Pain management in children

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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).
  • Stitches.
  • 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.
  • 7-12
    • are more flexible: easy to reason on the "validity of the care",
    • are in phase of interiorisation, which complicates the expression of pain.
  • 12-15
    • 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
      • cries
      • grimaces

Limits of the means

  • Inaccuracy (scales, intuition).
  • Not very qualitative (scales).

Managing pain


  • Analgesics :
    • Anaesthetic cream or patch,
    • Nonsteroidal anti-inflammatories.
  • Paracetamol (after vaccine).
  • Codeine.
  • Psychological care:
    • to reassure,
    • to explain,
    • to encourage.

The relation parent/child/practitioner


There is:
  • 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.

Recommandations

  • 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.

Sources


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