A provincial-wide online survey was conducted to: 1) ascertain frequency of use of breastfeeding (BF), skin-to-skin care (SSC) and sucrose for pain reduction during heel lance and venipuncture in maternal newborn units and neonatal intensive care units (NICUs), and 2) to identify barriers to using these strategies for pain reduction. An invitation and link to an electronic survey were emailed to nurse managers of 91 maternal newborn units and NICUs in Ontario, Canada, and 40 completed surveys were submitted (44%). Results showed variable but infrequent use of pain reduction strategies. Barriers were coded as health care provider (HCP), infant, parent and organizational factors. Most barriers related to BF and SSC and included: preference to perform blood sampling without parents; parental preference to not be involved during blood sampling; unit cultures; out of date policies; insufficient time, knowledge and education; and staff being uncomfortable performing blood sampling with infants BF or held SSC. (C) 2015 Elsevier Inc. All rights reserved.