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Do abused young children feel less pain?
Marie-Hélène Drouineau1, Elise Guenego1, Véronique Sebille-Rivain2
1Pediatric department, University Hospital of Nantes, France.
Insights
Acute pain in abused children is often under-recognized by healthcare professionals compared to children with accidental injuries. This under-recognition may stem from abused children exhibiting reduced pain expression following trauma.
Area of Science:
- Pediatrics
- Child Abuse
- Pain Management
Background:
- Under-recognition of acute pain in abused children is a significant clinical challenge.
- Pain perception and expression in abused children may differ from those with accidental injuries.
Purpose of the Study:
- To investigate the recognition of acute pain in abused children versus children with accidental injuries.
- To determine if pain under-recognition is a symptom of child abuse.
Main Methods:
- Observational prospective case-control study in an emergency department.
- Inclusion criteria: children <6 years, trauma within 7 days, bone injury or burn, able to express pain.
- Case group: confirmed abuse; Control group: plausible injury cause, no abuse signs. Matched by age and trauma type.
Main Results:
- Pain was significantly less recognized in abused children (relative risk=0.63, p=0.04).
- Discrepancy noted between nurses' and doctors' pain assessment scores (Kappa=0.59).
- Abused children may exhibit reduced pain expression post-trauma.
Conclusions:
- Medical staff under-recognize pain expression in abused children.
- Abused children might display diminished pain responses after traumatic events.
- Focused attention on abused children's pain can optimize analgesic treatment.
Abstract:
The objective of this study was to investigate whether acute pain in abused children was under recognized by doctors and nurses compared to children evaluated for accidental injuries. We hypothesize that an abused child's reaction to physical pain could be an additional symptom of this challenging diagnosis. For the observational prospective case control study in an emergency department, children were eligible when: younger than six years old, the reported trauma occurred within the previous seven days, the trauma comprised a bone injury or burn, and the child was able to express his or her pain. The case group comprised children for whom the medical team reported their abuse suspicions and supporting information to a court, and whose cases of abuse were subsequently confirmed. The control group consisted of children with a plausible cause for their injury and no obvious signs of abuse. The children were matched according to their age and type of trauma. The pain was assessed by doctors and nurses before analgesic administration using a certified pain scale. Among the 78 included children, pain was significantly less recognized in the abused children vs. the controls (relative risk=0.63; 95% CI: 0.402-0.986; p=0.04). We observed a discrepancy between the nurses' and doctors' scores for the pain assessments (Kappa coefficient=0.59, 95% CI: 0.40-0.77). Our results demonstrate that pain expression in abused children is under recognized by medical staff. They also suggest that abused children may have reduced pain expression after a traumatic event. Paying particular attention to the pain of abused children may also optimize the analgesic treatment.