When a child ends up in hospital, we assume everything will be done to care for them, including minimizing pain.
Unfortunately, that assumption is wrong. Two new research papers serve as a grim reminder that pain is systematically undertreated in children.
One study, led by Kathryn Birnie of the Centre for Pediatric Pain Research at Dalhousie University in Halifax, found that fewer than half of hospitalized children have a pain management plan. In other words, controlling pain is often an afterthought.
The paper, published in the medical journal Pain Research and Management, also shows that even so-called low-intensity pain matters a lot to patients.
A second paper, published in the Canadian Journal of Emergency Medicine, also shows wide variations in how children are treated for pain in the ER. The research team, led by Dr. Samina Ali of the department of pediatrics at the University of Alberta, found that the decision to give pain medication, or what strength is used, can be very different from one hospital to the next, regardless of the ailment or procedure.
Both papers show that younger children tend to get especially short shrift.
"Most people don't take pain seriously," said Dr. Christine Chambers, a Dalhousie University professor who was, until recently, the Canada Research Chair in pain and child health. She said Canadian health professionals aren't taught enough about it – veterinarians get five times as much education on pain management as physicians.
Parents tend to mistakenly think either that not much can be done, or that everything possible is being done, to control their child's pain. They have to be demanding, which shouldn't be the case.
It's not that doctors and nurses don't care. Pain relief just isn't seen as a priority when there are so many demands on their time.
Until the 1980s, babies, and premature infants in particular, received no pain relief at all, even when they underwent procedures like open-heart surgery. Instead of anesthetics to control pain, they were given paralytics to keep them from moving.
The belief that babies don't feel pain was widespread, but nonsensical. Every parent knows they do. The notion that anesthetics were too dangerous for children has also been disproven.
Practice changed dramatically when, in 1983, Dr. Kanwaljeet (Sunny) Anand, a pediatric pain specialist at Le Bonheur Children's Hospital in Memphis, Tenn., published research showing that babies who did not get anesthetics during surgery suffered far more complications and were more likely to die than those who did get pain relief.
Since then, our knowledge of pain has undergone a revolution. Yet, some procedures, like circumcision outside hospitals, can still take place without pain relief.
While anesthesia is now the norm during surgery, the research shows we still lag on controlling postsurgical pain. We're also more miss than hit on controlling chronic pain. At least children with cancer, who used to die excruciating deaths, now benefit from much better pain control.
Yet, the study of pain practices in the emergency room demonstrates that we still don't do near enough to relieve procedural and "routine" pain, such as that from vaccination needles. (Children now get about 20 shots before they're 5.)
When these young ones get poked and prodded – heel pricks, IV lines, catheters, blood tests, vaccines – everything should be done to minimize their pain, which can be considerable and traumatizing.
We have a wealth of knowledge of what works, including topical analgesics (rubbing a bit of cream on a child's arm ahead of time can reduce a lot of needle pain), breastfeeding, distraction, sugar water, skin-to-skin contact and Tylenol, to name a few.
"It doesn't have to hurt," is how a video produced by IWK Children's Hospital in Halifax puts it. And it shouldn't.
Pain is very subjective. But not taking it seriously is cruel and can have lasting impacts. Suffering does not make kids tougher – on the contrary, it leaves psychological scars. Pain during childhood interventions, even routine vaccines, can make people less likely to seek medical care when they get older.
And the sad reality is that, in Canada today, Dr. Chambers reminds us, "your dog could get better pain care than your child."
That's not right. We need to heed our children's cries.
André Picard