Managing pediatric pain in minor injuries

June 1, 2011

A 3-year-old child presents to your community urgent care clinic with a small laceration along her chin that requires just a few sutures. The young girl is crying and anxious. It is worth it to come up with a creative strategy to handle her pain and anxiety in order to ensure success in handling the sutures.

A 3-year-old child presents to your community urgent care clinic with a small laceration along her chin that requires just a few sutures. The young girl is crying and anxious, and her mother is worried that she will not comply with being restrained in a papoose board for the short procedure. Rather than force her into a position to begin the repair under extreme distress, your team briefly confers and involves the girl and her mother in the process.

First, you prepare the young girl for the procedure by showing her the instruments you will use to suture and allow her to do medical play to gain mastery of the experience. You then give her a choice between blowing a pinwheel or looking through a slide viewer during the procedure. Then, you let the girl pick out a bandage for afterward-she wants Dora the Explorer, her favorite. You position her for the repair by letting her lay across the exam table with her head in her mother's lap. A lidocaine gel is applied to the area of the laceration to avoid the need for an injection. Intranasal fentanyl is given for pain control, which also helps the child relax.

In 30 minutes, the wound is numb, and the child is relaxed. You instruct the mother to gently place her hands on the child's shoulders for both comfort and as a reminder to lay still. As an additional means of distraction, the child also is offered modeling clay, which will help control fidgeting and keep her hands from reaching for the sterile field. During the procedure, you give the girl words of encouragement. The mother is actively involved by telling her a favorite story and keeping her engaged with the distraction items.

The case for effective management of pain in young children

The case outlined above is one that plays out in emergency departments (EDs), urgent care centers, and community clinics throughout the country on a daily basis. Whether it is a minor burn, laceration, fracture, or other sort of minor traumatic injury, pain management in pediatric patients is a vital part of care. Because these injuries and their treatments are common, painful, and anxiety provoking in young children, it is imperative that pediatricians keep an important philosophy in mind: No needless pain.

Pediatricians have a duty to calm anxieties, placate fears, and reduce pain in even the youngest of patients. Children have the right to the best pain relief and symptom management that can be safely provided. Working from this philosophy, it is recommended to take a multidisciplinary team approach to pain and symptom management using pharmacologic and nonpharmacologic measures.

Studies have shown that pain in young children can have lifelong psychological effects, and memories of pain can lead to delayed medical care for people in their later years.1 Research has shown that infant boys who were circumcised shortly after birth with no pain control express a higher level of pain when they receive their infant immunizations.2

The objective of pain management is to appropriately address each patient's situation and prevent lasting negative effects from those procedures. In essence, proper pain management brings both immediate and long-term benefits. The other indirect benefit is parent satisfaction, which may drive future use of medical services.3