Pain management in pediatric patients


It is difficult to imagine that premature babies and neonates were often not treated post operatively for pain. Yet this is exactly what one of the first studies into pain in children revealed. In 1977, a nurse in the United States compared postoperative pain management for adults with that for premature babies, neonates and children. The results of the study showed that children almost never received any analgesia post operatively to help them manage their pain. Conversely, the adult patient population was being treated with narcotics.

Dr. Celeste Johnston, a nurse and researcher at the Montreal Children’s Hospital of the McGill University Health Centre and the James McGill professor in the School of Nursing at McGill University has been studying pain in newborns, infants and children for many years. Through her research work and the work of her colleagues, pain management in this group of patients has improved significantly since the 1977 study.

Trying to determine the right kind of pain management for neonates has been a primary focus for Johnston. For example, studies show that sucrose can effectively manage pain in newborns. Johnston set out to determine the efficacy of sucrose analgesia for procedural pain during the first week of life in premature newborns. The results of the study suggested that infants repeatedly treated with sucrose had lower scores on tests that measured their motor development and vigor, and were less alert. Johnston’s work showed that more studies needed to be done to figure out how best to use sucrose as analgesia in preterm infants.

In another study, Johnston and her colleagues wanted to test the efficacy of Kangaroo Care on diminishing the pain response of preterm neonate to heel lancing. This practice, which places the mother and child in skin-to-skin contact, is gaining acceptance as a standard of care in neonatal intensive care units (NICU) throughout the world. The study showed that when swaddled next to their mother’s skin, premature infants undergoing a heel lance had a significantly lower pain score.

The results of these studies has changed they way pain is managed in the neonate group. Kangaroo care in particular has the potential to become a beneficial strategy for promoting family health by allowing parents to participate more directly in comforting their children. Additionally sucrose analgesia can be more safely administered to neonates with a better understanding of important thresholds based on the results of Johnston’s work.

Research in other areas of pain management has led to the development of reliable pain scales which enable clinicians to assess pain in patients, including those who are either cognitively impaired, non verbal or with non typical behaviors. Holly Vali, clinical nurse specialist for acute pain service at The Children’s, explains the “scales include objective criteria such as, monitoring blood pressure, pulse, respiratory rate, and oxygen saturation, as well as behavioural signs of pain such as grimacing and stiffness in limbs or other parts of the body.” These scales help care providers to understand the level of pain in the neonate and infant population and manage it more effectively.

“Parents always want to know how we will manage the pain for their children,” Vali says. We have also found ways to decrease the use of opiates in treating severe type pain by using adjunctive therapies such as anti-inflammatories with analgesics.

Celeste Johnston also points out that “we are using non-pharmacological interventions for children by teaching them basic biofeedback or magical thinking.” Magical thinking can include the use of an imaginary magical glove or sock to cover the area of a minor intervention, such as a needle stick, and prevent the pain from the procedure to penetrate.

These improvements in pain management in the neonate and infant group have certainly helped in improving the quality of care that children receive during hospitalizations. The benefits of better pain management are that it allows the patient to recover more quickly and may significantly reduce future stress by diminishing “painful” memories of past pain episodes.