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[Analgesics in pediatrics. Before prescribing: recognize and evaluate pain, reassure]
E Fournier-Charrière1, J P Dommergues
1Service de pédiatrie générale, Hôpital de Bicêtre, Le Kremlin-Bicêtre.
Insights
Accurate pain assessment in children is crucial for effective treatment. This involves careful observation of behaviors and utilizing tools like the visual analogue scale (VAS) and DEGR scale for objective evaluation.
Area of Science:
- Pediatric Medicine
- Pain Management
- Clinical Assessment
Context:
- Pediatric clinics commonly prescribe analgesics for all pain, necessitating careful evaluation.
- Pain expression in children varies significantly between acute and prolonged types.
- Establishing trust and clear communication is vital for managing pediatric pain and anxiety.
Purpose:
- To emphasize the importance of objective pain assessment in children before treatment.
- To differentiate between the signs and assessment methods for acute and prolonged pain in pediatric patients.
- To highlight the role of the healthcare provider in creating a supportive environment for children in pain.
Summary:
- Objective evidence is essential for valid pain assessment in children, moving beyond habitual analgesic prescription.
- Acute pain signs (crying, agitation) are nonspecific, while prolonged pain may present with sadness and depression, requiring specific diagnostic approaches.
- Tools like the visual analogue scale (VAS) for older children and family-questioning/specific signs for younger children, alongside the DEGR scale for prolonged pain, aid intensity assessment.
Impact:
- Improved diagnostic accuracy for pediatric pain, leading to more appropriate and effective treatment strategies.
- Reduced reliance on routine analgesic prescriptions by promoting evidence-based pain assessment.
- Enhanced patient and family experience through better communication and a supportive clinical environment, mitigating the cycle of pain and anxiety.
Abstract:
CAREFUL ASSESSMENT: In pediatric clinics, it has become habitual to prescribe analgesics in all painful situations. Particular attention must be paid to pain experienced by the child and obtaining objective evidence allowing valid assessment prior to treatment. ACUTE PAIN: Usually clearly expressed by crying screams, agitation, retraction and protection of the painful area, signs of acute pain are nonspecific and not proportional to its intensity. PROLONGED PAIN: Sadness and depression confound the expression of prolonged pain. Diagnosis may be difficult; an association between a potentially painful situation, pain relieving positions, and retraction behavior is specific. ESTABLISH CONFIDENCE: For both the child and his family, an atmosphere of confidence and a clear explanation of the lesions and their treatments are essential to break the viscious cycle of pain and anxiety. EXAMINING A CHILD WITH PAIN: Patience is the essence of examining children, facial mimics, reactions, movements and positions all provide essential information. ASSESSING PAIN INTENSITY: Using the visual analogue scale, VAS, children over 5 years of age can show where the pain is on a drawing of the body. For those under 5, questioning the family and looking for specific signs is an essential source of information. The DEGR scale can be used to score prolonged pain in children from 2 to 6 or 8 years of age.