NEW YORK--Children's fears about needles and their physical pain during
medical procedures are not being adequately managed, according to a Gallop
telephone survey of 500 children (aged 6 to 14), 1,000 parents of children
under 14 (not parents of the children surveyed), and 300 pediatricians.
The majority of the pediatricians (87%) felt that more could be done
to manage children's pain. About 48% of the pediatricians said it was extremely
important to them, personally, to manage a child's pain during a medical
procedure, and 77% believe techniques and procedures to manage children's
pain have improved.
Use of a topical anesthetic to numb needle pain and the general availability
of pain medications were the most frequently mentioned improvements.
Even with these developments, fewer than half (41%) said that were very
satisfied with the way their offices manage pain, and fewer than 20% of
office-based physicians said that they have a way to measure children's
pain in their office. About 20% estimate that medical procedures are delayed
or canceled at least once a month because of a child's fear of needle pain.
When asked what more could be done to help manage children's pain, the
physicians' most frequent response was the need for more parent-child education.
Yet, 75% said they did not have written information in their offices
to help families prepare a child for a painful medical procedure, and this
lack of educational material was reflected in the parents' responses to
The Parents' Responses
Nearly half of the parents did not think there was anything available
to reduce a child's pain during medical treatments. A substantial number
(44%) said it was okay for children to experience a little pain in the
doctor's office, and 75% said they did not pass along their children's
fears or complaints about pain to their pediatricians. Only 26% of parents
agreed that doctors are sensitive to children's feelings about needles.
As for the children, 63% said they were more likely to discuss their
fears about painful procedures with their parents rather than with their
Over half (58%) of the children said they had developed their own ways
to deal with painful procedures, such as thinking of something else (20%),
not looking (19%), closing their eyes (15%), or squeezing a parent's hand
(12%). Talking, holding their breath, counting to 10, breathing heavily,
gritting their teeth, or just crying are other methods the children mentioned.
"Getting better," "getting shots and needles," and
"being scared" are the thoughts children say first come to their
mind when they think about going to the doctor. Nearly half (47%) said
that shots or needles are what they dislike most about doctor visits. Getting
better is the thing they like most, and pain is the most bothersome thing
about getting a shot.
Pediatric Pain Awareness Initiative
"Parents and medical staff can combine pharmacological and nonpharmaco-logic
approaches to managing children's pain," said Steven J. Weisman, MD,
associate professor of anesthesiology and pediatrics, and director of the
Pediatric Pain Service, Yale University School of Medicine.
Dr. Weisman is also a member of the Pediatric Pain Awareness Initiative
(PPAI), a multidisciplinary group formed to highlight the lack of adequate
pediatric pain management. He made his remarks at the group's press conference
held to discuss the Gallop survey results.
The PPAI, which is supported by a grant from Astra USA, Inc., manufacturer
of EMLA Cream (lidocaine 2.5% and prilocaine 2.5%), also announced a toll-free
number (1-888-569-5555) for parents and health care professionals to call
to receive free information on children's pain management.
Dr. Weisman said that he has had many years' experience with pediatric
cancer patients who undergo frequent painful procedures.
"I can't tell you how much suffering I saw in all those years,
how much pain in the repeated procedures we had to do to kids, the IVs
we had to start, and the chemotherapy injections," he said. "The
crying stopped when people who understood pain management started treating
For example, he said, if an oncologist knows that a child is going to
have blood work, he or she can dispense a topical anesthetic in the office
or write a prescription for it so that the child can put on the cream at
home before coming to the office or clinic.
Preventing Sensitization to Pain
"This lessens anxiety in kids and helps prepare them for other
painful procedures later on," Dr. Weisman said. "Thus, we can
prevent kids from being sensitized to pain and over-reacting to pain down
Nonpharmacologic techniques such as distraction can be used to change
a child's focus during a painful procedure. These include using party blowers,
listening to music, blowing bubbles, or reading pop-up or other books,
Dr. Weisman advised parents and health professionals to tell children
the truth about what will happen during a medical procedure and how it
will feel. He also said that pediatricians should keep pain assessment
scales on hand that are appropriate for children, such as the ones that
employ happy and unhappy faces.
Finally, he provided a checklist of common myths about children and
pain that need to be replaced with facts:
Myths and Facts About Children and Pain
|Pain builds character.||There is absolutely no evidence for this assumption.|
|Children will tell you if they are in pain||Children often do not convey that they are in pain, but turn inward
and become quiet to cope with it.
|If children say they are in pain, but do not appear to be, they don't
|Children learn to adapt and may not show visible signs of pain. But
it is the health professional's ethical obligation to offer them medication
if they say they are in pain.
|Pain killers are addictive in therapeutic doses.||Pain killers are not addictive in therapeutic doses. Overdoses are
rare, and in most cases can be reversed.
|Children neither experience nor remember pain to the same degree as
|Very young children feel and experience pain in similar ways as adults.|
Information adapted from a Pediatric Pain Awareness Initiative