PAIN MANAGEMENT IN

CHILDREN
GROUP TWO
BROAD OBJECTIVE
• By the end of the lesson , learners must be equipped with
knowledge , attitude and skills in managing children’s pain.
SPECIFIC OBJECTIVES
1. Define pain management
2. Describe principles of pain management
3. Explain types of pain management
4. List the barriers to pain management
5. Nurses responsibilities in pain management
INTRODUCTION

• Pain management is defined as appropriate treatment and

interventions developed in relation to pain assessment .

• It should be developed in collaboration with the patient and family

(Wong, 2015).
Introduction cont.
• Children may experience pain as a result of surgery, injuries, acute
and chronic illness and medical or surgical procedures.

• Several erroneous beliefs contributed to the inadequate attention

among children such as assumption that children did not experience
pain to the extent that adults do, because of the immature nervous
system, or that children would not remember the pain.
PRINCIPLES OF PAIN MANAGEMENT

Pain is always subjective , patient has a right to appropriate pain

assessment and management. Patient deserves adequate pain
management.
PRINCIPLES OF PAIN MANAGEMENT
The principles can be remembered with ABCDE
• Ask about pain regularly
• Believe the patient or family’s report of pain
• Choose appropriate pain approaches and treatment options
• Deliver interventions in a coordinated and timely fashion
• Empower patient and their families
Types of pain management
NON PHARMACOLOGICAL
• Comprises of physical and cognitive strategies of relieving pain
Physical therapy
• Massage
• Exercise
• Transcutaneous electrical stimulus
• Heat or cold
• Repositioning
• Therapeutic touch
Cont....
• Decreasing environmental stimuli (sound, light, temperature)
• Range of motion or physical therapy
• Cognitive therapy
• Immobilization
NON PHARMACOLOGICAL CONT
Cognitive or psychotherapy
• Distraction therapy
• Hypnosis
• Relaxation techniques
• Music therapy
PHARMACOLOGICAL PAIN RELIEF
• The use of medications to treat pain and it considers age, type of
pain ,current medications and patient medical history.
WHO Analgesic Ladder
It is used as a guideline.
Step 1; mild pain use non opioid, non steroidal anti inflammatory drugs
and other non pharmacological
Step 2; moderate pain medications in step one plus mild opioid
Step 3 ; severe pain along with medications in one , add a more potent
opioid for example morphine
Non opiods commonly used
DRUG ROUTE PAEDIATRIC DOSE DOSING INTERVAL
Ibuprofen p.o 5 – 10 mg/kg 6-8 hrs
Acetaminophen p.o 10- 15 mg / kg 4-6 hrs
Acetaminophen iv <10kg= 7.5mg/kg
1-2yrs =15mg/kg
<50kg = 15mg /kg
>50 kg = 100mg/kg
OPIOD ANALGESIC FOR MILD TO
MODERARE PAIN
• Tamadol orally , 1-2mg /kg body weight every 4- 6 hrs with a
maximum dose of 50 – 100 mg
 Opiod analgesic for moderate and severe pain
Drug route Initial pediatric dosage Dosing interval

morphine Iv, sc, 0.05 -0.1mg /kg 2-4hrs

Oral , PR o.15 – 0.3mg /kg

pethidine IM 1- 2mg/kg 4 – 6 hrs.

PHARMACOLOGICAL CONT
Note;
• Brufen should not be used in babies less than 3 months
• Start with oral analgesics and give injectable when necessary as the
inflict pain
• Paracetamol doses should be appropriately followed as overdose can
cause liver failure
BARRIERS TO PAIN MANAGEMENT
• Fear of causing addiction or over sedation with patients
• Tolerance
• Underestimating patients pain
• Disregarding or disbelieving self reports of pain
NURSES RESPONSIBILITIES IN PAIN
MANAGEMENT
• Pain assessment
• Pain rating
• Patient and family involvement in pain management
• Physician communication
• Medication administration
• Patient and family education
• Pain evaluation
• Record pain and report
REFERENCES
Lewis, S.L, Dirksen, S.R, Heitkemper, M.M, Bucher, L. & Camera, I.M.
(2011). Medical Surgical Nursing assessment and management of
clinical problems (8th ed). Riverport line. Elsevier Mosby.
Hockenberry, J.M., & Wilson, D. (2015). Wong’s Nursing Care of Infants
and Children. (10th ed). St Louis, Missouri. Elsevier Mosby.