I wanted to share with you all a story recently published in the New York Times about how pain control is becoming more and more important in pediatric medicine. It wasn’t too long ago when holding children down and just “getting it done” was the common thought process for painful procedure. But more and more hospitals and medical teams are getting on the “no pain” band wagon. This article is another example of how much pain management has changed in even the past 5 years. I remember how just 4 years ago the common response to comfort positioning in our ED was “that’s not a good idea” or “I’m not comfortable with that.” But the last few times I’ve answered a page for an IV start, the medical staff doesn’t even blink an eye when I ask if the child can sit in the caregivers lap. Not only that, but I don’t have to prompt them to grab the numbing spray. Of course, we still have a long way to go. I am very impressed that at Children’s Minnesota uses numbing cream with every child. Numbing cream is generally speaking a better pain management option compared to numbing spray. I would love for our hospital to one day have that same standard.
I really liked how the article gave specific examples for pain management. What people don’t always realize is that there isn’t a perfect pain management solution that works for every person. Some people do well with the numbing cream, while others prefer the spray, and still others need some nitrous oxide. Infants from 0-6 months benefit the best from oral sucrose on a pacifier, but after 6 months of age, the oral sucrose really is not as effective anymore. Additionally, some individuals need to watch the procedure and distraction can actually increase their anxiety. So thrusting a light spinner or a tablet in front of their faces is not the most effective way to control their emotional responses. And it is a rare child who benefits from being held down. The only instances where I would be inclined to advocate for wrapping a child is if it’s an infant who calms with swaddling or a child with sensory needs that include strong pressure.
If you are a caregiver, I would second Dr. Chambers’ recommendation to speak up for appropriate pain control. I agree that a good starting point is to say “What can be done to manage my child’s pain?” If you are unsure of appropriate pain management choices, a child life specialist is a wonderful professional to consult. If there is not a child life specialist available at the medical establishment, reach out to the closest child life program or see if there is a child life specialist in community practice near by. It is true that the caregiver is the child’s first advocate for their pain control.
Do you have any success stories regarding a patient’s pain control? Post in the comments below! You can read the story in it’s entirety here!
A Little Playfullness 