Pain Management in Pediatric Trauma-Handout: Pain Management in Pediatric Trauma

Handout: Pain Management in Pediatric Trauma

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Pain management in pediatric trauma can be challenging due to the multifactorial nature of pain and the difficulty in assessing pain in children. Children may not exhibit typical signs and symptoms of pain, making it important to take a holistic approach and consider the circumstances when managing pain in pediatric patients. The principles of pain management include recognizing age-appropriate signs, allowing for self-reporting when possible, promptly administering analgesics after pain recognition, and conducting frequent pain reassessments.<br /><br />Common causes of inadequate pain management, known as oligoanalgesia, include an inability to recognize pain, decreased perception of pain, lack of awareness of analgesic modalities, incorrect medication dosing, and fear of medication side effects/toxicity. It is important to address pain in children promptly and provide effective pain relief to prevent the development of hyperalgesia later in life.<br /><br />Different pain assessment scales are used depending on the age of the child, including the CRIES scale for neonates, NIPS scale for infants under 1 year old, FLACC scale for children over 1 year old, and FACES scale for school-aged children. Non-pharmacologic analgesia strategies can be used for pain management, such as engaging and comforting parents, using soothing sensory measures like gentle touch and rocking, and providing comfort techniques like pacifiers and swaddling.<br /><br />Pharmacologic modalities for pain management in pediatric trauma include medications like acetaminophen and ibuprofen for mild pain, topical analgesia for moderate to severe pain, intranasal administration of fentanyl, ketamine, and hydromorphone, intravenous pain control with ketorolac, morphine, hydromorphone, and fentanyl, naloxone for opioid reversal, and regional anesthesia with peripheral nerve blocks. Inhaled analgesics like opioids and nitrous oxide are also used in older school-aged children and adolescents.<br /><br />In summary, effective pain management in pediatric trauma requires recognizing the unique experiences of pain in children, promptly treating pain, combining non-pharmacologic and pharmacologic interventions, and using a stepwise approach based on the severity of pain. Communication, reassurance, and frequent reassessments are key components of effective pain management in pediatric patients.

Keywords

pain management

pediatric trauma

assessing pain

analgesics

oligoanalgesia

pain assessment scales

non-pharmacologic analgesia

pharmacologic modalities

regional anesthesia

communication