Children's pain: a mandate for change.

Andrea L Brennan-Hunter

doi:10.1155/2001/271702

Abstract

There have been tremendous research advances in the past 15 years in knowledge about children's pain, and strategies for recognizing and managing that pain. However, the clinical care of children in pain remains a challenge. Children's pain continues to be frequently unrecognized, dismissed or ineffectively managed. A loud call for change is being voiced by physicians, nurses, children and their families. A review of the literature was conducted to document this issue. Starting with a Medline search of the key word 'child* + pain' and continuing with a snowball technique, articles and resources addressing children's pain were collected. Resources presented or published after 1990 were particularly sought because they theoretically reflect both current knowledge about children's pain and the implementation of this knowledge in practice. Unfortunately, although information on pain is available to help children, in many instances, it is not being used. The purpose of the present paper is twofold - to present an overview of current knowledge of children's pain, and factors that hinder its effective assessment and management; and to present a mandate for change. Children's postoperative pain is highlighted in this paper as an example of the gap between pain knowledge and clinical practice. Although treatment strategies differ across different types of pain, children's conditions and ages, the principles and mandate for change discussed in this paper are directly relevant to all categories of children's pain.

Highlights

Many of the needed changes are, small adjustments to care that are already being provided
· Romsing and Walther-Larsen [128] found that 29% of the parents in their study reported that their child had experienced “unbearable severe pain” during the 24 h following surgery; nine of the 16 children interviewed on the second postoperative day reported that they had pain
Parents of 115 of 189 (61%) children reported that their child had significant pain one day after the surgery

Summary

Introduction

Many of the needed changes are, small adjustments to care that are already being provided. In establishing clinical practice standards for institutions, health professionals, as individuals and as groups, can systematically and regularly assess and document children’s pain; become more knowledgeable about pain relief regimens being used in respective institutions, and how these regimens can be maximized within individual practices and disciplines; facilitate communication among disciplines involved in each child’s care; and, as indicated, organize policy changes to ensure an ongoing, comprehensive approach to children’s pain

Objectives

Findings

Conclusion