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Pain Management in the

Pediatric Patient

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.• Pain is a neurologic response to tissue injury;

Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage.

• Pain is whatever the patient says it is, it cannot be experienced or understood who is experiencing it. by anyone other than the patient

Children must be believed when they say they are in

pain.

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.Part of the reasons for under medication of pain

in the pediatric patient were based on lack of information, inadequate research, fear of respiratory depression, fear of addiction, the belief that children could not tell you where it hurts, and that children do not always tell the truth about pain.

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Physiologic Indicators of Pain

Acute pain stimulates the nervous system and results in physiologic changes, including tachycardia, tachypnea, hypertension, pupil dilatation, pallor and increased perspiration. As the body adapts physiologically, vital signs return to near normal and perspiration decreases after several minutes.

For this reason changes in vital signs are not a reliable indicator of pain in children.

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Developmental characteristics of children in

pain

Young infant 0-6 months• Rigidity, thrashing, localized withdrawal of

stimulated area.• Facial expression of pain (brows lowered

and drawn together, eyes closed tightly, mouth open.

• Demonstrates no association between approaching stimulus and subsequent pain.

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Older Infant (6 months – 1 year)

• Localized body response with deliberate withdrawal of stimulated area.

• Loud crying• Facial expression of pain and or anger.• Physical resistance, especially pushing away

the stimulus away after it is applied

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.Young Child• Loud crying & screaming• Verbal expressions of “your hurting me” “OW” “Ouch”• Thrashing of arms & legs• Attempts to push stimulus away before it is applied• Uncooperative, needs physical restraint• Requests termination of procedure• Clings to parent, nurse or other person• Requests emotional support, like hugs, hand holding• May become restless and irritable with

continuing pain• All of these may be seen in anticipation of actual

procedure

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School aged child• May see all behaviors of the young child,

especially during the actual procedure, less seen in anticipation

• Stalling behavior “in one minute”, “I’m not ready”

• Muscular rigidity, clenched fists, gritted teeth, contracted limbs, closed eyes, wrinkled forehead

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Adolescent• Less vocal protesting• Less motor activity• More verbal expressions• Increased muscle tension and

body control

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Behavioral indicators of acute pain:

• Children in acute pain behave in many of the same ways as children who show signs of fear and anxiety. These behaviors include:– Restless, agitated, hyperalert.– Child is difficult to distract.– Irritability, difficult to comfort.– Posturing, remaining immobile, protecting painful

areas.– Drawing up knees, flexing limbs.– Anorexia.– Lethargy, withdrawal, being quiet.– Sleep disturbances

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Nursing Assessment of Pain in Children

Questt pain assessment:– Question the child.– Use a pain rating scale– Evaluate behavioral and physiologic

changes.– Secure parents involvement.– Take the cause of pain into account.– Take action and evaluate results.

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Wong Baker Pain Scale

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.• Children’s verbal statements and description

of pain are the most important factors in assessing pain. Children might not know what the word “PAIN” means, and may need help describing it. The nurse can use a variety of phrases to help the child express the pain such as “boo-boo,” hurt, feels funny.

• Children as young as 4 can point to the area of pain.