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Appropriate and safe treatment of pain and anxiety in children is an integral component of an emergency department's clinical practice. Children are reported to be less adequately treated for pain than their adult ED cohorts.1
Pediatric pain experience, perception, and expression is determined by many factors, including the nature of the illness, injury, or procedure, developmental level, emotional and cognitive state, personal concerns, the meaning of pain, family attitudes, culture, and the environment. Basically, anything that is painful for an adult is likely to be painful for a child.
Children experience fear and anxiety in addition to physical pain, and all must be assessed and managed in an age and developmentally appropriate fashion. Parents or caregivers are also distressed about the child's pain. The QUESTT approach is a useful tool in addressing pediatric pain management. 2
question the child for a description and location of the pain, using age and culturally appropriate and familiar language. Toddlers, and some older children who have difficulty understanding pain scales, can usually locate pain by pointing to the affected part.
Use a pain rating scale (Fig 130-1 and Fig 130-2) to provide a quantitative measure of pain intensity. Scales differ in their developmental appropriateness, i.e., the child's ability to grasp numeracy, abstract thought, pictorial appreciation.
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FIG. 130-1. FACES pain scale. (From Wong DL, Hockenberry-Eaton M, Wilson D, et al: Whaley and Wong's Nursing Care of Infants and Children, 6th ed. St Louis, Mosby, 1999, p 1153. Copyright © Mosby. Reprinted by permission.)
FIG. 130-2. Oucher pain scale. (From Beyer JE, Aradine CR: Patterns of pediatric pain intensity: A methodological investigation of a self-report scale. Clin J Pain 3:130, 1987.)
evaluate behavior and physiologic responses to pain, such as facial expression. This is particularly useful in nonverbal children.
secure parents'/caregivers' involvement. They know their child best. Encourage their involvement in pain assessment, and facilitate participation in the management.
take cause of pain into account. The nature of the pathology or type of procedure permits anticipation of the type, duration, and intensity of pain.
take action: Ensure that all appropriate modalities are enlisted to treat the specific disorder and the pain, with ongoing assessment and documentation of pain until it is resolved.
A child who presents to the ED without a guardian or adult consent should have life- and limb-threatening conditions and severe pain managed without delay. Each institution should have policies that outline the procedures to follow in such cases.
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