Gallop Survey Shows Pediatric Pain Is Inadequately Managed

May 1, 1997

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.

NEW YORK--Children's fears about needles and their physical pain duringmedical procedures are not being adequately managed, according to a Galloptelephone survey of 500 children (aged 6 to 14), 1,000 parents of childrenunder 14 (not parents of the children surveyed), and 300 pediatricians.

The majority of the pediatricians (87%) felt that more could be doneto manage children's pain. About 48% of the pediatricians said it was extremelyimportant to them, personally, to manage a child's pain during a medicalprocedure, and 77% believe techniques and procedures to manage children'spain have improved.

Use of a topical anesthetic to numb needle pain and the general availabilityof pain medications were the most frequently mentioned improvements.

Even with these developments, fewer than half (41%) said that were verysatisfied with the way their offices manage pain, and fewer than 20% ofoffice-based physicians said that they have a way to measure children'spain in their office. About 20% estimate that medical procedures are delayedor 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, thephysicians' most frequent response was the need for more parent-child education.

Yet, 75% said they did not have written information in their officesto help families prepare a child for a painful medical procedure, and thislack of educational material was reflected in the parents' responses tothe survey.

The Parents' Responses

Nearly half of the parents did not think there was anything availableto reduce a child's pain during medical treatments. A substantial number(44%) said it was okay for children to experience a little pain in thedoctor's office, and 75% said they did not pass along their children'sfears or complaints about pain to their pediatricians. Only 26% of parentsagreed that doctors are sensitive to children's feelings about needles.

As for the children, 63% said they were more likely to discuss theirfears about painful procedures with their parents rather than with theirdoctor.

Over half (58%) of the children said they had developed their own waysto 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 theirmind when they think about going to the doctor. Nearly half (47%) saidthat shots or needles are what they dislike most about doctor visits. Gettingbetter is the thing they like most, and pain is the most bothersome thingabout getting a shot.

Pediatric Pain Awareness Initiative

"Parents and medical staff can combine pharmacological and nonpharmaco-logicapproaches to managing children's pain," said Steven J. Weisman, MD,associate professor of anesthesiology and pediatrics, and director of thePediatric 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 adequatepediatric pain management. He made his remarks at the group's press conferenceheld to discuss the Gallop survey results.

The PPAI, which is supported by a grant from Astra USA, Inc., manufacturerof EMLA Cream (lidocaine 2.5% and prilocaine 2.5%), also announced a toll-freenumber (1-888-569-5555) for parents and health care professionals to callto receive free information on children's pain management.

Dr. Weisman said that he has had many years' experience with pediatriccancer 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 IVswe had to start, and the chemotherapy injections," he said. "Thecrying stopped when people who understood pain management started treatingthe kids."

For example, he said, if an oncologist knows that a child is going tohave blood work, he or she can dispense a topical anesthetic in the officeor write a prescription for it so that the child can put on the cream athome before coming to the office or clinic.

Preventing Sensitization to Pain

"This lessens anxiety in kids and helps prepare them for otherpainful procedures later on," Dr. Weisman said. "Thus, we canprevent kids from being sensitized to pain and over-reacting to pain downthe road."

Nonpharmacologic techniques such as distraction can be used to changea 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 childrenthe truth about what will happen during a medical procedure and how itwill feel. He also said that pediatricians should keep pain assessmentscales on hand that are appropriate for children, such as the ones thatemploy happy and unhappy faces.

Finally, he provided a checklist of common myths about children andpain that need to be replaced with facts:

Myths and Facts About Children and Pain

MythFact
Pain builds character.There is absolutely no evidence for this assumption.
Children will tell you if they are in painChildren often do not convey that they are in pain, but turn inwardand become quiet to cope with it.
If children say they are in pain, but do not appear to be, they don'tneed medication.Children learn to adapt and may not show visible signs of pain. Butit is the health professional's ethical obligation to offer them medicationif they say they are in pain.
Pain killers are addictive in therapeutic doses.Pain killers are not addictive in therapeutic doses. Overdoses arerare, and in most cases can be reversed.
Children neither experience nor remember pain to the same degree asadults.Very young children feel and experience pain in similar ways as adults.

Information adapted from a Pediatric Pain Awareness Initiativehandout.