Kids and Pain

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Managing pain in pediatric patients goes beyond medicating physical symptoms. Simply finding ways for young patients to articulate their feelings can pose a challenge. However, by providing information and choices to pediatric patients at Hamilton Health Sciences, Children’s Hospital, Child Life Specialists are often able to find ways to help children take control and express how they’re feeling to those who may be able to do something about it.

“Play is a child’s work – it’s what they know,” said Child Life Specialist Cathy Humphreys. “Through expressive and therapeutic play, we try to find ways to get the children talking about their experience and how they’re feeling.”

Engaging in forms of play with patients provides Child Life staff the opportunity to talk about a range of topics, including fears about medical procedures, misconceptions about a child’s illness and any pain the child may be experiencing. This, in turn, helps caregivers determine what the children might need physically as well as emotionally.

While other hospitals offer similar services to pediatric patients, Hamilton Health Sciences has a dedicated Child Life department offering psychosocial support to patients and their siblings on a daily basis. They have a strong affiliation with McMaster University which offers the only Child Life educational program in Canada through the Faculty of Health Sciences.

“All children respond differently,” Humphreys said, “so it’s a matter of finding out what coping strategies work best for them. A child’s temperament, previous medical experiences, and outside stressors all impact on how they cope in hospital.”

By using a number of different mechanisms, including pictographic rating scales that help patients indicate how much pain they are feeling at any given time, the medical team can determine the best way to help patients through their stay in the hospital. Humphreys explained that one child found particular comfort in relaxation and imagery so Child Life staff made a recorded tape of some of the techniques that worked for him. The child was able to play the tape at night when he felt anxious or uncomfortable and thereby exert some control over his own pain.

Making sure children are informed about what is going to happen to them while they are in the hospital can also play an important role in lessening anticipatory anxiety and fear of the unknown. Meetings with Child Life staff are a staple for planned pediatric procedures. These meetings provide developmentally appropriate education and preparation. The children are encouraged to ask questions to dispel some of the misconceptions that may go along with their visit to the hospital.

Humphreys said that information is very empowering for pediatric patients and is also an important part of gaining trust with medical staff as children often imagine much worse things than the truth.

“The experiences children have now will impact the way they feel about future medical experiences,” Humphreys said, adding that if initial hospital experiences are honest and as positive as possible, patients will remember that.

And by gaining the trust of pediatric patients from the start, the medical team is able to offer believable options when it comes to managing their pain or anxiety down the road.

“As a team we may not be able to make the pain associated with certain procedures go away entirely,” Humphreys said, “but we can offer them some choices about options that we know might make them feel better. Asking children if they would like to sit on their mom’s lap or lay down during an IV start and implementing deep breathing or distraction techniques for example will include them in the process and help them feel a little more in control.”