Neonates experience pain and may be more sensitive to it. Our objective was to assess pain management strategies in Irish neonatal units. We performed a cross-sectional telephone survey of all twenty neonatal units in the Republic of Ireland. Nurse managers or the on call registrar was questioned about their unit's analgesia practices. Four units (20%) had guidelines for neonatal procedural pain management Two units (10%) used the PIPP pain assessment tool. Non-nutritive sucking and swaddling were most popular for minor procedures, but use was infrequent. Eight units (40%) had access to sucrose but use was low in most units. Three units used breast-feeding (15%) for heal lancing, IM injections and venepuncture. Most units (60%) stated emergency situations as the main reason for not using analgesia. Despite growing evidence supporting neonatal pain experience and increased sensitivity, neonates are not often afforded the benefits of intervention in Irish NICUs.