21 September 2010
Diagnosis and treatment of pain in children can be extremely difficult. For a small child that cannot yet speak, it may be nearly impossible to know that the child is in pain and what it may be caused by. Children may flinch away from contact, cry (with or without tears), may be unable to be comforted, and may make facial expressions that indicate they are feeling pain. Detecting pain in children often mostly depends on what an observer can report. Even if the child is older and is capable of telling their parents they suffer from chronic pain, they may shy away from doing so, as they don’t want to be taken in for a doctor’s visit or do not want to place stress on their parents. Another issue that may arise is that a physician may be so concentrated on trying to treat and find the causation of the child’s pain that the actual pain goes untreated.
Chronic pain in a small child is physically and emotionally taxing not only on the child but on their parents and family as well. Many parents may prefer for children to manage their pain non-pharmacologically, and look for techniques they will be able to implement at home. These techniques can be used independently or along with medication treatments. For infants, swaddling, skin-to-skin contact, a pacifier and oral sucrose have been shown to calm the infant down and seem to relieve some or all of their pain. Once the child reaches the age of a toddler, they can often be distracted from their pain using techniques such as the child’s favorite television show or movie, a simple game, and the like. Distraction techniques are thought to be effective, as it takes the child’s focus off the pain, and seems to lower the level of “perceived pain” by the child. Parents may be taught to use hypnosis on their small child in a clinical setting, and then may feel compelled to practice this technique at home.
Older children may be able to be taught and then to utilize relaxation techniques and deep breathing exercises, which have a similar purpose to distraction techniques used in younger children, but have the dual purpose of training the child to effectively manage their pain.
Pharmacologic techniques may be necessary in conjunction with the aforementioned therapies and treatments. While many treating physicians are not sure exactly why, sucrose and glucose tablets have been found to be efficacious in treating mild pain in infants and small children. Acetaminophen is one of the most common medicines for children, as it is mild and has minimal side-effects. Aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) as their usage is linked to the onset of Reye’s syndrome in children. As a child ages, however, the likeliness of this dangerous side-effect does go down in percentage.
Some medical treatments used on adults can be effective for children. For example, use of a transcutaneous electrical nerve stimulator (TENS) ma y aid in pain relief. Massage, the use of biofeedback, and positive reinforcements from family members may also aid in pain relief for children. It is recommended that pain management be administered with the goal of helping the child regain function and normalcy in their life.
References:
Raj, (2008) Raj’s Practical Management of Pain.415. (Benzon, Rathmell, Wu, Turk, Argoff Eds.)Philadelphia: Mosby Elsevier
American Pain Society Website
www.ampainsoc.org
