Acute Pain Management in Children

Abstract

Children’s pain may be difficult to recognize and to measure reliably. Pain assessment tools must be age and developmentally appropriate because children’s understanding and ability to describe pain changes as they grow. The options available to manage pain also vary with age. Non-pharmacological strategies supplement analgesic drugs and are especially useful for procedural pain. The metabolism of analgesic drugs matures during growth, affecting doses in neonates and infants. Some drugs that are useful analgesics in adults cannot be used in children because they are not available in liquid form for oral dosing. Morphine is the most widely studied and used opioid in children. Morphine metabolism is reduced in neonates and infants, and the incidence of respiratory depression from opioids is almost ten times more in neonates than adults. Intravenous opioids are the preferred route for the management of severe pain. Intravenous infusions for children are made up differently to those for adults—the concentration in the syringe varies with the weight of the child, but the volume administered is similar regardless of age. This standardizes volume independent of age and weight, and staff can see the infusion rate and are able to place the dose into context of the dose range usually given to children. Children aged 6 years and older are usually able to use patient controlled analgesia, but unlike adults, background infusions improve analgesia, promote sleep and do not increase adverse effects in children with severe and constant pain.

Review Questions

• 1. You are asked to review a 7 year old boy who has inadequate analgesia after open fixation of a fractured femur. His current treatment is with a nurse-controlled infusion of morphine. What will you do?

• 2. Why are smaller doses of morphine than would be used in adults appropriate for infants?

• 3. What are the post operative analgesic options available to manage a severe spastic quadriplegic 8 year old scheduled for elective major bilateral lower limb surgery? Discuss and justify your choices.

• 4. Please discuss how paracetamol may be administered to children.

• 5. What considerations should be given prior to prescribing procedural analgesia for ward patients?

• 6. A 3 year old child has a broken leg. What is the best way to assess pain in this child?