{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T19:36:11Z","timestamp":1773776171540,"version":"3.50.1"},"reference-count":96,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T00:00:00Z","timestamp":1769558400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T00:00:00Z","timestamp":1769558400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Annals of the Child Neurology Society"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Pain perception is a conscious experience, but neither pain nor consciousness is defined in the developing human fetus. Emergent consciousness may be regarded as a phenomenon that ultimately arises from an essential minimum of functional neuronal connectivity. Proposed U.S. federal legislation asserts that a functioning cerebral cortex is not necessary to experience pain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We assess the scientific premise of the 13 assertions in the \u201cPain\u2010Capable Unborn Child Protection Act\u201d with analysis and interpretation from a developmental neuroscience perspective. We review the biological requisites of fetal sentience, the emergence of involuntary spinal cord and brainstem reflexes, the early appearance of autonomic homeostatic stress reactions, and measures of synaptogenesis and neuronal connectivity through immunocytochemistry and fetal functional neuroimaging.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The formation of functional synapses can be demonstrated by synaptophysin immunoreactivity in the receptive sensory layers of fetal cerebral cortex at around 25 weeks' gestation, but immunoreactivity is not uniformly intense until after 35 weeks. In vivo, fetal functional magnetic resonance imaging confirms immunocytochemical results by showing complex, interconnected brain networks developing at similar gestational ages. Fetal magnetoencephalography detects magnetic fields from fetal brain activity and demonstrates second\u2010order rule learning in fetuses over 35 weeks' gestation. The neural pathways required for the emotional and evaluative aspects of pain processing in the brain are still incomplete in term newborns.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Given the limitations of reductionism to explain the subjective nature of consciousness, evidence from developmental neuroanatomy, neurophysiology, and functional neuroimaging infers that fetal pain perception requires the emergence of conscious cortical processing beginning with weak functional thalamocortical connectivity well after the age of fetal viability.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/cns3.70057","type":"journal-article","created":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T09:54:01Z","timestamp":1769594041000},"page":"15-28","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Fetal Pain Perception:\n                    <b>Legislative Assertions and Developmental Neuroscience<\/b>"],"prefix":"10.1002","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0460-4605","authenticated-orcid":false,"given":"William D.","family":"Graf","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Division of Neurology Connecticut Children's and The University of Connecticut Farmington Connecticut USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4752-9118","authenticated-orcid":false,"given":"Timothy M.","family":"Crombleholme","sequence":"additional","affiliation":[{"name":"Department of Surgery, UConn Health, Fetal Surgery Section Division of Pediatric General and Thoracic Surgery Farmington Connecticut USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4264-3867","authenticated-orcid":false,"given":"Leon G.","family":"Epstein","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Northwestern University's Feinberg School of Medicine and The Ann &amp; Robert H. Lurie Children's Hospital of Chicago, Pediatrics and Neurology Chicago Illinois USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4192-2362","authenticated-orcid":false,"given":"Dawn","family":"Gano","sequence":"additional","affiliation":[{"name":"Departments of Neurology, UCSF School of Medicine University of California, San Francisco San Francisco California USA"},{"name":"Department of Pediatrics, BC Children's Hospital Research Institute University of British Columbia Vancouver British Columbia Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6373-1068","authenticated-orcid":false,"given":"Phillip L.","family":"Pearl","sequence":"additional","affiliation":[{"name":"Department of Neurology Boston Children's Hospital and Harvard Medical School Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1871-6969","authenticated-orcid":false,"given":"Timothy V.","family":"Salomons","sequence":"additional","affiliation":[{"name":"Department of Psychology Queen's University Kingston Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3410-6797","authenticated-orcid":false,"given":"Mark S.","family":"Scher","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Neurology, Division of Pediatric Neurology, Fetal\/Neonatal Neurology Program Case Western Reserve University School of Medicine Cleveland Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4802-6774","authenticated-orcid":false,"given":"Elise","family":"Turk","sequence":"additional","affiliation":[{"name":"Department of Neonatology, University Medical Center Utrecht Utrecht University Utrecht the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Klaus\u2010Peter","family":"Zimmer","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Neonatology Justus\u2010Liebig\u2010University Giessen Giessen Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6953-2959","authenticated-orcid":false,"given":"Harvey B.","family":"Sarnat","sequence":"additional","affiliation":[{"name":"Departments of Paediatrics, Pathology (Neuropathology) and Clinical Neurosciences University of Calgary Cumming School of Medicine, and Alberta Children's Hospital Research Institute (Owerko Centre) Calgary Alberta Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2026,1,28]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1017\/CBO9780511816789.016"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1162\/neco_a_01521"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/bies.202000261"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.3390\/e22090921"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1093\/jnen\/nlae057"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1177\/00243639211059245"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.2147\/JPR.S117959"},{"key":"e_1_2_10_9_1","unstructured":"Pain\u2010Capable Unborn Child Protection Act S.61 117th Cong. 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