• R d Xavier Balda, R Guinsburg, M F de Almeida, C d Peres, M H Miyoshi, and B I Kopelman.
• Department of Neonatal Medicine, Federal University of São Paulo-Escola Paulista de Medicina, São Paulo, SP, Brazil.
• Arch Pediat Adol Med. 2000 Oct 1;154(10):1009-16.

ObjectiveTo determine whether adults can recognize neonatal facial expression of pain.DesignA cross-sectional study.SettingNeonatal intensive care unit, nursery, and outpatient clinic of one university hospital and one private hospital in São Paulo, Brazil.PatientsFour hundred five adults divided into 2 groups: health and nonhealth professionals.InterventionThe faces of 3 healthy full-term newborns who needed glucose screening were photographed at rest and during light exposure, heel rubbing, and heel puncture. A series of adults answered a questionnaire on personal and professional data and then they analyzed for 1 minute each of the 3 sets of pictures to answer the following question: "In which picture of this set do you think that the baby is feeling pain?"Main Outcome MeasureNumber of correct answers for the 3 sets of photographs shown to the adults.ResultsSeventy-four percent of the health professionals and 86% of the nonhealth professionals indicated correctly the picture with facial expressions of pain in at least 2 of the 3 sets. Regarding which picture was picked out by the interviewee, 94% of the health professionals and 92% of the nonhealth professionals indicated the picture taken during the heel puncture in set 1. The same observation was made by 53% and 54% of the health professional and by 68% and 66% of the nonhealth professional interviewees for sets 2 and 3, respectively.ConclusionsFacial expression of pain represents an effective neonatal communication tool. However, the health professional group achieved a lower level of recognition of neonatal facial expressions of pain. Factors related to the personal and professional characteristics of the adults interviewed probably contributed to this result.

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