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Targeting Pain in Children

Topic Team Training

The below information, considerations and checklist provides support to enable you to run a team training session and identify opportunities for learning within the topic of Pain in Children.

Pain is defined as a highly unpleasant physical sensation caused by illness or injury. Acute pain is one of the most common adverse stimuli experienced by children, occurring as a result of injury, illness and medical procedures. If a child’s pain is not treated quickly and effectively, it can have long-term consequences, which may include anticipatory anxiety during future procedures, a lowering of the pain threshold and sensitisation to future pain, reduced effectiveness of analgesics and increased analgesic requirements subsequently.

To adequately assess a child’s response to treatment, it is necessary to have ongoing assessment of the child’s pain. However, for children who cannot communicate this information due to age or developmental status, observational and behavioural assessment tools are acceptable alternatives when valid self-report is not available. Depending on the age of the child and his/her ability to communicate the information to the health care provider, there are many reliable, valid and clinically sensitive assessment tools available; for example, the Face, Legs, Activity, Cry and Consolability (FLACC) scale, which incorporates 5 pain behaviours that make up the scale’s name: facial expression, leg movement, activity, cry and consolability.

Fever
Fever is a normal physiological response to illness that facilitates and accelerates recovery. Although it is often associated with a self-limiting viral infection in children, it may also be a presenting symptom of more serious conditions requiring urgent medical care. Therefore, it is essential to distinguish between a child with fever who is at high risk of serious illness and who requires specific treatment, hospitalisation or specialist care, and those at low risk who can be managed conservatively at home. It is vital that pharmacists, when assessing children who present with fever, can make appropriate decisions on when to refer, the appropriate use of medication and how to advise parents and caregivers.

Discomfort during a febrile illness is often due to associated pain; e.g. myalgia, sore throat, headache. Ibuprofen and paracetamol may be considered to improve comfort (with accompanying improvements in feeding activity and irritability), because they may also provide relief from pain and may reduce the risk of dehydration. They should be used to make the child more comfortable and not used routinely with the sole aim of reducing the temperature. Both paracetamol and ibuprofen are safe and effective for short-term use in children.

Dose of antipyretic medication in children should be accurately based on body weight and should not merely be estimated. For accurate dosing, liquid medicines should be administered with a syringe.

Learning – www.hse.ie/my-child – Guide to Pregnancy, Baby and Toddler Health

 

Consider:
 Am I, and my team, aware of the different presenting symptoms of pain in children?
 Are my pharmacy staff aware of suitable products they can offer to parents?
 Is the pharmacy team aware of various aids designed to help administer medications to children, such as medicine soothers?
 Conditions in children that cause pain and fever
 What types of pain in children can be managed in the pharmacy
 Which painkillers and cough and cold ingredients are suitable for children at different ages
 The importance of not using ibuprofen and paracetamol together in children
 The symptoms of meningitis and the importance of looking out for these
 Normal body temperature for children and the temperature at which a child is deemed to have a fever.

 

Key Points:
Check your pharmacy team are aware and understand the following key points:
 Customers that should be referred to the pharmacist
 Those suffering with chronic pain symptoms should be referred to their GP
 A good range of products for various childhood ailments is vital. All need to be clearly signposted in store to make it quick and easy to identify suitable treatments
 Ensure effective category management with allied condition treatments close to hand
 Remind parents to take care with child doses.

Recent research suggests that parents can often misinterpret dosage instructions for liquid medicines

 

Actions:
 Include POS that will allow children to feel comfortable and make shopping easier for parents by allowing room for manoeuvring pushchairs
 Ensure that child and infant health products are merchandised together, along with related products such as thermometers, to help build sales
 Ensure that this important category is fully stocked at all times and merchandising plans are amended based on school term times
 Ensure that I know the recommendations for analgesic use following childhood vaccinations
 Train the team to meet all the above considerations

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