Recognition and treatment of procedural pain and discomfort in the neonate remain a challenge. Procedural sedation and control of pain and discomfort are frequently managed together, often by using the same intervention. Therefore, although this article focuses on sedation, separating sedation from pain control is not always possible or wise. Despite significant progress in the understanding of human neurodevelopment, pharmacology, and more careful attention to how we care for sick infants, we still have much to learn. Protecting and comforting our fragile patients requires us to use poorly validated tools to assess and intervene to minimize distress, often applying data derived from adult patients to infants. Our first priority should be to minimize pain and distress. Further exploration of nonpharmacologic methods of procedural pain and distress control are needed. When pharmacologic intervention is necessary for procedural pain control and sedation, we need to use the least amount of drug that controls the pain and distress for the shortest period of time. As newer techniques and medications are introduced to clinical practice, we must demonstrate that such additions achieve their goal of sedation or pain control, and are safe over the lifetimes of our patients. Clinicians should identify appropriately the need for and use of sedatives and analgesics in the neonate.
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