Management of Pain and Distress in a Paediatric Population

Written by: Dr Deirdre Philbin-  Fellow in Paediatric Emergency Medicine

Written by: Associate Professor Michael Barrett – Department of Emergency Medicine, Children’s Health Ireland. University College Dublin, Children’s Health Ireland at Crumlin

HPN December 2021 Digital – pages 34, 36, 38

Introduction

Most healthcare visits are related to pain as well as distress.

The extensive short and long-term consequences of inadequately treated acute pain have led to universal acceptance that pain management should begin at the earliest opportunity.

Therefore the effective management of pain in children is a priority for patients, parents, and health-care providers.

Current standards recommend simple, timely, sequential processes of recognition, assessment, intervention, reassessment, and maintenance of pain relief.

‘Children’ encompasses an extremely broad group from premature neonates to adolescents.

Age related differences can affect all aspects of pain management. This is including assessment, physiological and pharmacological responses as well as clinical outcomes.

When managing paediatric pain it is important these parameters are took into consideration.

There are numerous perceived barriers to the treatment of pain in children outlined in Table 1. These barriers can mean that paediatric pain is frequently under-recognised and unfortunately, under-treated.

Recognising pain

It is important for healthcare providers to learn how to recognise that a child is in pain.

In the acute setting, behaviour is the main way that infants and preverbal children communicate their pain.

In addition to this, always consider co-existing states that may mimic or exacerbate pain.

A child may present with acute uncontrolled pain (e.g., fracture, appendicitis) or may present with pain due a underlying chronic condition (e.g. sickle cell disease).

The expression of pain in both of these circumstances can be quite different e.g. acute distress vs becoming quieter and more withdrawn. As healthcare providers, we must recognise the pain presentation and then manage it appropriately.

Management of pain

Interventions in pain management should include both non-pharmacological and pharmacological methods.

It must be emphasized that it may not be possible to achieve a completely “pain-free” condition.

Therefore, a realistic target is that the child should be comfortable (or have self-control) with the pain they are experiencing.

Useful online references:

Children’s Health Ireland formulary app

Irish Association of Emergency Medicine Clinical Guideline

Pain Management for Paediatric Emergency Care IAEM-Pain- Management-in-Paediatric- Emergency-Care.pdf

Translating Emergency Knowledge For Kids Pain Treatment 2021-03-16_Pain_Treatment_v2.0.pdf (trekk.ca)

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