Pain management in children
Current state of affairs
- Parents have a tendency
- to deny the pain
- or to communicate their anxiety and stress to the child
- The child
- wishes to be reassured before and after the care
- presence of the mother
- empathy of the practitioner
- would like to be more informed on the care
- The practitioner
- denies pain
- or does not communicate sufficiently
- with the parents
- with the child
Medical acts where pain intervenes
- Vaccines and blood samples (distresses, stress anticipator).
- Removal of bandages.
- Otitises (sounding).
- Care in physiotherapy (where pain forms an integral part of treatment).
Why deal with the pain of the child in the care
- 18-24 months
- Vulnerable to pain: no possible verbalisation.
- 3-7 years
- described as a rebellious age (rejection of care),
- expresses pain spontaneously (tears...) from where the assumption that if there is pain, the child will express himself.
- are more flexible: easy to reason on the "validity of the care",
- are in phase of interiorisation, which complicates the expression of pain.
- are autonomous: facilitate relation patient/practitioner,
- have a decency to express their pain.
Means to evaluate pain
Evaluation techniques and tools
- Intuition is used most of the time in the evaluation of pain, but there are tools for practitioners :
- verbal scale,
- analog scale (smiling or sad face),
- numerical scale (from 1 to 10).
- For parents
- they use their intuition
- they analyse the behaviour of their child
Limits of the means
- Inaccuracy (scales, intuition).
- Not very qualitative (scales).
- Analgesics :
- Anaesthetic cream or patch,
- Nonsteroidal anti-inflammatories.
- Paracetamol (after vaccine).
- Psychological care:
- to reassure,
- to explain,
- to encourage.
The relation parent/child/practitioner
- a difference in the evaluation of pain by the child compared to that of the parents or the practitioner,
- a difference in evaluation between the relative and the practitioner.
- To mitigate ideological cleavage between parents/practitioner on the evaluation of the child's pain.
- To work with the parents and the practitioners.
- Promote the fact that pain is "a total phenomenon": to surpass the differences between physical suffering and psychological suffering.
- To inform in a didactic way:
- on pain,
- on the means of evaluation,
- on antalgic products.
- To use easy tricks to diminish the pain:
- reduce standby time (limited nervousness and anxiety),
- put the child at ease,
- a distracting dialog,
- have games, colouring pens at the child's disposal, etc, during the consultation,
- make the child feel at ease with the medical tools,
- hide the preparation, the instruments,
- active participation of the relative,
- words of encouragement, empathy,
- to promise a small reward.
Photographic copyright: Beatricekillam | Dreamstime.com
Prise en charge de la douleur chez l'enfant
Cómo calmar el dolor del niño