Pain management at C.S. Mott Children's Hospital
Seeing your child in pain or discomfort is incredibly difficult.
Good pain management can improve your child's recovery, and there are many things parents can do to comfort or console their child. We may not be able to get rid of all pain, but will work together with you to make your child as comfortable as possible after a procedure.
Here are some tips to help you support your child with pain management:
- Be your child’s voice. Some children will not report pain to their health care providers but will tell you. Tell your child’s doctors and nurses that your child is in discomfort or pain.
- Tell the health care team what words and signs your child uses to tell you that he/she is hurting; tell them about pain control methods and medications that have and have not worked in the past.
- Ask for help managing your child’s discomfort and anxiety through consultation with a social worker, child psychologist, spiritual care advisor, and/or child life specialist.
- Distraction is a great way to help manage your child’s pain and anxiety. Contact Child and Family Life for help.
- Speak up if your child’s pain is not improving or is getting worse. Ask your child’s nurse or doctor whether a visit from the Pain Service may be helpful for your child.
Assessing your child’s pain
There are a number of ways to figure out how much pain a child is having:
- Ask the child, if they are able to talk. Children as young as 3-4 years can often tell us that they are hurting. Younger children may be able to point to FACES to tell us how much pain they have. Older children can usually tell us how much pain they have by using numbers (0-10, where 0 = no pain and 10 = worst possible pain).
- Observe behaviors. Babies, young children and some children with disabilities cannot tell us about their pain. These children usually have behavior changes that tell us they are hurting. We look for facial expression, movement of the body or legs, verbal expressions (e.g., crying), and response to comfort measures.
Pain medicines and blocks
Mild pain is generally treated with non-opioid pain medicines like acetaminophen (Tylenol®) or ibuprofen (Motrin®)
Moderate to severe pain is managed with opioids like morphine.
Combining non-opioids with opioids is a very effective way to manage pain.
Medicines are given by mouth (oral and IV (a small tube in the vein). Sometimes small IV doses can be given with a button on a pain pump. Older children can push their button. The nurse will be in charge of the button with younger children.
If pain medications are prescribed for your child, make sure you know who and when to call if your child’s pain is not well controlled. Also ask about the possible side effects of the medication.
There are many operations for which regional blocks are a good way to manage postoperative pain. Regional analgesia blocks the passage of pain through a nerve by depositing a medicine around the nerve.
Common regional blocks include:
- Epidural infusions with catheters
- Spinal injections
- Peripheral nerve blocks
Each of these blocks for pain has its own benefits, risks, and side effects. This information can be discussed with the Nurse Practitioners in the Procedural Readiness Center and your anesthesia care team.
Preventing and managing side effects
Most patients undergoing surgical procedures receive morphine or morphine-like medications. These medications can have side effects that become more common as doses are increased. Your child will be checked frequently for these side effects to keep them safe and comfortable.
Side effects include:
- Nausea and vomiting
- Excessive sleepiness
- Slowed breathing
Managing these side effects is an important part of your child’s plan of care and can include:
- Treating the side effect with medicines like Zofran® (for nausea, vomiting and itching),
- Decreasing the dose of morphine or switching to a different medication
- Adding Tylenol® or Motrin® for pain relief so that the morphine dose can be reduced
Non-Drug therapies for pain management and comfort
Pain is complex and there are many non-drug therapies that can be used to manage pain and help decrease a child’s anxiety. These techniques also can become coping skills that you / your child can use in future life experiences.
Distraction: Giving your child something else to focus on is a very effective way to help him/her cope with pain. Interactive toys, blowing bubbles, singing or music, deep breathing, story telling, video games, computer activities and TV are useful distractions for children in the hospital and clinics
Relaxation: Simple things such as imagining a favorite place can relax even very young children during painful moments. Child Life Specialists can help you and your child learn more about relaxation methods
Music: A child’s favorite music may be comforting during stressful times in the hospital or during a painful moment.
Tactile Methods: The use of cold, heat, massage, gentle touch and positioning can help soothe pain.
Positions of Comfort: A young child often feels more in control when sitting up. Older children often prefer to choose the position of comfort. A nurse can help you and your child decide what positions might be comfortable for procedures
Environment: Lowering lights, decreasing noise and limiting visitors may help some children. Favorite blankets, toys, and pictures are also comforting.
Oral Sucrose: Oral sucrose (sweet water) and sucking can soothe newborns and infants during pain procedures. Learn more about oral sucrose.
Parent Presence: Children have reported that having a family member present during a painful procedure helps them feel better. Ask you nurse or doctor how you can help and coach your child through a painful moment.
Questions to ask before procedures
When your child is going to have an operation or a procedure (even simple procedures such as placing an IV line) you may want to ask:
- Will there be much pain during or after the procedure?
- How long will the pain last?
- What will be done to help my child’s pain?
- What are the side effects of the pain treatments?
- What can I do to help my child during and after the procedure?
Treating pain at home after surgery
- You will receive information on how best to treat your child’s pain after discharge.
- Pain medicine should be given as directed.
- It is helpful to have acetaminophen (Tylenol®) and ibuprophen (Motrin®) available at home for use after surgery. Your surgeon and recovery room nurse will let you know if they can be given.
- Favorite toys, games, books, music, videos and TV can help distract children and help them cope with pain after an operation.
Remember, you and your child are essential members of the pain management team! If you have any questions about managing your child’s pain, please don’t hesitate to call your child’s surgical clinic.