Young Children and Pain

What You Can Do to Increase Your Child's Comfort During Medical Procedures.

All of us parents, at one time or another, have gone through it. Whether because of routine treatments like vaccinations or hospital Emergency Room visits we as parents have likely felt utterly helpless as our children experience the pain of medical procedures. Some of us look away during treatment; others cry with them. And still yet some us get so upset when our child is hurting that we lash out at the person who's trying to help them. I'll never forget how my husband reacted when the E.D. nurse stuck our 3 year old son over and over again with an intravenous needle for treatment of dehydration. He shouted to leave our poor son alone only out of sheer desperation as our boy was screaming out in pain. Gratefully, this kind of scenario is on its way toward change for the better.

Within the last ten years there has been increased awareness and action taken when it comes to pain and young children. No longer is it believed that infants and children can't feel pain. In fact evidence has indicated quite the contrary to be true. Research has shown that not only do they feel pain but when their pain is not adequately addressed they can become more sensitive to pain in the future. And Post-traumatic Stress Disorder, (a psychological condition caused by a traumatic experience that is evidenced by sleep disturbances, anxiety, flashbacks, tiredness, and depression), has also been seen in children who did not receive appropriate pain control or sedation during painful medical procedures. Within the healthcare field a thorough pain assessment is now as important as the assessment of the other vital signs including blood pressure, respirations, pulse, and temperature.

So why haven't our children been adequately protected from pain all these years? As mentioned there was this misconception that they do not feel pain as older children or adults do. Also was the healthcare practitioner's fear of the side effects of certain pain medications. Fear of oversedation, respiratory depression, low blood pressure, addiction, and unfamiliarity with the use of these drugs all played a part in the lack of addressing our children's pain.

What You Can Do To Ease Your Young Child's Pain and Anxiety

Routing Pediatric Procedures (Vaccinations, Drawing Blood, Finger Lancing, etc.)

Before a procedure: If you know that your office visit to the pediatrician entails either your child receiving vaccinations or blood drawing there are a couple of things you can conveniently do yourself before heading out. (*Always discuss the appropriateness and safety of any treatment with your child's medical practitioner before taking any advice from this article. There are numerous conditions that may prevent the use of any of the following suggestions.) * You may, with your doctor's approval, pre-medicate your child for vaccinations with both acetaminophen (Tylenol) and a topical lidocaine or benzocaine based anesthetic like LMX4. LMX4 is a topical cream with 4% lidocaine and is available without a prescription at most pharmacies. It can be applied to the injection site 30 minutes before the procedure. The lidocaine topical cream acts to numb the area where the needle will be inserted and the acetaminophen will address any discomfort which may occur within the 4 hours after the procedure. Additional doses of acetaminophen may be administered as directed by your pediatrician. The lidocaine topical cream can also be used prior to your child having to get his or her blood drawn.

During a procedure: If possible, you can offer your child a pacifier or for women who are breastfeeding they may offer to nurse during uncomfortable procedures. Sucking has long been known to soothe young children and close contact with the child's mother adds to the analgesic effect.

Many pediatric offices now have a skin vapo-coolant spray that can be used just before administering an injection. It works to cool, and thus dull the sensation of the prick of a needle. Ask your pediatrician if she has this nifty item in her office and it can then be used instead of the lidocaine cream for topical relief of pain.

But perhaps just as important, if not more, is the comforting presence of you, the parent. If possible hold your child and speak in reassuring tones that will soothe and calm her. This may not decrease her pain but it will certainly decrease any distress she may experience during the procedure.

After a procedure: As mentioned earlier and with your doctor's approval, you may administer an oral analgesic like acetaminophen to decrease any soreness or unpleasant side effects from immunizations, other shots or procedures. Try to be mindful of where your child got his injections and avoid putting pressure on the site. If you as an adult have ever received a tetanus or penicillin injection you should know the kind of soreness she may be feeling for the next several days. Monitor the site of a procedure, including injections, for excessive swelling or bruising and/or oozing of any kind; call your practitioner with any concerns.

Emergency Department and Hospital Inpatient

The following list will of course serve as a guideline; information of what you may see, expect, or ask for if your child is treated in the Emergency Department or as an inpatient of a hospital. Because of the increased awareness and action when it comes to treating children's pain and anxiety new protocols are being instituted nationwide.

Pediatric areas may have a calming, child-friendly environment with colorful walls, pictures on the ceiling, and a collection of toys and games. Distraction as a means of managing a child's stress may involve the usage of a bubble blower, light wands, and imagery projectors. And hospital staff may increasingly allow family members to be present during potentially painful procedures as it is known that doing so decreases anxiety and stress for both the child and the family member(s).

Of special note is the fairly recent finding of something so simple though very effective when it comes to the delicate pain management of young children. Sugar. Studies have shown that dipping a pacifier in a solution of 24% sugar (sucrose) water can have a similar effect to that of an opioid drug. (Opioids are powerful pain medicines like morphine and Demerol). However, eliminated are the undesirable side effects of these drugs like respiratory depression, over sedation, and low blood pressure. In fact, the use of sucrose for pain relief in infants is now becoming common in hospitals because of its safety and effectiveness.

Children of all ages feel pain. In fact research has shown that a 20 to 22 week old fetus has the ability to experience pain. And it was only until the last five or so years that infants received some pain relief for such agonizing procedures as circumcision. What is painful or stressful to you as an adult is just as, or perhaps even more so, for young children. The difference lies in the ways we each show that pain and distress. My only question now is…what took so long?

Overview of Procedure Type and Possible Pain Interventions: