I am a child psychologist and pain scientist. For the past 20 years, I’ve been studying pain in children. Looking back, we’ve certainly made major improvements in managing pain in children. It’s hard to believe that even as late as the 1970’s and 80’s, it was widely believed that babies, especially premature babies, weren’t able to feel pain and that it was too risky to use anaesthetics with them. Instead of proper anaesthesia, it was standard practice to give these babies only drugs that would paralyze them so that they wouldn’t move during surgery.
Fortunately today, pain management for babies has improved dramatically. There are a variety of effective treatments available to prevent and relieve the pain of medical procedures, including effective drugs as well as other methods that reduce pain, like sucrose (sugar water) and skin-to-skin contact with the mother during procedures.
However, even today there are still many ways we continue to fail our children when it comes to pain. Take, for example, children’s vaccinations. By age 5, even healthy children will experience as many as two dozen needles from routine vaccinations. We know that there are effective ways to reduce needle pain, including pharmacological interventions, like topical anesthetic creams, and psychological interventions, like distraction and relaxation. We also know that what parents say and do has a big impact on how much pain children feel. When parents use reassuring statements like, “It will be okay” or “It will be over soon”, this can serve as a signal to the child that the parent is feeling nervous or worried, and can actually make their child’s pain worse.
No parent likes taking their children for needles. This seemingly minor pain, however, causes many children to develop a huge fear of needles that can lead them to avoid going to the doctor and getting appropriate medical care, for the rest of their lives. As a psychologist, I’ve worked with hundreds of children and adults with these severe needle phobias and almost all of these patients can trace their fear back to one poorly managed needle experience as a child.
So why aren’t children getting the pain management for procedures they deserve? It’s a complicated issue. Part of the problem is that there are a lot of misconceptions about pain. Some believe that pain has no long-lasting effects. But research with animals and humans has shown that early poorly managed painful experiences actually lead the body’s nervous system to become more sensitive to pain. Another part of the problem is that health professionals don’t get much training in pain. In fact, veterinarians receive more than 5 times the education about pain during their training than doctors do.
We need to increase awareness about pain and empower patients to demand and expect the best pain care available, for themselves and for their children. A study showed that when parents were asked why they weren’t using pain management for vaccinations with their children, parents said it was because their doctor didn’t suggest it. But when the doctors were asked why they weren’t using pain management for vaccinations with their patients, they said it was because the parents weren’t asking for it. We have a problem here.
This year, I decided I wanted to reach parents directly about pain. We created a fun, 2 minute YouTube video for parents called “It Doesn’t Have To Hurt”.
In the video, a cute 4-year-old girl teaches parents simple things they should – and shouldn’t – do to make painful needle procedures, like vaccinations, hurt less. In 2 weeks, the video had over 26,000 views. Parents loved it; they gave us feedback on our Facebook page like “My kids got their flu shots today and the advice from your video made a real difference!”
But parents also shared challenges they had had with health professionals around pain management: “I asked at the pharmacy for the anaesthetic cream, but they said it didn’t work and wouldn’t sell it to me”. Even parents were asking: “What can we as parents do when the medical professionals just say it’s going to be okay and then don’t provide us and our kids with any real comfort?”
The feedback about our video from health professionals was mixed. While many praised us for our efforts, we also heard things like “I don’t want my patients asking about pain management” and “It takes too much time”.
Well, that’s too bad! It’s time we all started thinking differently about children’s pain. Today we shudder to think that 30 years ago it was ever acceptable that babies underwent surgeries without anaesthetics. Let’s make sure that 30 years from now, when we look back on today, we don’t have more regrets about what we should have been doing differently for children in pain.
Submitted by Christine Chambers PhD (twitter: @drcchambers)
Dr Christine Chambers is a clinical psychologist and Professor in the Departments of Pediatrics and Psychology and Neuroscience at Dalhousie University in Halifax, Nova Scotia, Canada. She is based in the Centre for Pediatric Pain Research at the IWK Health Centre. Dr Chambers’ research examines developmental, psychological, and social influences on children’s pain, with a focus on family factors in pediatric pain and pain measurement in children. She is a recipient of the International Association for the Study of Pain’s (IASP) Ulf Lindblom Young Investigator Award, given to an individual under the age of 40 who has made significant contributions to clinical pain research. She will be speaking at the upcoming annual meeting of the Australian Pain Society in Hobart, Tasmania. #APS2014