| Infants Babies rely on you, the caregiver to notice their pain.
They may become restless and cling or whine. They may have decreased activity
(sleep more, lose interest in favorite toys) or increased frantic activity. They
may have a loss of appetite. They will be difficult to console.
Toddlers and Preschoolers ( 2-5 years)
Children in this age group experience pain and cannot
always identify the source or location of their pain. They need to be reassured
that their pain is not punishment for real or imagined misbehavior. They believe
in magical disappearance of pain and that their pain is someone's fault.
Children in this age group require less practice with relaxation techniques than
children in older groups.
School Age ( 6-12 years )
Children in this group can tell you the location of their
pain in terms of body parts. They are afraid their bodies will be damaged or
changed. They require more practice with relaxation techniques than do younger
children. They often feel a lot of injury related guilt. For example a child
doing something wrong when he is injured may feel he/she deserves the pain from
the injury.
Adolescents ( 13 years & older )
Teens are often afraid of loosing face or looking like a
baby. They are often hesitant to express feelings of pain. They should not be
teased or ashamed if they cry or demonstrate pain in other ways. This age group
often has pre-conceived notions about relaxation and may require more
practice than any other age group.
Age Group 0-1 years
Pacifier / Blanket / Touch / Music / Mobile / Musical Toy
Age Group 1 - 3 years
Favorite toys / Blow bubbles / Hold hand / Pop up Book /
Count to 10 / Alphabet / Magic wand / pin wheel
Age Group 3 - 6 years
Deep Breathes / Blow away pain / Imagination: somewhere
else doing something else you enjoy / Blow bubbles / Hold hand / Listen to music
/ sing a song / Pop-up books / Squeeze ball
Age Group 7 - 12 years
Imagine & pretend both of you are on an adventure /
Deep breathing exercise / Hand held games / Music / Squeeze ball
Age Group 13 & up
Deep breathing / Music / Computer Games / Imagery /
Fantasy / Imagining favorite activities/ Watching TV
RESPONSES TO ILLNESS & HOSPITALIZATION
Infants
Fussiness and irritability due to disruption of normal routines. Immediate
physical response to pain. Needs & seeks comfort. Stranger anxiety begins at
about six months.
Preschool
Separation anxiety. Anxiety about intrusions and mutilation. Anxieties due to
magical thinking or fantasies about what is going on around them. Child may feel
that he/she is the cause of the illness and therefore being punished. Regression
may occur.
Toddler
Separation anxiety. Fear of strangers. Immediate physical responses to pain
& unfamiliarity. Frustration due to monitoring of independence. May revert
to earlier stages of develompent (regression) in the areas of language, motor
ability & toilet training.
School Age
Fear of pain. Fear of injury, mutilation and never being well again. Fear of
loss of control, loss of respect, love. Separation concerns with respect to
disruption in daily living school and peers. Modesty concerns.
Adolescent
Anxiety related to long-term implications of the illness, disability.
Separation concerns related to peers; fear of loss of status to peer group.
Anxiety related to body injury & pain. Concern for body image & changes
in physical appearance. Concern for privacy, modesty.
TREATMENT ROOM DYNAMICS
Its important that we are all on the same team. There are no
"good-guys" or "bad-guys"
Designate one person to lead the discussion in the room. Too many people
speaking at once can be overwhelming for the child
Offer honest choices
Be specific with praise so that children know what it is that they are doing
right.
Keep instructions to a minimum and focus only on the most important
instructions.
CHILDREN AND PAIN
Untreated pain may cause anxiety depression, irritability, exhaustion, and
can slow healing
Children who are playing may still be experiencing pain
Starting an intravenous line (IV) and blood draw can be made less painful by
using a local anesthetic, such as EMLA cream when applied 2 -3 hours prior to
the procedure, it helps reduce the pain of needles.
Non pharmacological techniques such as distractions, relaxation or coping
training can help relieve a child's anxiety and pain.
Children need to be honestly prepared for painful procedures with a full
range of possible sensations (e.g. "this may sting for a minute" or
"this may feel very cold and a pinch")
The best way to measure pain is to ask the child how much he/she hurts.
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