Pain in Children
It can be a challenge to recognise the symptoms of pain in children. Are they really hurting, or are is the parent overreacting? Pain is a highly individual and complex experience. Here we take a look at reading the symptoms of pain in children.
Symptoms of Pain in Babies
Unlike with older children, crying isn’t always a reliable pain indicator in babies. That’s because crying is a baby’s way of expressing a whole host of needs. Here are signs that a baby may be in pain.
Changes in crying patterns. A baby’s distressed cry sometimes, but not always, sounds different from ordinary crying. Changes in a baby’s behaviour can also be a tip-off. For example, crying that can’t be soothed with a bottle, diaper change, or cuddling could signal pain. Also, a calm baby who becomes unusually fussy could be in pain.
Crying while nursing. The baby who cries while nursing could very well have a painful ear infection. Prolonged, intense crying, often at the same time each day. This behaviour is common with colic. It often starts at the age of 2 weeks, peaks at 6 weeks, and then gradually declines.
Crying and drawing the legs up to the abdomen. The baby could have colic or a serious medical condition.
Withdrawing. Chronic pain can sap a baby’s energy, causing him or her to become still, quiet, and to avoid eye contact.
Symptoms of Pain in Toddlers
Fortunately, at this age, children in pain can talk. They will often also clutch the part that hurts. Pulling or rubbing the ear is common in toddlers and although it can sometimes indicate ear pain, it may be habit. Suspect an ear infection if the child has had cold symptoms or a fever and begins to tug at the ear suddenly.
Symptoms of Pain in Children and Adolescents
Chronic or recurrent pain is common in children and adolescents. Research has shown that as many as 30% to 40% complain of pain at least once a week.
Acute abdominal pain. Pain that comes on suddenly can be caused by viral infections or by something more serious like appendicitis. If a child’s pain seems to be localised to the right of the belly button and is accompanied by nausea, vomiting, and desire to stay very still, they should be evaluated for appendicitis.
Recurrent stomach aches and headaches. A stomach ache that goes away after a bowel movement could signal a problem with constipation or, less often, inflammatory bowel disease. Daily abdominal pain without nausea, vomiting, or diarrhea could be a special form of migraine, or could fall under the category of chronic recurrent abdominal pain, a common but frustrating complaint in children.
Communicating with and involving children in taking their medications will have a significant impact on their adherence. Children take responsibility for their medications at different ages. Children are often not present when their parents collect their medications from the pharmacy and, therefore, this prevents them from receiving support and advice from community pharmacists so ensure parents are well educated on the symptoms, medications and side effects.
Communication
• Check parents understand what the medication is for and supplement knowledge if needed;
• Ensure parents are aware of the most common adverse effects and what to do if these occur;
• Explain what to do if their child misses a dose;
• Explain anything relevant to the particular medication (e.g. to take phenoxymethylpenicillin on an empty stomach);
• Check parents understand how to administer the medication to their child;
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. The use of antipyretic medication and attention to the fever must not detract from monitoring the child’s activity and level of consciousness (as an indicator of worsening illness) and paying attention to adequate hydration.
Both paracetamol and ibuprofen are safe and effective for shortterm use in children. The practices of combining or alternating paracetamol and ibuprofen have limited value and are not recommended. 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. The use of NSAIDs has been associated with an elevated risk of severe skin and soft-tissue infections in patients with varicella zoster virus infection. Therefore, paracetamol is recommended as the antipyretic of choice in children with chicken pox. Medicines containing combinations of NSAID(s), paracetamol, codeine and/or antihistamines should not be used in children.
Nonpharmacological measures can be used as an adjunct therapy in the management of pain in both adults and children. Nonpharmacological strategies such as physical and psychological comfort measures are useful in conjunction with pharmacological options to help lower levels of anxiety, distress and pain. Some physical comfort measures include the use of massage or heat and/or cold compresses, applying pressure or vibration and repositioning. Psychological comfort measures include use of imagery, distraction and relaxation techniques.
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