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New Guidelines for Procedural Pain in Children

New Guidelines for NZ Doctors Managing Procedural Pain in Children, Including Suggestions for Parents

SYDNEY, Oct. 17 /MediaNet International-AsiaNet/ --

17 October 2005, Launch in Sydney today

Doctors now have new guidelines for treating and managing children experiencing procedure-related pain. The guidelines also give parents some handy suggestions on how they can support their child during medical procedures, such as during immunisation injections, tube insertions, wound dressing and foreign body removal.

The guidelines for the management of procedure-related pain in children and adolescents, and the statement for neonates are being launched today in Sydney by the Paediatrics & Child Health Division of The Royal Australasian College of Physicians. Today is Global Day Against Pain and the theme for this year is pain in children, the beginning of the International Global Year Against Pain.

“Pain in children is often poorly managed and many children continue to suffer unnecessarily. Children who experience extreme procedural pain can develop post-traumatic stress disorder. Up to 25% of adults experience significant fear of needles, hospital and dental care and have an avoidant attitude to health care.

Of the 10% of adults with needle phobia, most date their phobia from experiences in the first 10 years of life,” Dr Angela Mackenzie, Chair of the Working Group, said.

“Pain in newborn babies is often unrecognised and under treated. Newborn babies do feel pain. If a procedure is painful in adults it should be considered painful in newborns, even if they are preterm. Compared with older age groups, newborns may experience a greater sensitivity to pain and are more susceptible to the long-term effects of painful stimulation.”

For Parents:

“Parents have the potential to play an important role in the preparation of children for medical procedures by providing information about what to expect- giving older children a chance to ask any questions and younger children the opportunity to act out the procedure with a toy medical kit. Parents may be helping themselves understand what to expect in the process. Siblings may also be helpful to distract a child especially before and after a procedure,” Dr Mackenzie said.

“Suggestions for parents include talking about activities or subjects that are not related to the procedure such as birthday parties, pets and favourite activities. Parents can also use distraction to help their child such as blowing bubbles, playing games, playing their favourite song or reading aloud.”

Another way parents can assist their children is through learning some basic breathing techniques and teaching the technique to their child. Parents may also develop their own ideas and coping strategies to support their child during painful medical procedures.

For Doctors:

“The aim is to prevent pain and distress as much as possible and ensure this is taken into account when planning the procedure. In practice it is important to find out if a child’s expectations of a procedure are realistic and, if not, correct them well before the procedure,” Associate Professor Neil Wigg, President of Paediatrics & Child Health Division said.

Important sections of the guidelines include:

* Adopting a child-centred approach (listening to the needs of the child and family) rather than procedure-focused “get-it-over-with” approach.

* Make the child and their family active participants and members of the team, rather than passive recipients. Use parents for positive assistance, not negative restraint.

* Ensure all procedures undertaken are necessary i.e. the benefit outweighs any negative impact caused by the procedure.

* Perform procedures in a child friendly environment, away from the bed where possible.

* Optimise waiting time: too little time increases distress but too much time increases anxiety. Time required for preparation is age and child-specific.

* Consider exposure and discussion on procedure; such as handling equipment, practicing procedure e.g. on a doll.

* Give child choices (e.g. whether to sit or lie, which hand to use) but not absolute control such as when to start procedure.

* Consider the child’s expectations of the procedure

“Measuring pain intensity is therefore an important part of pain assessment for all children. One tool for measuring pain is The Pieces of Hurt, also known as the Poker Chip Tool, which allows children to rate their pain by using chips that are described as ‘pieces of hurt’ (one white chip representing no pain, and four red ones representing pain). The more chips the child uses, the greater their hurt,” Associate Professor Wigg said.

Some children can’t verbalise or rate their pain, such as newborns, toddlers and non-verbal or cognitively-impaired children. Doctors can assess pain in these children by recognising behavioural and physiological responses to noxious stimuli.

The RACP is responsible for training, educating and representing over 9,000 physicians in Australia and New Zealand. The RACP represents 25 medical sub-specialties including paediatrics, public health and occupational medicine. Physicians are often called medical specialists. They are doctors who have completed an extra eight years or more of training after their initial university medical training. Patients are generally referred to a physician by a general practitioner seeking expert medical advice.


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