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Doctors urge pain relief for children

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As any parent knows, it hurts to hear a child cry in pain. Despite progress in understanding pain in children and infants, the youngest patients still aren’t getting the relief they need from doctors, according to researchers.

Feeling a child’s pain is a difficult task. Babies can’t tell you when something hurts and older children are notoriously unreliable when it comes to interpreting their own pain.

But while there have been advances in the safe management of children’s pain, it hasn’t been translated to routine clinical practice, Dr. Richard Howard, director of children’s pain management service at Great Ormond Street Hospital for Children in London, writes in the current issue of The Archives of Pediatrics & Adolescent Medicine, one of the Journal of the American Medical Association’s publications.

“Children in pain rarely get the attention they need,” Howard said during a recent news conference on pain management in New York. “We’ve learned a lot about how to safely treat pain, but there’s a substantial gap between what we know about pain in children and what we do.”

Howard’s article appeared in the November issue along with several other reports on the subject of pain management in children.

For example, many premature babies still undergo numerous painful procedures without receiving appropriate pain reducing drugs, doctors at the Sophia Children’s Hospital in Rotterdam, The Netherlands reported in the journal, published this week.

The researchers studied 151 premature babies during their first two weeks in neonatal intensive care units.

On average, preterm babies are subjected to 14 procedures per day, but analgesic therapy was given to fewer than 35 percent of them, the researchers said.

Most children experience pain at some point, either from a skinned knee, immunizations or even a serious illness. But chronic pain is more common than previously thought, writes Howard.

An estimated 10 million Americans 18 or younger suffer chronic or recurring pain, research indicates.

In the past, “we thought that children felt less pain than adults,” said Dr. Zeev Kain, professor of anesthesiology, pediatrics and child psychiatry at Yale University, who did not participate in the studies. “Now everyone agrees that they feel pain at least as much as adults.”

Not treating children’s pain could have a long-term impact. Coping with a high level of pain can have a negative psychological impact, hinder a child’s development or cause them to be afraid of future medical care, doctors say.

Howard analyzed studies showing that boy babies who were circumcised without pain reduction medication reacted more strongly to an immunization shot given six months later than infants who were given an analgesic during circumcision.

Fear of side effects from medications and doctors’ lack of education about managing pain in children are chief reasons that many children still aren’t getting the relief they need, says Kain, adding that due to financial restrictions, only top-tier hospitals have pediatric pain services programs.

Hold your baby

But soothing a child’s pain doesn’t always require expensive programs.

Immunizations are one of the most common painful and frightening events for children. With the constant introduction of new vaccines, kids can receive up to 20 injections by their 2nd birthday, say researchers at Children’s Hospital in Pittsburgh.

Babies who are held by a parent and given a bottle of sugar water or a pacifier during multiple immunization shots cried less than infants who were left on an examination table, the researchers found in a study of more than 100 2-month-olds, which was published in this week’s JAMA journal.

The infants who remained on the table cried for nearly a minute, compared to the babies who received intervention who cried for just 19 seconds.

“This simple approach is inexpensive and convenient, allowing it to be easily adopted into practice,” the researchers said.