Managing Pediatric Pain in Low-Resource Emergency Settings: Barriers, Advances, and Future Directions

Pediatric pain remains frequently under-recognized and inadequately managed in emergency departments (EDs), particularly in low- and middle-income countries (LMICs), leading to significant physical and psychological harm. This narrative review synthesizes current evidence on pediatric pain management in LMIC emergency settings, highlighting both established practices and emerging innovations. Established approaches include pharmacologic interventions such as acetaminophen, NSAIDs, and opioids and cost-effective non-pharmacologic methods like distraction, guided imagery, and parental involvement. Despite their demonstrated benefits, implementation in LMICs is hindered by limited provider training, restricted access to essential analgesics, and cultural misconceptions about childhood pain. Emerging innovations involve task-shifting models to expand workforce capacity, digital and AI pain assessment tools, and context-adapted community interventions. Improving pediatric pain care in LMICs demands a multifaceted strategy integrating culturally adapted assessment tools, equitable access to analgesics, scalable non-pharmacologic interventions, and sustainable workforce development supported by technology-driven solutions.