Can Babies Remember Pain?

You may find this hard to believe, but up until the 1990s, infants were routinely subjected to medical procedures, including surgery, without the benefit of anesthesia.

Pain research’s most famous infant, Jeffrey Lawson, was born prematurely in February 1985 and underwent open heart surgery shortly thereafter.¹ What made this particular surgery noteworthy was the fact that Jeffery was awake and conscious throughout the entire procedure. The anesthesiologist had administered only Pavulon, a paralytic that has no effect on pain.

Only after Jeffrey died five weeks later did his mother, Jill, learn the truth about his surgery. Jeffrey had been too young to tolerate anesthesia, the anesthesiologist said, and anyway, “It had never been demonstrated to her that premature babies feel pain."¹ This was not the case of a rogue anesthesiologist; textbooks at the time taught that the surgery Jeffrey underwent “could be safely accomplished with only oxygen and a paralytic.”

Not until a research report from Anand and Hickey, “Pain and Its Effects in the Human Neonate and Fetus,” was published in the New England Journal of Medicine in 1987 did this practice finally begin to end.

Similar to the denial of infant physiological pain has been the denial of psychic pain, including the pain of separation in infancy and childhood. Until the 1970s, infants and children who were hospitalized were denied visitation by their parents.

The need for parental love and care and the pain that children suffer without this were considered unimportant in the physical recovery process—and the attachment needs of the young child went completely unrecognized in medical circles.

Even now, some question whether trauma and/or loss occurring in the early months and years of life can be remembered. Many deny the importance of separations in the first weeks of life and some doubt whether separations or early trauma of other kinds are encoded in memory.

But this is what Susan Coates, a well-known psychologist and the author of September 11: Trauma and Human Bonds, among other books, has to say:

It is now well documented that very young children show the same three basic categories of posttraumatic symptoms observed in adults: reexperiencing, numbing, and hyperarousal.² These three clusters of symptoms are the means by which posttraumatic disorders in adults are diagnosed. These clusters have consistently been shown to represent independent factors in the traumatic response process, and there are now over fifty published case reports documenting their presence in children under the age of four.³

She goes on to say:

Both Lenore Terr (1988) and TJ Gaensbauer (1995) report that children under the age of three, though unable to describe a trauma in words, enact it in play through motor behavior and somatic responses. Doing this requires a preverbal capacity to symbolically represent traumatic events in memory.

Posttraumatic play in very young children is readily distinguishable from ordinary play. It is compulsively driven and it includes repetitive reenactment of the trauma. In addition, very young children show symptoms of reexperiencing the trauma that are highly reminiscent of what is seen in older children and adults: repeated nightmares, distress at exposure to reminders of the trauma, and episodes with features of flashbacks or dissociation.

Coates’ case of “Betsy" helps illustrate this point. This case involves a 10-month-old girl who was stabbed repeatedly by a psychotic man while sitting in her stroller in a park. Thanks to the fast action of her babysitter, a police officer, and a surgical team, she survived. Her parents noticed no posttraumatic symptoms, did not think she remembered the event, did not think it necessary to tell her about what happened, and, in fact, were counseled not to do so.

One day, when she was three and playing in the kitchen sink with her father, she leaned against the counter and said “My line hurts.” When her father said, “Oh, you mean your special boo-boo?” she said, “No,” and made slashing motions with her hand. She said, “It was a very bad day.” This suggested she had a memory of the traumatic event.

Her parents realized that she needed help to understand what had happened to her. They took her to see Coates for psychotherapy and together, Betsy, her parents, and Coates reconstructed what had happened and what it meant to Betsy.

So, not only do infants experience pain—and severe stress—but evidence suggests that they are also capable of forming symbolic representations and somatic memories of traumas they have suffered. In addition, we now know that their capacities for other kinds of memory are far more sophisticated than was thought even 30 years ago, and that these capacities include the rudiments of an episodic memory system even before the onset of language.

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These two factors—the experience of pain and its memory—create necessary and sufficient conditions for traumatization and the development of posttraumatic stress disorder (PTSD), whether around trauma or loss.

Why is this important for parents to know?

It is important to recognize that early experiences of pain and separation may be important to your child and how she sees herself and the world. If a child has suffered an early and prolonged separation or a difficult medical experience, parents may be tempted to discount the possibility that this affected them or that they have some residual memory of what happened. It is painful for parents to think otherwise.

But it is important to acknowledge that these experiences can affect small children and to talk with them about what happened and how hard it may have been for them—even though they were very little at the time. It is important to be open to what they have to say about it and to not make this a one-time conversation. It is important to talk about it with them from time to time and try to help them understand what this experience might have been like for them and what it may have meant to them.