Recent concepts in understanding a child's pain

1991 ◽  
Vol 81 (5) ◽  
pp. 231-242 ◽  
Author(s):  
KT Mahan ◽  
DC Strelecky
Keyword(s):  
Pain Management ◽  
Pain Assessment ◽  
Psychological Aspects ◽  
Pediatric Pain ◽  
Complex Process ◽  
Assessment Techniques ◽  
Children's Pain

The management of pain in children is a complex process that has significant differences from adult pain management. The authors describe the myth of children's lack of pain and how that myth has resulted in frequent undermedication of children's pain. The authors describe the physical and psychological aspects of pain. Assessment techniques for more accurately determining pain in children are also described. The authors conclude with a description of pharmacologic aspects of pediatric pain management.

Dynamics on the field: A focused ethnographic study of pediatric pain management at four Ghanaian hospitals

2020 ◽  
Author(s):  
Abigail Kusi Amponsah ◽  
Evans Oduro ◽  
Victoria Bam ◽  
Joana Kyei-Dompim ◽  
Collins Kwadwo Ahoto ◽  
...  
Keyword(s):  
Pain Management ◽  
Pain Assessment ◽  
Management Practices ◽  
Participant Observation ◽  
Symbolic Capital ◽  
Ethnographic Study ◽  
Pediatric Care ◽  
Pediatric Pain ◽  
Improvement Programs ◽  
Children's Pain

Abstract BackgroundAs part of efforts to develop and implement a short course educational program on pediatric pain management, the current study sought to understand the culture and contextual factors that influence children’s pain management in order to improve the practice in pediatric care settings.MethodsGuided by Bourdieu’s theory of practice, a focused ethnographic study was conducted from October, 2018 to February, 2019. The study was contextualized at four Ghanaian hospitals among purposefully sampled nurses, physicians, hospitalized children and their families. During the 20-week study period, three ethnographers spent 144 hours conducting participant-observation sessions. Formal and informal interviews were held with participants in addition to review of hospital records. Results Analysis of the field data resulted in four themes. “Children’s pain expression and response of caregivers” described the disposition (habitus) of both children and caregivers to act in particular ways due to children’s incomplete health status (bodily capital) which caused them pain and also resulted in discomforting procedures. “Pharmacological pain management practices and attitudes” elucidated the use of analgesics as the mainstay disposition (habitus) in children’s pain management due to high level of respect (symbolic capital) given to such interventions on the pediatric units (field). “Managing pain without drugs” illustrated healthcare providers and family caregivers’ disposition (habitus) of using diverse nonpharmacological methods in managing children’s pain. “Communication and interaction between pain actors” depicted how children’s access to care givers (social capital) can serve as a powerful tool in influencing pediatric pain assessment and management disposition (habitus) on the pediatric units (field). ConclusionsThe habitus of pediatric pain actors toward pain assessment and management practices are influenced by various forms of capital (social, cultural, symbolic, bodily and economic) operating at different levels on the pediatric care field. Quality improvement programs that seek to enhance pediatric pain management should use the insights obtained in this study to guide the development, implementation and evaluation stages.

scholarly journals Dynamics on the field: a focused study on the culture and context of pediatric pain management at four Ghanaian hospitals

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Abigail Kusi Amponsah ◽  
Evans Oduro ◽  
Victoria Bam ◽  
Joana Kyei-Dompim ◽  
Collins Kwadwo Ahoto ◽  
...  
Keyword(s):  
Pain Management ◽  
Pain Assessment ◽  
Management Practices ◽  
Participant Observation ◽  
Symbolic Capital ◽  
Ethnographic Study ◽  
Pediatric Care ◽  
Pediatric Pain ◽  
Improvement Programs ◽  
Children's Pain

Abstract Background As part of efforts to develop and implement a short course educational program on pediatric pain management, the current study sought to understand the culture and contextual factors that influence children’s pain management in order to improve the practice in pediatric care settings. Methods Guided by Bourdieu’s theory of practice, a focused ethnographic study was conducted from October, 2018 to February, 2019. The study was contextualized at four Ghanaian hospitals among purposefully sampled nurses, physicians, hospitalized children and their families. During the 20-week study period, three ethnographers spent 144 h conducting participant-observation sessions. Formal and informal interviews were held with participants in addition to review of hospital records. Results Analysis of the field data resulted in four themes. “Children’s pain expression and response of caregivers” described the disposition (habitus) of both children and caregivers to act in particular ways due to children’s incomplete health status (bodily capital) which caused them pain and also resulted in discomforting procedures. “Pharmacological pain management practices and attitudes” elucidated the use of analgesics as the mainstay disposition (habitus) in children’s pain management due to high level of respect (symbolic capital) given to such interventions on the pediatric units (field). “Managing pain without drugs” illustrated healthcare providers and family caregivers’ disposition (habitus) of using diverse nonpharmacological methods in managing children’s pain. “Communication and interaction between pain actors” depicted how children’s access to care givers (social capital) can serve as a powerful tool in influencing pediatric pain assessment and management disposition (habitus) on the pediatric units (field). Conclusions The habitus of pediatric pain actors toward pain assessment and management practices are influenced by various forms of capital (social, cultural, symbolic, bodily and economic) operating at different levels on the pediatric care field. Quality improvement programs that seek to enhance pediatric pain management should use the insights obtained in this study to guide the development, implementation and evaluation stages.

scholarly journals Canadian Emergency Medicine Residents’ Perspectives on Pediatric Pain Management

CJEM ◽  
2015 ◽  
Vol 17 (5) ◽  
pp. 507-515 ◽  
Author(s):  
Huma Ali ◽  
Janeva Kircher ◽  
Christine Meyers ◽  
Joseph MacLellan ◽  
Samina Ali
Keyword(s):  
Emergency Medicine ◽  
Pain Management ◽  
Online Survey ◽  
Oral Morphine ◽  
Management Approach ◽  
Developmentally Delayed ◽  
Pediatric Pain ◽  
Graduate Curricula ◽  
Facilitators And Barriers ◽  
Children's Pain

AbstractBackgroundUnder-treatment of children’s pain in the emergency department (ED) can have many detrimental effects. Emergency medicine (EM) residents often manage pediatric pain, but their educational needs and perspectives have not been studied.MethodsA novel online survey was administered from May to June 2013 to 122 EM residents at three Canadian universities using a modified Dillman methodology. The survey instrument captured information on training received in pediatric acute pain management, approach to common painful presentations, level of comfort, perceived facilitators, and barriers and attitudes towards pediatric pain.Results56 residents participated (46%), 25 of whom (45%) indicated they had not received any training in pediatric pain assessment. All levels of residents reported they were uncomfortable with pain assessment in 0-2 year olds (p=0.07); level of comfort with assessment increased with years of training for patients aged 2-12 years (p=0.02). When assessing children with disabilities, 83% of respondents (45/54) indicated they were ‘extremely’ or ‘somewhat’ uncomfortable. Sixty-nine percent (38/55) had received training on how to treat pediatric pain. All residents reported they were more comfortable using pain medication for a 9 year old, as compared to a 1 year old (oral oxycodone p<0.001, oral morphine p<0.001, IV morphine p=0.004). The preferred methods to learn about children’s pain management were role-modeling (61%) and lectures (57%). The top challenges in pain management were with non-verbal, younger, or developmentally delayed patients.ConclusionCanadian EM residents report receiving inadequate training in pediatric pain management, and are particularly uneasy with younger or developmentally disabled children. Post-graduate curricula should be adjusted to correct these self-identified weaknesses in children’s pain management.

Considerations for neonatal and pediatric pain management

2019 ◽  
Vol 76 (19) ◽  
pp. 1511-1520 ◽  
Author(s):  
Pooja Shah ◽  
Anita Siu
Keyword(s):  
Pain Management ◽  
Acute Pain ◽  
Pain Assessment ◽  
Pediatric Patients ◽  
Safety Data ◽  
Clinical Situation ◽  
Assessment Tools ◽  
Patient Specific ◽  
Pediatric Pain ◽  
Unique Challenge

Abstract Purpose Current literature and clinical practice guidelines on pediatric pain management are reviewed. Summary Acute pain is commonly present in neonatal and pediatric patients due to underlying disease states or procedures. Especially in institutions with limited pediatric pain services, it is imperative to describe the appropriate management of pain and pharmacotherapy options that are effective and safe in pediatric patients. Despite the knowledge of pain being an important aspect in the management of children, barriers exist, leading to suboptimal treatment. Addressing these barriers through education of healthcare practitioners, families, and patients will lead to optimizing the patient pain experience. Tools for pain assessment vary depending on the type of pain, the child’s age and understanding of pain, and the clinical situation. Pharmacotherapy options for pain management in neonates and pediatric patients include opioid and nonopioid agents. Efficacy and safety data on the use of medications for the treatment of pain in pediatric patients is described. The delivery of medication encompasses patient-specific factors and preferences. Strategies for opioid stewardship and management of iatrogenic withdrawal pose a unique challenge in pediatric patients. Conclusion The management of acute pain in neonates and pediatric patients should be a priority for all practitioners caring for these patients. Use of age-appropriate pain assessment tools and understanding of the mechanisms of action and roles in therapy of various nonopioid and opioid therapies can help optimize treatment of pain in neonatal and pediatric patients.

scholarly journals NON - PHARMACOLOGICAL PAIN MANAGEMENT IN POSTOPERATIVE CARE OF SCHOOL - AGE CHILDREN

2017 ◽  
Vol 27 (6) ◽  
pp. 71-79
Author(s):  
Svajūnė Goštautaitė ◽  
Viktorija Piščalkienė ◽  
Sari Laanterä ◽  
Leena Uosukainen
Keyword(s):  
Pain Management ◽  
Pain Assessment ◽  
Assessment Methods ◽  
School Age Children ◽  
School Age ◽  
Structured Interviews ◽  
Parental Assessment ◽  
Subjective Pain ◽  
Data Content ◽  
Children's Pain

The aim of this study was to evaluate children‘s postoperative pain assessment and management methods applied in practice by nurses from Lithuania and Finland. Methods. Individual in - depth semi - structured interviews by non - probabilic snowball (network) and purposive sampling, data content analysis. 20 nurses in Lithuania and 5 nurses in Finland, who work at pediatric surgical and pediatric wards, where children after surgeries are treated. Results. The research has shown differences between postoperative school - age children‘s pain management practise by Lithuanian and Finnish nurses. Lithuanian nurses use smaller variety of these methods than nurses from Finland. All nurses agree that non - pharmacological children pain management is effective and useful. Conclusions. The usage of subjective and objective pain assessment methods by Finnish and Lithuanian nurses is similar, just Lithuanians mostly trust subjective verbal and objective behavioral, appearance pain assessment methods, whereas Finnish combine and use all the subjective pain assessment methods like verbal, parental assessment and using scales as well as objective behavioural assessment. There is a difference between pain management practise by Finnish and Lithuanian nurses. Finnish nurses evenly use all of non - pharmacological methods, whereas Lithuanian nurses mostly trust on physical and rehabilitation methods as well as communication.

scholarly journals Balancing Knowledge Among Resident Specialties: Lecture-Based Training and the OUCH Card to Treat Children's Pain

2010 ◽  
Vol 2 (1) ◽  
pp. 73-80 ◽  
Author(s):  
John M. Saroyan ◽  
William S. Schechter ◽  
Mary Ellen Tresgallo ◽  
Adrienne G. Pica ◽  
Matthew D. Erlich ◽  
...  
Keyword(s):  
Acute Pain ◽  
Pain Assessment ◽  
Clinical Care ◽  
Assessment Tools ◽  
Repeated Measure ◽  
Pediatric Pain ◽  
Convenience Sample ◽  
Assessment And Treatment ◽  
Children's Pain ◽  
Resident Learning

Abstract Background There are well-established deficiencies in residents' knowledge of acute-pain assessment and treatment in hospitalized children. Methods Among residents in 3 specialties (anesthesiology, orthopedics, and pediatrics), we investigated whether a pediatric pain management (PPM) curriculum that offered a lecture combined with a demonstration of how to use the OUCH card would yield higher performance on a subsequent PPM knowledge assessment. The OUCH card was created as a portable reference tool for trainees to provide analgesic dosing information, pain-assessment tools, and treatment of opioid-induced adverse effects. There was an initial convenience sample of 60 residents randomized to Form A or B of the pretest. From this, 39 residents (15 anesthesiology, 13 orthopedic, 11 pediatric) completed a PPM knowledge posttest approximately 4 weeks after the pretest, PPM lecture, and OUCH card instruction. Results Using a repeated measure design, the interaction of resident specialty and pretest to posttest scores was significant (P  =  .01) along with the covariate of residency year (P  =  .026). Conclusions These preliminary data based on a convenience sample of residents suggest that PPM training along with use of the OUCH card may help to reduce knowledge differences among residents. Faculty whose clinical practice includes children with acute pain should consider including learning or performance aids like the OUCH card in education and clinical care for its potential benefit in resident learning.

scholarly journals Assessment of Saudi Mothers’ Attitudes towards Their Children’s Pain and Its Management

2021 ◽  
Vol 18 (1) ◽  
pp. 348
Author(s):  
Sultan M. Alghadeer ◽  
Syed Wajid ◽  
Salmeen D. Babelghaith ◽  
Mohamed N. Al-Arifi
Keyword(s):  
Social Sciences ◽  
Pain Management ◽  
Healthcare Providers ◽  
Pediatric Pain ◽  
Cross Sectional ◽  
Web Based ◽  
Awareness Programs ◽  
Children's Pain ◽  
Arabic Speaking

Background and objective: Pain is a bothersome issue that is common among newborns and children of all ages. Pain can be managed using various pharmacological and/or non-pharmacological strategies, which can be delivered by healthcare providers or parents. The aim of this study is to assess the attitude of mothers toward their children’s pain and its management. Methods and materials: A descriptive cross-sectional web-based study was conducted using a developed self-reported questionnaire, from March 2018 to April 2018. Participants involved were Arabic-speaking mothers of children aged between 0 and 12. The data collected included pharmacological and non-pharmacological treatment methodologies utilized to treat pain and the mothers’ attitude towards pain management. Statistical Package for Social Sciences, version 25 was applied to analyze the data, and descriptive statistics were performed. Results: As per the results of this study, the most common site of children’s pain as reported by the mothers was mouth/throat (211; 52.9%), abdomen (199; 49.9%), followed by head (58; 14.5%), and finally, ears (69; 17.3%). The frequency of children’s pain, as stated by the mothers, was less than once a month (196; 49.1%), once in a month (137; 34.3%), and once in a week (48; 12%). The non-pharmacological methods used by mothers at home for the management of their children’s pain were as follows: letting them take rest or sleep (250; 62.6%), feeding them with fluids (228; 57.1%), applying cold packs (161; 40.4%), providing massage therapy (147; 36.8%), using warm packs (141; 35.3%), and taking them to play (119; 29.8%). Conclusion: The misconceptions about pediatric pain management among Saudi mothers that can affect the children’s quality of life are quite noticeable. Implementing educational and awareness programs about the management of child pain could play a major role in making the parents understand the impacts of their misconceptions.

Emergency Medical Services Provider Comfort with Prehospital Analgesia Administration to Children

2014 ◽  
Vol 30 (1) ◽  
pp. 66-71 ◽  
Author(s):  
Amaly Rahman ◽  
Sarah Curtis ◽  
Beth DeBruyne ◽  
Sunil Sookram ◽  
Denise Thomson ◽  
...  
Keyword(s):  
Pain Management ◽  
Emergency Medical Services ◽  
Medical Services ◽  
Clinical Judgement ◽  
Pediatric Pain ◽  
Emergency Medical ◽  
Emergency Medical Services Personnel ◽  
Pediatric Analgesia ◽  
Children's Pain ◽  
The City

AbstractIntroductionThe undertreatment of pediatric pain is a significant concern among families, clinicians, and researchers. Although some have examined prehospital pain management, the deterrents to pediatric analgesia administration by Emergency Medical Services (EMS) have not yet been examined in Canada.ProblemThis study describes EMS pain-management practices and prehospital provider comfort treating pediatric pain. It highlights differences in pain management between adults and children and assesses the potential barriers, misconceptions, difficulties, and needs related to provision of pediatric analgesia.MethodsA study-specific survey tool was created and distributed to all Primary Care Paramedics (PCPs) and Advanced Care Paramedics (ACPs) over four mandatory educational seminars in the city of Edmonton (Alberta, Canada) from September through December 2008.ResultsNinety-four percent (191/202) of EMS personnel for the city of Edmonton completed the survey. The majority of respondents were male (73%, 139/191), aged 26-35 (42%, 80/191), and had been in practice less than 10 years (53%, 101/191). Seventy-four percent (141/191) of those surveyed were ACPs, while 26% (50/191) were PCPs. Although the majority of respondents reported using both pain scales and clinical judgement to assess pain for adults (85%, 162/191) and adolescents (86%, 165/191), children were six times more likely than adults (31%, 59/191 vs 5%, 10/191) to be assessed by clinical judgement alone. Emergency Medical Services personnel felt more comfortable treating adults than children (P < .001), and they were less likely to treat children even if they were experiencing identical types and intensities of pain as adults (all P values <.05) and adolescents (all P values < .05). Twenty-five percent of providers (37/147) assumed pediatric patients required less analgesia due to immature nervous systems. Three major barriers to treating children's pain included limited clinical experience (34%, 37/110), difficulty in communication (24%, 26/110) and inability to assess children's pain accurately (21%, 23/110).ConclusionEmergency Medical Services personnel self-report that children's pain is less rigorously measured and treated than adults’ pain. Educational initiatives aimed at increasing clinical exposure to children, as well as further education regarding simple pain measurement tools for use in the field, may help to address identified barriers and discomfort with assessing and treating children.RahmanA, CurtisS, DeBruyneB, SookramS, ThomsonD, LutzS, AliS. Emergency Medical Services provider comfort with prehospital analgesia administration to children. Prehosp Disaster Med. 2015;30(1):1-6.

scholarly journals PEDIATRIC PROCEDURAL PAIN MANAGEMENT: A REVIEW OF THE LITERATURE

2012 ◽  
Vol 3 (4.1) ◽  
pp. 569 ◽  
Author(s):  
Kristy Petovello
Keyword(s):  
Health Care ◽  
Pain Management ◽  
Health Care Professionals ◽  
Complex Nature ◽  
Pediatric Pain ◽  
Health Seeking ◽  
Health Care Experiences ◽  
Values And Beliefs ◽  
Early Health ◽  
Children's Pain

<p>Research in the last two decades has revealed the complex nature of pain and has thereby improved the understanding, treatment, and management of pediatric pain by health care practitioners. However, a significant gap between knowledge and practice still exists. Pediatric pain remains under-managed. Several themes emerged in this literature review as factors influencing adequate pain management. These include: outdated beliefs about pain management; inconsistent use of evidence-based interventions; difficulties assessing children’s pain; and the role of the values and beliefs of caregivers and practitioners. The literature indicates a high risk of deleterious consequences of under-managed pediatric pain, linking early health care experiences to later health-seeking behaviours. Implications for practice are considerable. Recommendations include: an individualized “3-P” approach combining pharmacologic, physical and psychological strategies; collaborative approaches eliciting expertise from caregivers and health care professionals across multiple disciplines; and utilizing interventions before, during, and after procedures. <strong></strong></p>

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