Pain Management in Children

As a physiotherapist, I treat many children with different pain conditions, so when I came across a journal article published in the journal Nursing Children and Young People titled "Factors Influencing Pain Management in Children", I was keen to have a read. The article discusses an essential aspect of paediatric care, which is the management of pain in children. 

Every child will experience an ankle or knee injury sustained while playing sports quite differently. Although the diagnosis or type of injury may be the same, each child may present with very different levels of pain and dysfunction. As such, all healthcare providers must understand what factors can impact how a child feels after an injury and how this may affect their treatment and recovery. 

Pain management in children is a crucial and often complex area, as children may not always express their pain clearly, making it sometimes challenging for healthcare providers like myself to assess and treat effectively. A thorough assessment, as well as developing good communication skills, can help this process considerably. 

Key factors to consider, as discussed in this article, include:

Children's Age: The child's age plays a significant role in pain management. Younger children may have difficulty communicating their pain, while older children can provide more detailed information about their pain experience.

Type of Pain: The article discusses the different kinds of pain that children may experience, such as acute pain from injuries or surgeries and chronic pain from conditions like cancer. The management of these various pain types may differ significantly, so it is essential to distinguish between the different kinds of pain, especially when other types may occur simultaneously. A good medical history can help is important, which is why it is essential to tell us about any recent medical procedures, for example, even if you don't think they are relevant. 

Psychological Factors: Psychological factors, including anxiety, fear, and previous experiences, can significantly influence a child's pain perception and may explain why an apparently minimal injury can sometimes result in a very high level of pain and disability. Healthcare providers need to consider these factors when managing pain in children and have the necessary strategies and skills to help manage the psychology of pain in children. 

Parental Involvement: Parents often play a crucial role in pain management for children, usually helpful but sometimes less helpful if their own unhelpful beliefs and fears are projected onto the child, for example. Their understanding, support, and ability to advocate for their child's pain relief are vital, and sometimes some guidance is helpful. 

Healthcare Provider's Competence: The knowledge and skills of healthcare providers, including nurses and physicians, in assessing and managing pediatric pain are critical. The article discusses training and education in this context.

Communication and Assessment Tools: Effective communication and age-appropriate pain assessment tools are essential to accurately determine a child's pain level. From my experience, using simple, clear and relatable language is very helpful; sometimes pictures and drawings can be used to help convey information.

Pharmacological and Non-Pharmacological Interventions: The article explores various approaches to pain management, including medications and non-pharmacological interventions like distraction techniques or relaxation methods, which may have value depending on the cause and nature of the pain, the age of the child and the impact.

Cultural and Societal Factors: Cultural beliefs and societal norms can also impact how children perceive and manage pain. Healthcare providers should be culturally sensitive in their approach. I have found that working in many different countries and with different cultures has helped expand my awareness of this point, as well as the importance of asking for advice or undergoing further training in cultural safety if required. 

The article highlights the multifaceted nature of pain management in children. It underscores the need for a holistic approach that considers the child's age, psychological factors, parental involvement, healthcare provider competence, and cultural factors in providing effective pain relief for paediatric patients.

By Simon Coghlan

Image by Hai Nguyen Tien from Pixabay