If Your Child Hurts

• What is pain?
• How can you know your child is in pain?
• Is there any such thing as perfect pain control?
• Do some children need more pain relief than others?
• Pain jargon explained:
• What are the different options?
• How are these drugs given?
• What about severe pain?
• How is long-term pain dealt with?
• What about a long-term problem with sudden attacks of pain?
• How you can help your child cope
• Handy tips for dealing with Pain
• Distractions
• Use your child's imagination

What is pain?

Pain is the body's protective warning that something is wrong. All children feel pain, just as much as adults. Some people have a high threshold and don't feel much pain; others have a low threshold and feel a lot more pain. Pain is a very individual experience.

How can you know your child is in pain?

• By watching him or her. He or she may seem noisier or quieter than usual, more sleepy or tense, flushed or pale. Many nurses know parents are often the best judge of this, as usually you notice when your baby or child looks different.
• By listening to him or her. Your child is the only one who is able to describe properly what he or she is feeling. Let your child know that it's all right to say that it hurts and that, together, you can look for help. To help, you can use a tool called a 'pain chart', like that below, which even small children can complete.
• By checking that the main problem is pain, and not that your child is tired, sad and upset or uncomfortable.

Why is it important to manage pain properly?

In the past, some children had to put up with a lot of pain. Nowadays it is different as doctors and nurses try to alleviate it as much as possible. Treating pain properly can help children to get better quicker. It can help them to relax, sleep and to get up and play. A child shouldn't have to wait in pain, because the fear of being in pain makes it much worse. When this happens, a higher dose of painkiller is needed. Speak about it to the doctor and nurses in the hospital and they should be able to find an adapted treatment to quickly relieve your child.

Can I do anything?

Yes, as a parent you have a key part in helping your child avoid or cope with pain. You know your child best. In some hospitals where more could be done about pain, you will make things better for other children - as well as your own - when you ask for better pain control.

Depending on the type and level of pain, you can also have a look at alternative and complementary therapies such as acupuncture, massage or plants. But remember to check with the doctor first if any of these therapies could be a problem when coupled with your child's normal medical treatment.

Some of these treatments have been proven to have a direct impact on pain and are even used in hospitals in some countries. For more information, please have a look at these links:

Pain Management 101
National Centre for Complementary and Alternative Medicine

American Academy of Medical Acupuncture

American Association of Massage Therapies

Is there any such thing as perfect pain control?

No, some drugs may make children feel sick or itchy, they may become constipated or have strange dreams. Yet when pain is the main problem, it should be relieved. Side-effects can be reduced by using additional drugs - such as anti-emetics - to stop sickness, or by changing the pain management method.

Do some children need more pain relief than others?

Yes, there is no such thing as the right standard dose. The amount is right if it suits that child, and working out the best safe dose is vital.

Pain jargon explained:

Pain-relief drugs: any pills, tablets, medicines, injections, creams, sprays, or suppositories that help reduce pain.

Analgesia: mild to moderate pain relief.

Anaesthetist: doctor who specialises in pain relief.

Anaesthetic: pain relief when a child undergoes an operation.

Local anaesthesia: given to provide loss of feeling and stop pain in order to dull or blot out pain from needles. It is delivered either through a special cream or gel rubbed into the skin, or by epidural/through the spine, when a tiny lube is fitted near the spine to deliver pain relief.

General anaesthesia: when the child is unconscious and put to sleep and feels no pain, for example during an operation.

Anti-emetics: drugs which stop the child feeling, and being, sick.

Acute: short-term, sudden onset.

Chronic: long-term.

What are the different options?

For mild pain: Paracetamol; paracetamol suspensions such as Calpol,Tixymol, Disprol. (These are available to buy without prescription in a pharmacy but always strictly follow the instructions.)

For moderate pain: Codeine, Diclofenac, lbuprofen, lndomethacin, Naproxen

For severe pain: Morphine, Diamorphine, Pethidine

A child who continues being in pain may need to have a higher dose, take the drug more often, or go onto a stronger drug, within safe limits. Valium is used very rarely with other drugs; it reduces anxiety but not pain and some children dislike it. Severe pain needs powerful drugs, and they will not turn your child into a drug addict. Don't worry, even if they have to take morphine for weeks, children come off it quite easily when the pain goes.

How are these drugs given?

Pills, tablets or medicine: by mouth - this is the easiest way (if your child can wait for them to take effect), but relies on him being able, and willing, to eat and drink

IV drip: If your child can't have pills or medicine, they will probably have a drip fixed into a vein. If the ward has the right kind of pump, drugs may be fed in painlessly through the drip.

If there isn't a drip, and your child is having long-term treatment for a chronic problem, he might have a central line. This is a needle left in the skin, taped on so that he/she can't feel it. Drugs can be given through the needle painlessly.

Spinal or Epidural: In a few hospitals, after some major operations, anaesthetists set up an epidural near the spine. They may also give a nerve block injection - before the child wakes up - which dulls the pain for hours.

Other options: Some pain is relieved by creams, skin patches, suppositories or nose-sprays.

What about severe pain?

For severe pain, PCA (Patient Controlled Analgesia) is very useful. This pain relief drip is timed to give a set dose, very slowly. There is a small button or pump for patients to press when they want or need it - either because their pain is coming on again, before physiotherapy, or when a wound is dressed.

How is long-term pain dealt with?

If there is long-term pain, doctors and nurses will probably be working with you and your child to manage it. If not, perhaps you and your child could talk to the doctor, using some of the points raised in this section as a guide. In the meantime, keeping a pain diary can allow you see how much relief is needed, the best times to take it, the triggers which seem to start off the pain, and how to avoid them.

What about a long-term problem with sudden attacks of pain?

If your child is in pain, such as that associated with sickle cell disease, they should rest, keep warm, have plenty to drink and take Paracetamol. If the attack is severe, they may have to stay in hospital and have morphine. Your child should be given urgent treatment as soon as they arrive and you should have a card or letter from your doctor explaining what must be done to show to hospital staff.

How you can help your child cope

The following methods work best for mild pain, or for a short procedure like an injection, and rely to a large degree on involvement by parents, nurses and play specialists. Comfort and support them - pain is much worse when children are scared, tense and tired!

Distraction (see below): Stroking and cuddling often make them feel a little better - sometimes they want to squeeze someone's hand while the pain lasts. Just being there helps, especially during tests and treatment that may be painful. Ask if you can stay if your child wants you to, and you can help them cope.

Handy tips for dealing with Pain

• Let your child know it doesn't matter if they show they are upset when they are in pain - even adults do this.
• They should have the choice whether they want to watch a needle go in or not.
• They may feel better if they give their teddy lots of injections, or make a toy crocodile bite all the toy doctors and nurses. You can be there to acknowledge their feelings and remind them that doctors and nurses are there to make them feel better.
• Try to stay calm and confident as much as you can - it is not a good time to show that you are upset
• Explain as much as possible because fear increases pain. The worst pain is fear of the unknown. So children need to know what to expect, and to be given choices and some control. They feel less upset if they are told honestly:

When something is going to hurt

Why they are having something painful done to them

That it is meant  to help them, not to punish them

 

• Do not tell them that it is not going to hurt if it is going to be painful.
• Quite often, you can find out what your child needs to know by getting them to talk about their pain and to visualise how they feel by drawing or painting. Puppets, toys and hospital play-sets are also useful tools!

Distractions

Stories, videos, cassettes and games, puppets or pop-up books, telling jokes or riddles may help children to feel less pain. The more you get a child to tell the story or work the puppets, the better. If your child has to have a needle, you could rub the other arm. Deep breathing, slowly counting four breaths in and four breaths out, or blowing bubbles can soothe a child. It can also help to calm you, which can have a positive effect on your child.

Use your child's imagination

Techniques called 'mind-over-body' are sometimes used to help children dealing with pain.

Here are a few useful examples:

• Before a blood test, encourage your child to imagine putting on a special long glove that blocks the pain.
• If your child is feeling sick, they could think of swallowing a cooling drink which soothes their mouth right down to his stomach.
• If your child has eczema, they can imagine rolling in special snow.
• If your child has long-term pain, they might think of slowly reducing the volume control on their TV or computer game down to a level that makes the pain bearable.
• To help your child relax, get them to shut their eyes and sleepily imagine walking slowly down ten steps to a door which opens into a secret place. This could be any place where they feel safe and happy, and they particularly enjoy, like a fun-fair, swimming pool or their bedroom at home. Then lead them back through the door and slowly back up the stairs again. By this time the pain may not have gone away, but it may not seem so bad

CHI would like to thank Action for Sick Children for their help in developing the content of this section.