1. Children and pain -prevention and treatment
Ann-Cathrine Bramhagen
RN, PhD, Directors of studies
Malmö University
Senior Clinical lecturer
Malmö University Hospital 1

2. Historically
Historically the decision whether the child experienced pain or not was based on the professional’s conceptions rather than scientific evidence.
One misconception has been that children do not feel pain to the same extent as adults
Review – 1985 – heart surgery without pain medication 2

3. Children are vulnerable
Age
Vulnerable
This is due to physical,
psychological and cognitive
limitations. This means
that all information and
preparation must be designed for each child
individually. 3

4. What do we actually know?4

5. We know that All infants are exposed to painful procedures
Blood sampling
Vaccination 5

6. We know that
Pain early in life present a stronger pain response later in life
Neonates exposed to 14 painful procedures/day
Nurses attitudes matters
Advanced education affect attitudes 6

7. How do we know? Pain scales - FLACC 2 months – 7 years Criteria
Score 0
Score 1
Score 2
Face
No expression or smile
Grimace or frown
Clenched jaw
Legs
Normal or relaxed
Uneasy or tense
Kicking or legs drawn up
Activity
Moves easily
Shifting back and forth
Arched rigid or jerking
Cry
No cry (awake or asleep)
Occasional complaint
Crying steadily or screams
Consolability
Relaxed
Distractible
Difficult to
comfort 7

8. How do we know?
Pain scale - Face scale > 3 years 8

9. How do we know? Pain scale CAS 5-16 years McGrath, PA. (1996)
A new analogue scale for
Assessing children´s pain: an initial
validation study, Pain64: 9

10. What can we do?
Distraction
Music
Storytelling 10

11. What can we do?
Play
Draw 11

12. What can we do? Sweet solutions Breastfeeding
Stevens, B et al (2010) Sucrose for analgesia in newborn infants undergoing painful procedures. Cochrane Collaboration
Harrisson, D et al (2010) Efficacy of sweet solutions for analgesia in infants between 1 and 12 months of age: a systematic review
Breastfeeding 12

13. The value of informing children prior to investigation and procedures Marie Edvinsson Månsson Lund 1992
Special psychological preparation reduced the number of anxious children needing premedication before X-ray
Parents who had participated in the information to the child felt more satisfied with the information
Extended information preoperative reduces the childrens fear

14. Aspects of prevention and assessment of neonatal pain Mats Eriksson Örebro/Linköping 2003
One ml of 30 % glucose reduces signs of pain from heel-stick and from venepuncture
Glucose shown to be better than EMLA®
Repeated administration did not decrease the pain relieving effect

15. Procedural and postoperative pain management in children Stefan Nilsson Jönköping 2010
Children require more than just analgetics in painful procedures
They need to feel secure and to be participating
The FLACC scale is valid and a reliable tool to measure pain
Music reduced the requirement of morphine and decreased distress after minor surgery

16. Procedural pain reducing methods and pain assessment in newborns Maria Gradin Linköping 2004
Breastfeeding before venepuncture has no major impact on the pain score but on crying time
The combination of oral glucose and breastfeeding showed the lowest pain score and significantly shorter duration of crying

17. Experiences, symtoms and signs in 3-11 year-old children undergoing day surgery in the context of the perioperative dialogue Berith Wennström Göteborg 2011
The perioperative dialogue might minimize distress and prepare the children
The perioperative dialogue were associated with low concentrations of salivary cortisol postoperative and reduced morphine consumption
Small children have difficulties in distinguishing pain, nausea and anxiety and postoperative discomfort was experienced in many different ways

18. What is my conclusion? We know a lot We can do a lot
We can measure a lot
The research question is: are children still experience pain?
11/13/2018

19. Studies to be started Bramhagen et al
Describe children and parent´s experience regarding pain during hospital admission
To examine the documentation in the child´s journal regarding pain.
To interview professionals in focus groups in order to illuminate their perceptions regarding children and pain during hospital admission.

20. Children need to be protected20

21. Nurses can make a difference21

22. THANK YOU FOR
YOUR ATTENTION