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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.

Child Abuse & Neglect
|February 15, 2017
PubMed
Summary

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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.
Keywords:
Acute painChild abuse

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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.