Young Children and Pain
What you can do to increase your child’s comfort during medical procedures.
by Christine Ramos, RN, BSN, CCE

PARENTGUIDE News March 2006

All parents, at one time or another, have gone through it. Whether because our baby is undergoing circumcision, being treated in the emergency department of a local hospital or even receiving routine vaccinations, we as parents have likely felt utterly helpless as our children experience the pain of medical procedures. Some of us look away during our child’s procedures; others cry with them. And still yet, some of us get so upset when our child is hurting that we lash out at the person who’s trying to help them.

Within the last ten years, there has been increased awareness and action taken when it comes to pain and young children. No longer is it believed that infants and children can’t feel pain. In fact, evidence has indicated quite the contrary to be true. Research has shown that not only do they feel pain but when their pain is not adequately addressed, they can become more sensitive to pain in the future. And Post-traumatic Stress Disorder, (a psychological condition caused by a traumatic experience that is evidenced by sleep disturbances, anxiety, flashbacks, tiredness and depression), has also been seen in children who did not receive appropriate pain control or sedation during painful medical procedures. Within the healthcare field, a thorough pain assessment is now as important as the assessment of the other vital signs including blood pressure, respirations, pulse and temperature.

What You Can Do To Ease Your Young Child’s Pain and Anxiety
• Routine Pediatric Procedures (Vaccinations, Drawing Blood, Finger Lancing, etc.)
Always discuss the appropriateness and safety of any treatment with your child’s medical practitioner before taking any advice from this article. There are numerous conditions that may prevent the use of any of the following suggestions.
Before a procedure: If you know that your office visit to the pediatrician entails either your child receiving vaccinations or blood drawing, there are a couple of things you can conveniently do yourself before heading out. You may, with your doctor’s approval, pre-medicate your child for vaccinations with both acetaminophen (Tylenol) and a topical lidocaine or benzocaine based anesthetic like LMX4. LMX4 is a topical cream with four percent lidocaine and is available without a prescription at most pharmacies. It can be applied to the injection site 30 minutes before the procedure. The lidocaine topical cream acts to numb the area where the needle will be inserted and the acetaminophen will address any discomfort which may occur within the four hours after the procedure. Additional doses of acetaminophen may be administered as directed by your pediatrician. The lidocaine topical cream can also be used prior to your child having to get his or her blood drawn.

During a procedure: If possible, you can offer your child a pacifier or for women who are breastfeeding, they may offer to nurse during uncomfortable procedures. Sucking has long been known to soothe young children and close contact with the child’s mother adds to the analgesic effect.

Many pediatric offices now have a skin vapo-coolant spray that can be used just before administering an injection. It works to cool, and thus dull the sensation of the prick of a needle. Ask your pediatrician if he has this mollifying item in his office, and it can then be used instead of the lidocaine cream for topical relief of pain.

But perhaps just as important, if not more, is the comforting presence of you, the parent. If possible, hold your child and speak in reassuring tones that will soothe and calm him. This may not decrease his pain, but it will certainly decrease any distress he may experience during the procedure.

After a procedure: As mentioned earlier and with your doctor‘s approval, you may administer an oral analgesic like acetaminophen to decrease any soreness or unpleasant side effects from immunizations, other shots or procedures. Try to be mindful of where your child got his injections and avoid putting pressure on the site. Monitor the site of a procedure, including injections, for excessive swelling or bruising and/or oozing of any kind. Call your practitioner with any concerns.

•Emergency Room and Hospital Inpatient
As mentioned, some of the changes we can expect to see have to do with helping reduce anxiety as well as pain for our children who require hospital care. It has been suggested that pediatric areas have a calming, child-friendly environment with colorful walls, pictures on the ceiling, and a collection of toys and games. Distraction as a means of managing a child’s stress may involve the usage of a bubble blower, light wands and imagery projectors. And hospital staff may increasingly allow family members to be present during potentially painful procedures as it is known that doing so decreases anxiety and stress for both the child and the family member(s).

Of special note is the fairly recent finding of something so simple though very effective when it comes to the delicate pain management of young children— sugar. Studies have shown that dipping a pacifier in a solution of 24 percent sugar water can have a similar effect to that of an opioid drug. (Opioids are powerful pain medicines such as Morphine and Demerol). However, eliminated are the undesirable side effects of these drugs like respiratory depression, oversedation and low blood pressure. In fact, the use of sucrose for pain relief in infants is now becoming common in hospitals because of its safety and effectiveness.

Children of all ages feel pain. In fact, research has shown that a 20 to 22-week-old fetus has the ability to experience pain. And it was only until the last five or so years that infants received some pain relief for such agonizing procedures as circumcision. What is painful or stressful to you as an adult is just as, or perhaps even more so, for young children. The difference lies in the ways we each show that pain and distress. My only question now is— what took so long?

Christine Ramos, RN, BSN, CCE, is a registered nurse and certified childbirth educator, with experience in the specialties of high-risk antepartum and maternal/child health. In addition to writing articles on parenting, Ramos offers private classes in childbirth preparation, breastfeeding and services in postpartum care in the Nassau and Eastern Queens areas of New York. Her first book, entitled A Journey Into Being. A Guide to Knowing Our Children As Spirit and How To Nurture Their Inner Being will be due out in winter of 2006. Ramos is the mother of three children; two boys ages 14 and 11 and a girl age 3. Her Web site is www.Intuitivenurturing.com.