Why Do We Ignore Pain in Children?
I just read “1 in 5 Limb Fractures in Children Receive Delayed Care”, and it ties in to my reflections recently on undermedication of pain in children. A close friend’s young child had surgery followed by a complication necessitating hospitalization and was clearly undermedicated for pain throughout the entire experience, despite her deliberately requesting treatment for his pain. She is not an ambiguous person, either. I’m sure the nursing supervisor and possibly the hospital CEO were involved in her complaints.
I remember from my ENPC (Emergency Nursing Pediatric Course) curriculum reading alarming statistics about undertreatment of pain in children. In the course, we discussed possible reasons for this from the medical provider standpoint. Children express pain differently, and those of us who are not solely pediatric nurses are not as finely attuned to how children communicate. Also, evidently some children cope with pain by totally shutting down and dissociating, so if you use one of the behavioral pain scales developed for children it will give you a much lower score than the actual pain should give. Preverbal children are unable to tell you that they are having pain or where it hurts or how badly it hurts; older children may not tell the truth for various reasons based on their developmental stages. All that aside, we as providers fall down on the job because if our patient is not telling us “I hurt, and I need something for the pain,” it is evidently not as far up on our priority list as it should be. Perhaps our mnemonic for priorities should be ABCDP (airway, breathing, circulation, disability, pain).
That experience and material aside, I read the article I mentioned about the limb fractures and researched undertreatment of pain in children, and to my surprise I found that the parents were the ones not bringing the children in to have fractures evaluated and not medicating them at home after procedures. I assumed before reading these articles that nurses and doctors were the ones responsible, because of what I’ve learned through my own education, but research indicates that not only are we failing to medicate children and address their pain while they’re in the hospital, but also we are failing miserably at educating parents in medicating them once they leave.
As for parents not bringing children in for evaluation of fractures, I’m at a bit of a loss. This study suggests that parents don’t take children’s pain seriously enough. Is it that children routinely bump and bruise themselves and cry, so parents are not aware that this is a different cry? I don’t have any ideas about how to address this specific problem or similar ones, other than it seems clear that nurses who work in areas where we are likely to encounter pediatric patients need to educate ourselves about children’s pain and their expression of it and find a way to educate parents about it—particularly if the child has had an operation or some other procudure and will require medication at home. We need to do a much better job making sure parents understand indications, dosing, and side effects to alleviate their fear of giving the child pain medicine, because studies show that parents report undermedicating their children out of fear (of addiction, oversedation, and so on).
This is an issue. Pediatric patients are not just little adults, as we all learned in nursing school, and they come with built-in secondary patients (their parents).
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