Your Child’s Pain
“My child just started treatment. I am worried about all of the painful tests and treatments he will have to endure and I want to know what I can do to help him.”
No matter how old your child is, when they feel pain, you feel it too. Unfortunately, there will be episodes of discomfort and pain from your child’s illness and treatment. That is why it is important to understand how to identify pain in your child, what you can do and what care providers care providers can do to help relieve the pain.
There are resources and information available that will help you keep your child comfortable. There are also guidelines to help you observe and “translate” the signs of pain in your child and communicate this information to the health care team.
You will often be the eyes, ears and hands of your child’s physician, both at home and at the hospital. No one knows your child as well as you do. You are the one who is most familiar with their subtle changes, expressions of distress, and signs of discomfort and pain. Therefore, you are likely to be the first one to recognize pain in your child and activate the proper relief.
In order for the doctors to better understand your child’s condition, they may need to conduct some tests that are uncomfortable or painful.
The following familiar comfort measures can be very effective in reassuring and relaxing your child during these procedures:
- Ask for something to prevent or decrease pain during painful procedures. Don’t be afraid to insist. You are your child’s pain advocate.
- Offer your ideas about what caregivers could do to maintain consistency in your absence and to make your child comfortable.
- When your child is in pain, try to distract them from the discomfort. One way is to help your child think of a peaceful or special place and imagine it with several senses.
- Bring stories and books from home to distract and redirect your child’s thoughts.
- Allow your child to have a comfort object, such as a bear, doll, animal, or headset with music while they are getting tests, procedures, etc. One mom left her (worn and smelly) tee shirt with her child so he could cuddle it and smell her when she couldn’t be there.
- Use your voice as a soothing mechanism. Record it for them to listen to on a headset when you can’t be there. You could read, say your goodnight, or reminisce.
- Maintain a positive outlook for your child. Offer positive reinforcement and encouragement despite the hurdles and challenges you are experiencing.
- Try tapes and CDs with relaxing nature sounds or music..
- Wash cloths somehow have “magical power” to make things feel better. Keep a special wash cloth handy to gently press on a sore area or your child’s forehead and eyes.
- Gently massage, rub, or stroke your child to soothe and distract them.
- Hold your child’s hand.
- Reassure your child that the pain will over soon.
- Help your child to be brave by not expressing fear yourself.
Your presence is the best way to reduce your child’s pain and anxiety during procedures or tests. Prepare your child by assuring them that you will be there during the entire procedure. Work together to create ways to make your child feel better, such as rituals, songs, holding each other, maintaining eye contact, etc. Explain to your child what is going to happen during the test. If you’re not sure, ask your doctor before the procedure begins so there are no surprises. Knowledge is empowering and it will help you overcome the anxiety you may feel.
What you need to know about pain management
Information can bring a sense of control when so much change is happening in your lives. If your child is in pain, insist on a consult with a pain specialist. Ask about the cause of your child’s pain, how you can detect it, and what you can do to help. Ask about your options for medication, including both over the counter and prescription drugs, and when and how often you can give it.
It is very important to ask your doctor how you will know when a stronger pain medication is needed. It is also a good idea to have something a bit stronger than what you currently need on hand should the need for it arise late at night or on the weekend. Remember that you are entitled to have the proper “ammunition” for mild, moderate or even severe pain when your child’s condition warrants it.
Good pain management is based on believing (and then acting upon) what the patient says is pain. Most hospitals will use a pain rating scale to evaluate the degree or intensity of pain. There are scales available for young children, school-age children and teenagers. Babies and non-verbal children “tell” us by their physical changes, cries and vital signs, etc. For example, one scale is rated from zero to ten with zero meaning “no pain” and 10 meaning “the worst pain”. The pain number rating helps the nurse and physician to determine the best medication and develop a care plan for managing the pain, now and ongoing.
Ask your health care professional which tool they use to evaluate pain so that you can become familiar with it. Understanding the tool can give you a sense of control, help your child communicate how they are feeling, empower you to report pain to your health care team, and choose the appropriate pain medications and comfort measures. Pain should be re-assessed frequently to ensure that the medications and comfort measures are sufficient.
Always remember that pain is what your child says it is, and we need to believe it as fact. Children want to be brave for you and for themselves but they do not need to suffer needlessly. Good pain relief will allow them to put their full energy into healing, getting well and feeling better.
Types of medication
Over the counter drugs such as acetaminophen (Advil) or ibuprofen (Tylenol) are used for general discomfort and mild pain. Make sure that you ask your physician about the appropriate dosage for your child’s unique condition and needs.
Moderate pain is pain that affects a child’s ability to enjoy activities and rest well. Moderate pain may also cause your child to be irritable or cranky. This type of pain may persist despite your comfort measures and current medicine. Some options that might be prescribed are codeine, oxycodone, or even morphine.
More severe and ongoing pain is often treated safely with morphine, hydrocodone and hydromorphone, etc. Your physician will discuss the need to increase the strength of pain medications as your child’s needs change.
It is important to understand that your child’s pain can be managed well with the available medicines. Morphine and similar drugs, given in amounts based on your child’s weight and condition, can be carefully monitored to determine the appropriate level for comfort while maintaining your child’s ability to function normally. Be sure you understand how often to give the medications. Is there a schedule or isthe medication to be to given on an “as needed” basis (when your child is hurting and you cannot relieve the pain with comfort measures alone)?
Keeping your child comfortable
The more frequently you give a medication, the more relief your child will feel. Medication given on an “as needed” basis, or “PRN”, means that you give the medication when a child tells you he is in pain. This works well when your child has only occasional pain and does not need medication on a daily basis. However, if your child has daily pain, even if it is sporadic, he may fluctuate between pain and relief throughout the day without consistent medication. If this is the case, a small regular dose should be given at scheduled times to best control pain and prevent the escalations that can be frightening or worrisome for both you and your child.
Getting through treatment and therapies can be challenging but keeping your child comfortable is both a right and a responsibility. It will help your child get stronger if their energy is devoted towards recovery rather than exhausted from pain.
Article contributed by Liz Sumner RN, BSN
Palliative Care Coordinator, The Elizabeth Hospice