Parents, Doctors Often Undertreat Children For Pain


IRVINE, CA (ASRN.ORG) - Parents have always nursed their kids through illness and patched up bumps and bruises. 

But today, with hospitals sending most kids home within hours of surgery, parents are also being asked to oversee their children's recoveries and pain management. About 84% of pediatric surgeries are performed as outpatient procedures, says pediatrician Zeev Kain, chairman of anesthesiology at the University of California-Irvine. 

Yet doctors give parents relatively little information about how to care for these young patients, Kain says. It's not enough to hand parents a prescription, he says. Doctors and nurses need to make sure parents will actually give the medication. 

Without such guidance, parents who are afraid of medication side effects often intentionally withhold medication, he says. 

Many withhold medicine 

In a study of 261 children, 24% of parents gave either no medication or a single dose, even though 86% of parents reported that their child was in "significant pain" on the first day after surgery, according to the study of children ages 2 to 12. Doctors typically advise parents to give pain relievers every four hours as needed. 

The study's results suggest that children are suffering needlessly, Kain says. "If 86% of parents think their child is in pain, then 86% should have given the child pain medication," he says. "If they think their child is in pain but don't give them anything, that is where we have failed." 

Ideally, parents should give the medication continuously rather than waiting for children to complain of severe pain, says psychologist Michelle Fortier, co-author of the Pediatrics article.

Many parents harbor misconceptions about pain control, believing that children will become addicted to narcotics, or that they aren't hurting unless they cry or complain. Many don't realize that a child in pain may become withdrawn, Kain says. 

Studies show that 40% of kids have behavioral changes after surgery, such as refusing to eat, being unable to sleep or having nightmares, Kain says. 

Four-year-old Chase Scheely, for example, is usually a "go-go-go" kind of kid, says his mother, Sara Frietchen of Parma, Ohio. 

After his tonsillectomy in June, however, he lost all interest in his toys and wanted to be alone. He became fussy and developed mood swings. He hated the bitter taste of his liquid pain medication and fought his mother's attempts to give it to him. 

"He would just rather be in pain than take his medication," Frietchen says. "Explaining to a 4-year-old — 'You need your pain medication. Just take it.' — doesn't work." 

Without pain relief, though, Chase's throat became too sore to swallow, his mother says.

The child refused to eat or drink, becoming so dehydrated that he threw up — a common problem in kids, doctors say. Within two days of his surgery, Frietchen brought him back to the hospital, this time to the emergency room, because she recognized that dehydration was making him much sicker. 

John Stork, an anesthesiologist at University Hospitals Rainbow Babies & Children's Hospital in Cleveland, where Chase had his surgery, says he has seen many cases like this. In severe examples, children who vomit after tonsillectomies can develop dangerous bleeding,

"That bleeding can be more risky than the original tonsillectomy," Stork says. "They swallow blood, so their stomach is full of blood. It's really an emergency." 

Pain can hinder a child's recovery in many ways, Kain says. "If you are in pain, you have a stress response in your body," he says. "That puts your body into a defensive mode, so there is less building of new tissue and less recovery." 

Strategies for care 

Kain recommends filling painkiller prescriptions as soon as kids are discharged so that the medication is available if kids wake up in pain at midnight. 

If children don't like the taste, parents can ask pharmacists to create alcohol-free versions, which are more palatable, says Mark Brown, an ear, nose and throat surgeon in Austin. Many pharmacies are now willing to add a child's favorite flavor, such as orange or grape. 

Parents also can request that children try a dose of medication before leaving the hospital, to make sure they are willing to swallow it, says Lisa Humphrey, medical director of pediatric palliative care at Rainbow Babies & Children's Hospital. When in doubt, parents shouldn't hesitate to call their doctors, she says. 

"If their child is not acting like themselves," Humphrey says, "then we should look at pain management so children can go back to their job at hand, which is to have fun and explore."

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