Parents' attitudes toward postop pain management in their children reflected in underuse of analgesics

Parents' misperception of analgesics leads to the undertreatment of postoperative pain in their children, even though the parents are aware of their children's pain, according to a study published in Pediatrics (2010;125[6]:e1372-e1378).

With the expected continued increase in the number of outpatient pediatric surgeries, breaking down attitudinal barriers to postoperative pain assessment and pain management of children is imperative, say the researchers. Currently, 4 of 5 pediatric surgeries are performed on an outpatient basis, they note.

Through the use of validated questionnaires and scales, 114 parents of children aged 2 to 12 years who underwent surgical procedures associated with pain during the first 24 postoperative hours had their knowledge of pain expression by children and their own attitudes toward pain medications assessed.

After discharge

After hospital discharge with instructions to manage pain, the parents were asked to document all analgesics the child received at home. Discharge pain management instructions called for the use of acetaminophen, ibuprofen, or acetaminophen with codeine every 4 to 6 hours.

More than one-third (36%) of parents responded that children always express pain by crying or whining, and 30% agreed that children always tell their parents when they are in pain. Twenty-two percent said that they thought that children report their pain immediately. These attitudes were discordant from parents' postoperative pain assessment, because 60% reported that they thought their child was in pain, but only 30% of the children expressed their pain verbally.

More than three-fourths of parents either agreed that analgesic pain medications were addictive (52%) or were uncertain (27%). Some 73% expressed worry over adverse effects of analgesics, and for this reason, 42% believed that analgesics should be used as little as possible.

Underuse of analgesics

These attitudes were reflected in the underuse of analgesics: a median of one analgesic dose was administered to the children on the first full postoperative day, and 26% of the parents gave no postoperative analgesic.

Fewer than 1 in 5 (17%) parents gave 4 or more doses of analgesics on the day after surgery. This underuse occurred in spite of 95% of the parents reporting that they did receive postoperative analgesic instructions and in spite of the parents rating their children's pain as clinically significant on the PPPM.

Parents who had more misconceptions about analgesia use in children gave fewer doses of analgesics.

Countering misconceptions

The researchers believe that scheduled reminders and tailored education based on parent personality traits may improve postoperative pain management for children at home.

They add, "Parents who hold more extreme misconceptions about analgesia are the most important to target through intervention."