Paediatric Pain Management

Understanding the child’s perspective on pain.

Katrina Shapland

Occupational Therapy Student.

Try and imagine a time when you were in hospital/in pain as a child:

How did you feel?

What did you do to cope?

What did people around you do?

Ward-groupGoals of ward group

Provide opportunity for children to enact hospital procedures through play

Facilitate social interaction

Provide normalcy - play is the primary occupation of childhood.

Allow projection of feelings and experiences onto the teddy to further sense of mastery and control.

Ward group - 2FW

Number of children per caseload identified to benefit from OT services verses number of referrals.

Medical Play

• http://www.youtube.com/watch?v=Go8N5i3lCWI

Play!

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What is pain? Pain is whatever the

experiencing person says it is, existing wherever they

say it does.

Evidence shows that pain is an inherently subjective, multifactorial experience.

For this reason it is impossible to treat pain on a physical level and expect it to disappear.

PEO(Person, Environment, Occupation)

EnvironmentOccupation

Person

Occupational performance

Piaget’s developmental stages

Cognitive Stage of Development

    Key Feature Impact on perception of pain

Preoperational2 - 7 yrs.

EgocentrismProcess of ‘getting better’ in response

to pain (2, 4)

Concrete Operational7 – 11 yrs.

ConservationAble to describe psychological feelings

of pain (3)

Table 1 ref: Piaget, 1932

What does the literature say - 2-

4years?

Getting better: (a) ‘hide away,’ (b) ‘fight it’, (c) ‘make it good’.

More frequent the pain, the more frequently these strategies were used.

Strategies: 2-4 years

Explaining the procedure just before it happens

Introduction of medical equipment prior to procedure through play (e.g. X-ray machine = space ship!).

Distraction: blowing bubbles, puppets, toys.

Reflecting on hospital experiences through play with other children.

What does the literature say - 7-11

years?Taking medicine and other curative actions

Resting and cognitive control strategies e.g. distraction

Decrease in parental support - view themselves as active agents in pain relief.

Non-observable components of pain.

What does the literature say - specific

conditions?Specific conditions develop their own pain patterns - specific strategies to target these.

For example: Tonsillectomy

Visual Analogue Scale O = no pain 10= extreme pain

Assessing pain• Situations that caused pain to all

children in hospital were procedures connected with treatment.

• Children described pain as physiological, and psychological feelings of pain.

• Research indicates school-aged children’s ability to describe their own pain.

Looking to the future:

• Assessments- to gauge pain perception before and after medical play

• Extending play for older children.

Future research

• Influence of individual’s personal experience on the concept of pain.

• Influence of socio-cultural factors

• Specialised pain intervention strategies

Thank you for your time.

Any questions?

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References

• Tonsillectomy picture: 200214425-001_XS.jpg retrieved from http://www.livestrong.com/tonsillectomies/

• Baum, C. M, & Christiansen, C. H. (2005). Person-environment-occupation-performance: An occupation-based framework for practice. In C. H. Christiansen, C. M. Baum, and J. Bass-Haugen (Eds.), Occupational therapy: Performance, participation, and well-being (3rd ed.). Thorofare, NJ: SLACK Incorporated.

• (Paediatric Pain Management: A Multi-Disciplinary Approach - By Alison Twycross, Anthony Moriarty, Tracy Betts 1998 )

• Piaget, J. (1932). The moral judgment of the child. London: Routledge & Kegan Paul.

• reference: 1995 Young children's behavioural responses to acute pain: strategies for getting better.http://www.ncbi.nlm.nih.gov/pubmed/7593943 

• reference: 1997 ["It feels like a hedgehog quill sticking in my foot...". School-aged children's experience of pain in the hospital].http://www.ncbi.nlm.nih.gov/pubmed/9429343 )

• reference: 1996  "Getting better from my hurts": toward a model of the young child's pain experience. http://www.ncbi.nlm.nih.gov/pubmed/8772041)

• Idvall, E., Holm, C., Runeson, I. (2005). Pain experiences and non-pharmacological strategies for pain management after tonsillectomy: a qualitative interview study of children and parents. Journal of Child Health Care, 9(3), 196-207.

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