Social barriers to optimal pain management in infants and children.

Abstract

To examine the social barriers that lead to less than optimal management of pain in children. Recognizing the vulnerabilities of infants and children and their dependence on caring adults, a model of pain communication is proposed. The model examines (a) the pain experiences of children, including social determinants; (b) developmental variations in the capacity to encode the severity and qualities of pain as expressive behavior; (c) adult skills and deficiencies in decoding pain; and (d) the actions of adults predicated on the meaning and significance attached to children's actions. Limitations in care were examined. The current research and professional literature were accessed through searches of the Psyclit and Medline databases for relevant investigations on the basis of our working knowledge of the literature. Numerous deterrents to optimal care are identified in the domains of commonplace beliefs about the nature of pain in infants and children: failure to recognize the impact of socialization in familial and cultural modes of experience and expression; needs for age-specific assessment instruments; the limited capacity to use available evidence concerning pain; the need to employ clinicians, parents, and other adults more effectively in delivering care; and structural problems in the health care system.