INFANT BEHAVIOR AND DEVELOPMENT, Volume 26, Issue 3: Pages 398-420,
August 2003.

An ethogram of neonatal distress behavior in response to acute pain (newborn male circumcision)

Fay Warnock

Center for Community Child Health Research,
BC Research Institute for Children's and Women's Health,
4480 Oak Street, L408,
Vancouver, BC, Canada V6H 3V4

Received 20 August 2002; revised 12 February 2003; accepted 25 February 2003; Available online 4 June 2003.


The aim of this basic observational study was to initiate development of a reliable ethogram of neonatal distress-related pain behavior. The videotapes of 10 full-term male newborns were observed repeatedly and systematically to inductively generate an exhaustive and structured listing of behavior. All 10 neonates were 72 hours of age or less, and all underwent the same distress-inducing events associated with newborn male circumcision. The reliably established ethogram contained 235 molecular and molar items for describing variation in neonatal motor movement, body postures, responsiveness, self-comfort, respiration, and vocalization. Also included were items for describing three distress-provoking stimuli: ambient sound, procedure-related stimuli, and innate responses made by the neonates. Novel descriptions contained in the ethogram extend knowledge of how neonates respond behaviorally to pain and non-pain situations. In combination with existing knowledge, they provide the descriptive prerequisites needed to distinguish newborn pain and the basis for further investigating important but poorly understood topics, such as newborn ability to self-organize or recover from significant exposure to pain and stress.

Author Keywords: Pain; Distress; Neonate; Pain behavior; Ethological methods; Basic observation

Corresponding author. Tel.: +1-604-875-3570; fax: +1-604-875-3569.

(File revised 31 December 2003)