Pain Management In Children

GENERAL INFORMATION:

What is pain? Pain is an unpleasant feeling and emotional experience related to injury or damage to your child's body. It is the most common complaint your child has when he is injured or hurt. It helps your child avoid more injury by warning him of the presence of a harmful thing. Pain may be expressed with actions, such as crying, or told directly by your child. It is a feeling which is different from one child to another. What may be painful to your child may not be painful to other children. Pain may be acute (sudden) or with a short duration that may last from a few days to a few weeks. Pain lasting for more than several weeks to months is known as chronic pain.

What may cause my child's pain? Your child's pain usually results from trauma or damage to a part of the body. It may also be caused by any of the following:

• Disease: Pain may be a signal that there is an ongoing disease or damage to an organ in your child's body. Long term conditions, such as cancer or damage to the nerves and immune (defense) system, may produce pain. Your child having chemotherapy treatments may experience more severe (bad) pain.
  
  
• Medical procedure or surgery: This may include immunizations, blood tests, circumcision, dental care, or repair of a wound. Major surgical procedures may cause more pain and may need pain control after the surgery. Intravenous lines, tubes, and drains may also add more pain.
  
  
• Physical injury: This may include bumps, bruises, cuts and falls.

How will I know if my child is in pain? Children who can talk may tell you exactly the location, intensity (how bad), and even the duration of the pain. Babies and very young children may have trouble saying what they really feel. Knowing they are in pain may be very hard for you. Some children may deny pain to show courage or to escape treatment. Pain may be known by observing behavioral changes in your child. These behavioral changes may include any of the following:

• Crying in a high-pitched sound most of the time.
  
  
• Not changing position very often to avoid the pain or positions himself in a way that it will not hurt.
  
  
• Poor feeding, appetite, or eating habits.
  
  
• Restlessness, cannot get comfortable, and moves around a lot.
  
  
• Pulls the part of his body that is hurting away from your touch or gets upset at being touched.
  
  
• Sleeps more or sleeps less than usual.
  
  
• Touches, tugs, rubs, or massages the part of his body that is painful.

What is a pain scale? A pain scale is a tool used by your child's caregiver to measure the level of pain. This tool may be used in the emergency room, at bedside during a hospital stay, or in a clinic. Your child's caregiver uses the pain scale together with physiologic and behavioral changes to check for pain. Physiologic changes may include your child's heart rate and blood pressure reading. Your child's caregiver may use any of the following pain scales:

• Body outline tool: Your child marks an X or colors the painful area on a drawing of a child's body. Different colors can be used to quantify the pain.
  
  
• Colored analog scale: Colors are assigned for most or worst hurt, a little less hurt, or no hurt. A number can also be placed on each color.
  
  
• Faces pain scale: This scale consists of 5 to 9 faces, ranging from happy or neutral (no pain) to sad or distressed. Scales may vary in the number of faces, but six faces are usually used. Your child may tell how much pain he has by pointing on the face he chooses. Scores are easily compared to a visual analog pain scale.
  
  
• Oucher scale: A vertical numerical scale from 10 to 100 for children who can count. The numbers have a corresponding vertical picture scale of expression of no hurt to worse hurt.
  
  
• Poker chip tool: Four poker chips are used. One chip represents a little hurt and four chips is the most hurt your child could experience.
  
  
• Visual analog pain scale: This is a 10 centimeter line scale with one end marked no pain and the other end worst pain. This method may be used in children as young as seven years old.

Why is pain control important? Pain can affect your child's appetite (ability or desire to eat) and how well he sleeps. It may also affect his energy and ability to do things. Pain may also change your child's mood (how he feels about things) and relationships with others. If caregivers can help control your child's pain, he will suffer less and can even heal faster.

What medicines are used to control pain? Medicines for pain work on the nervous system to help your child feel less pain. Almost all types of pain may be controlled with medicine and other treatments. Sometimes getting your child's pain to go away completely may be hard. Decreasing your child's pain level so he can be comfortable doing everyday things may be needed. Your child may be given any of the following:

• Analgesics: These medicines may include acetaminophen and morphine. It may be taken every 4 to 6 hours for mild to moderate pain. Morphine is given to provide longer control of pain.
  
  
  • Patient controlled analgesia (PCA): A device is used to give your child pain medicine. This device has an electric pump connected by a tube to an IV line. The IV tube is placed in your child's vein usually in the arm. Your child receives medicine from the pump through the tube when he is in pain. Ask your child's caregiver for more information about PCA.
    
    
  
  
• Anesthesia: Anesthesia is numbing medicine to control pain and make your child comfortable. This works by blocking the pain signals from the nerves.
  
  
• Non-steroidal anti inflammatory drugs (NSAIDS): This medicine may be given to decrease inflammation which is redness, pain, and swelling. It is used for mild to moderate pain control, such as pain coming from a pulled tooth. It may also be used in controlling pain after surgery.

How can I help my child in pain? The best way to decrease pain is to treat the cause of the pain. Do the following to help your child in pain:

• Always tell your caregiver if your child's pain gets worse. Your child's caregiver will tell you how much medicine to give your child and how often. Give the medicine regularly as directed by your caregiver.
  
  
• Do not wait until your child's pain is too severe. The medicine may not work as well at controlling the pain if you wait too long to give it.

What are the unwanted side effects of pain medicines? Giving your child medicines to control pain may have some unwanted side effects. Your child may have any of the following:

• Irregular heartbeats and seizures (convulsions).
  
  
• Nausea (upset stomach), vomiting (throwing up), or constipation (dry, hard bowel movement).
  
  
• Pain in the lower abdomen or problems passing urine.
  
  
• Pruritus (itchiness of the skin).
  
  
• Trouble breathing.

CARE AGREEMENT:

You have the right to help plan your child's care. To help with this plan, you must learn about your child's health condition and how it may be treated. You can then discuss treatment options with your child's caregivers. Work with them to decide what care may be used to treat your child.

Copyright © 2008 Thomson Healthcare Inc. All rights reserved. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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