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 survey.
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 doctor.
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(Drug information on 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 the kids."
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 the road."
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, he said.
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
| Myth | Fact |
| 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 need medication. | 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 adults. | Very young children feel and experience pain in similar ways as adults. |
Information adapted from a Pediatric Pain Awareness Initiative handout.
