arrive at judgments of infant's needs and make decisions concerning interventions.