In Summary
  • As recently as the early 1980s, the pain of children and infants was thought to be different from that of adults and was sometimes treated differently, or sometimes not treated at all.
  • Change doesn’t always come easily in medicine, so there’s a certain onus on parents to make sure that their children get state-of-the-art pain management around procedures, large and small.

Pain control in infants and children has come a long way over the past few decades.

Experts know how to provide appropriate anaesthesia when children need surgery and understand the ways that even very young children express distress when they’re hurting afterward.

There is a lot of evidence about reducing the pain and anxiety that can accompany immunisations and blood draws, and there is increasing expertise about helping children who struggle with chronic pain.

But today’s parents may be shocked to learn that was not always the case.

As recently as the early 1980s, the pain of children and infants was thought to be different from that of adults and was sometimes treated differently, or sometimes not treated at all.

Change doesn’t always come easily in medicine, so there’s a certain onus on parents to make sure that their children get state-of-the-art pain management around procedures, large and small.

That means preparation before any planned surgery, ideally with a child life specialist, and it means careful attention to the child’s pain afterward, with parents well backed up by medical specialists.

TISSUE DAMAGE

Let me start in the bad old days: About 30 years ago, when I was doing my residency, my 4-year-old son fractured his femur.

After surgery, he found himself on the orthopaedic ward of my very own hospital, and in a fair amount of pain (the femur is the biggest bone in the body, and there was a lot of tissue damage).

As his busybody on-call paediatric resident mother, I discovered that the pain control ordered by the surgeons was “IM MSO4 PRN.” That meant he could have an intramuscular dose of morphine whenever the pain from the fracture was so bad that it overcame a 4-year-old’s fear of shots.

To get pain relief, he would have to request the needle.

I paged the orthopaedic resident and demanded that the order be changed to IV pain control, since he already had an IV.

When the resident tried to scare me by telling me that IV morphine might suppress his breathing, I just plain pulled rank, insisting that I was a doctor myself and had managed lots of kids on IV morphine.

My son got the IV pain control, but it was very much a case of special pleading.

You shouldn’t have to do any special pleading (or be a doctor yourself) to get pain relief for your child nowadays.

We’ve come a very long way in the management of paediatric pain over the last few decades.

In fact, children used to get much less pain medicine than adults with the same problems, said Dr. Neil Schechter, the director of the chronic pain clinic at Boston Children’s Hospital, who showed in the 1980s that adults got two to four times as many doses of pain medicine as children with the same problems, and much of the pain control was indeed done by intramuscular injection, “and for children, that’s obviously particularly noxious and feared.”

“On top of that, one of the issues with kids historically is there was no easy way to measure pain in kids,” Schechter said. If your 4-year-old was crying it might be “because he missed mommy and daddy, or he was anxious.”

The real problem, he said, was that nobody knew how to dose pain control medications safely in children, because the research hadn’t been done.

Today, “nobody’s getting intramuscular injections,” said Dr. Charles Berde, the founder of the division of pain medicine at Boston Children’s Hospital.

As pain management improved, a first, the focus was indeed on giving opioids — like morphine — but on giving them intravenously, and with older children at least, on having the patient actually control the dose, with devices called PCAs, for patient-controlled analgesia.

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