Tucking and Breast Milk Ease Tape Removal Pain in Preterm Infants

Even the most routine procedure in a neonatal intensive care unit can hurt. Peeling an adhesive tape off the fragile skin of a preterm infant, a task performed countless times a day to secure tubes and sensors, triggers measurable pain responses in babies who are often less than a kilogram of struggling nerve endings and immature physiology. Now a randomized controlled trial conducted in a Level III neonatal intensive care unit in Turkey has tested two remarkably simple, drug-free ways to soften that experience, and the results suggest that comfort can be engineered into even the smallest clinical moments.

The study, published in the Journal of Perinatology, enrolled 119 preterm infants born between 30 and 36 completed weeks of gestation and randomly assigned them to one of three groups during adhesive tape removal. One group received facilitated tucking combined with oral breast milk, another received kangaroo care combined with oral breast milk, and a third served as a control group receiving standard care. Facilitated tucking is a positioning technique in which a caregiver gently contains the infant’s arms and legs close to the trunk, mimicking the curled posture of the womb. Kangaroo care places the baby skin-to-skin against a parent’s chest, a practice long associated with stabilized heart rate, temperature regulation, and bonding. Oral breast milk, delivered a few drops at a time, adds a third sensory channel: the taste and smell of the mother, which previous research has repeatedly linked to calming and analgesic effects in newborns.

The researchers measured pain using the Premature Infant Pain Profile-Revised, or PIPP-R, a validated composite score that integrates physiological indicators such as heart rate and oxygen saturation with behavioral cues like facial grimacing, and adjusts for gestational age and behavioral state. Because a single snapshot in time can mislead, the team recorded pain scores across multiple phases of the procedure, before, during, and after tape removal, and analyzed the physiological data using generalized estimating equations, a statistical framework well suited to repeated measurements collected from the same infant.

The findings were unambiguous. Both intervention groups showed significantly lower pain scores than the control group, with the difference reaching a p value below 0.001. The temporal pattern of the results tells a subtler story. Pain scores naturally climbed during the act of tape removal itself, the sharpest mechanical stimulus in the sequence. But in the minutes afterward, while infants in the control group continued to show elevated pain indicators, babies in both intervention arms returned toward baseline more quickly. In other words, the combination strategies did not eliminate the pain spike entirely, but they blunted its aftermath, shortening the period of distress that follows an unavoidable procedural touch.

Perhaps the most clinically useful result was what the researchers did not find: no statistically significant difference between the two intervention groups. Facilitated tucking plus oral breast milk performed just as well as kangaroo care plus oral breast milk. That equivalence matters because the two strategies carry very different practical burdens. Kangaroo care requires a parent to be physically present, available, and willing to hold the infant skin-to-skin during a procedure, a condition that is not always met in a busy unit where parents may be recovering themselves, traveling long distances, or managing other children. Facilitated tucking, by contrast, can be performed by any trained nurse at the bedside, requires no parent in the room, and can be applied within seconds of deciding to remove a tape or adjust a line.

The trial was registered at ClinicalTrials.gov under identifier NCT06455631, although the authors candidly note that enrollment began before registration because of the urgency of recruiting within a limited study window and delays in accessing the registration platform. They emphasize that the study protocol was finalized and approved by the institutional ethics committee before any infant was enrolled, and that no changes were made to the protocol after registration. Written informed consent was obtained from the parents of all participating infants, and the study was approved by the Medipol University Clinical Trials Ethics Committee.

The scientific rationale for combining interventions rests on the idea that pain in newborns is a multisensory event. Preterm infants experience procedures through touch, smell, taste, and the proprioceptive sense of body position simultaneously, and each channel can be modulated independently. Oral breast milk likely engages orosensory and olfactory pathways, with the sweet taste and familiar maternal odor activating endogenous opioid and oxytocinergic systems that dampen nociceptive signaling. Facilitated tucking provides deep, distributed tactile input that promotes a flexed, contained posture associated with self-regulation, while kangaroo care adds the warmth, heartbeat, and breathing rhythm of a parent, which together stabilize autonomic function. Layering these inputs appears to produce analgesic effects that no single measure achieves alone, a conclusion consistent with prior trials showing that non-nutritive sucking, oral sucrose, maternal voice, and breast milk odor each reduce procedural pain when used individually.

What distinguishes the present study is its focus on adhesive tape removal, a procedure that is nearly invisible in pain research precisely because it seems trivial. Yet the accumulating evidence that early, repeated pain exposure in preterm infants can shape long-term neurodevelopment, alter stress reactivity, and sensitize pain pathways makes every needle, lance, and peel worth counting. A baby in a neonatal intensive care unit may undergo dozens of painful procedures per week, and skin injury from adhesive removal is itself a recognized complication of intensive care. Guidelines from neonatal nursing organizations already recommend minimizing skin trauma and pairing procedures with non-pharmacological comfort measures, but the evidence base for tape removal specifically has been thin. This trial helps fill that gap with rigorous randomized data.

For clinicians, the message is refreshingly low-tech. Neither intervention costs anything meaningful, requires no equipment, carries no known side effects, and can be implemented tomorrow morning in any intensive care unit in the world. Where parents are present, skin-to-skin contact with a few drops of breast milk offers a powerful and emotionally meaningful buffer. Where they are not, facilitated tucking with oral breast milk provides an equally effective alternative that fits seamlessly into routine care. In a field where analgesia for preterm infants often stalls at debates over sucrose doses and opioid risks, a study showing that the position of a caregiver’s hands and the taste of a mother’s milk can measurably change a baby’s pain trajectory is a reminder that some of the best medicine in the neonatal unit is not pharmacological at all.

Subject of Research: Non-pharmacological pain relief during adhesive tape removal in preterm infants

Article Title: Multimodal non-pharmacological pain relief during adhesive tape removal in preterm infants: a randomized controlled trial

Article References: Akbari, N., Genc, C., Gozen, D., Tastekin, A., & Abayli, E. I. (2026). Multimodal non-pharmacological pain relief during adhesive tape removal in preterm infants: a randomized controlled trial. Journal of Perinatology. https://doi.org/10.1038/s41372-026-02911-7

Image Credits: AI Generated

DOI: 10.1038/s41372-026-02911-7

Keywords: preterm infants, neonatal pain, facilitated tucking, kangaroo care, oral breast milk, adhesive tape removal, randomized controlled trial, PIPP-R, neonatal intensive care, non-pharmacological analgesia, procedural pain, Journal of Perinatology