Pediatric Pain Management



Pediatric Pain Management


Suzan Schneeweiss



Introduction



  • There is a lack of recognition and treatment of pain in children.


  • Pain relief for adult patients in the emergency department (ED) is 73% versus 53% for children.



    • Younger preverbal children generally receive less analgesics than older children.


  • Medical procedures in the ED are often painful, unexpected, and heightened by stress and anxiety.


  • Use of analgesic agents allows child to be more comfortable and improves cooperation during diagnostic evaluation.


  • Appropriate management of pain reduces negative long-term effects of pain which include:



    • Conditioned anxiety response.


    • Increased response to pain with subsequent procedures.


    • Diminished analgesic response at subsequent visit.


    • “Blood-injection-injury phobia,” which affects up to 25% of adult population.


Pain Assessment





  • Need to consider the following with a careful pain assessment:



    • Age of child.


    • Developmental level.


    • Cognitive and communication skills.


    • Previous pain experiences.


    • Associated beliefs.


  • Pain history: location, intensity, quality, duration, frequency, duration, and aggravating and relieving factors.


  • Pain assessment and documentation improves administration of analgesics.


Three Main Methods Are Currently Used to Measure Pain Intensity



  • Self-report – considered gold standard.



  • Behavioral measures



    • Crying, facial expressions, body postures, and movements.


    • Generally used with neonates, infants, and younger children where communication is difficult.


  • Physiologic measures



    • Heart rate, blood pressure, respiration, oxygen saturation, palmer sweating, and sometimes neuroendocrine responses.


    • Similar physiological responses occur during stress, which result in difficulty distinguishing stress versus pain responses.


Developmental Issues



  • Children have pain words by 18–24 months (e.g., “hurt,” “ow,” “ouch”).


  • Word “pain” appears much later in children’s vocabularies.


  • Children can report degree of pain by 3–4 years.


  • Children >6 years can provide detailed descriptions of pain intensity, quality, and location.


Pain Scales (See Chapter 13)


FLACC (Face, Legs, Activity, Cry, Consolability)



  • For infants and children ages 2 months–7 years and cognitively impaired.










Table 22.1: FLACC scale for pain assessment


































Category 0 1 2
Face No particular expression or smile Occasional grimace or frown, withdrawn, disinterested Frequent to constant quivering chin, clenched jaw
Legs Normal position or relaxed Uneasy, restless, tense Kicking, or legs drawn up
Activity Lying quietly, normal position, moves easily Squirming, shifting back and forth, tense Arching, rigid or jerking
Cry No cry (awake or asleep) Moans or whimpers; occasional complaint Crying steadily, screams or sobs, frequent complaints
Consolability Content, relaxed Reassured by occasional touching, hugging, or being talked to, distractible Difficult to console or comfort
Each of the five categories is scored from 0–2, which results in a total score of 0–10.
From Merkel SI, Voepel-Lewis T, Shayevitz JR, Malyvia S. The FLACC: a behavioral scale for scoring postoperative pain in young children. Pediatr Nurs 1997;23(3):293–297.



Pain Word Scale



  • For children ages 3–7 years and older children unable to use numerical rating scale.


  • “None,” “a little,” “medium,” and “a lot.”


Faces Pain Scale-Revised (FPS-R)



  • For ages 5–12 years (Figure 22.1).



    • Point to the face that shows how much you hurt. Score the chosen face 0, 2, 4, 6, 8, or 10, so “0” = no pain and “10” = very much pain.






Figure 22.1: Faces scale for pain assessment.


Numerical Rating Scale



  • For children >7 years.


  • Numerical scales from 0–10 or 0–100.


Nonpharmacologic Measures for Pain Management

Aug 1, 2016 | Posted by in ANESTHESIA | Comments Off on Pediatric Pain Management

Full access? Get Clinical Tree

Get Clinical Tree app for offline access