Pediatric pain treatment and prevention for hospitalized children

Stefan J Friedrichsdorf; Liesbet Goubert

doi:10.1097/PR9.0000000000000804

Pediatric pain treatment and prevention for hospitalized children

Pain Rep. 2019 Dec 19;5(1):e804. doi: 10.1097/PR9.0000000000000804. eCollection 2020 Jan-Feb.

Authors

Stefan J Friedrichsdorf^{1

2

3}, Liesbet Goubert⁴

Affiliations

¹ Center of Pain Medicine, Palliative Care and Integrative Medicine, University of California at San Francisco (UCSF), Benioff Children's Hospitals in Oakland and San Francisco, CA, USA.
² Department of Pain Medicine, Palliative Care and Integrative Medicine, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, USA.
³ Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA.
⁴ Department of Experimental-Clinical and Health Psychology, Ghent University, Ghent, Belgium.

Abstract

Introduction: Prevention and treatment of pain in pediatric patients compared with adults is often not only inadequate but also less often implemented the younger the children are. Children 0 to 17 years are a vulnerable population.

Objectives: To address the prevention and treatment of acute and chronic pain in children, including pain caused by needles, with recommended analgesic starting doses.

Methods: This Clinical Update elaborates on the 2019 IASP Global Year Against Pain in the Vulnerable "Factsheet Pain in Children: Management" and reviews best evidence and practice.

Results: Multimodal analgesia may include pharmacology (eg, basic analgesics, opioids, and adjuvant analgesia), regional anesthesia, rehabilitation, psychological approaches, spirituality, and integrative modalities, which act synergistically for more effective acute pediatric pain control with fewer side effects than any single analgesic or modality. For chronic pain, an interdisciplinary rehabilitative approach, including physical therapy, psychological treatment, integrative mind-body techniques, and normalizing life, has been shown most effective. For elective needle procedures, such as blood draws, intravenous access, injections, or vaccination, overwhelming evidence now mandates that a bundle of 4 modalities to eliminate or decrease pain should be offered to every child every time: (1) topical anesthesia, eg, lidocaine 4% cream, (2) comfort positioning, eg, skin-to-skin contact for infants, not restraining children, (3) sucrose or breastfeeding for infants, and (4) age-appropriate distraction. A deferral process (Plan B) may include nitrous gas analgesia and sedation.

Conclusion: Failure to implement evidence-based pain prevention and treatment for children in medical facilities is now considered inadmissible and poor standard of care.

Keywords: Breastfeeding; Comfort positioning; Distraction; Multimodal analgesia; Pain prevention; Pain treatment; Pediatric pain; Sucrose; Topical anesthesia.