IntroductionOur objective was to compare pain assessments by patients, parents and physicians in children with different medical conditions, and analyse how this affected the physicians' administration of pain relief.Patients and methodsThis cross-sectional study involved 243 children aged 3–15 years treated at Bergen Accident and Emergency Department (ED) in 2011. The child patient's pain intensity was measured using age-adapted scales while parents and physicians did independent numeric rating scale (NRS) assessments.ResultsPhysicians assessed the child's mean pain to be NRS=3.2 (SD 2.0), parents: NRS=4.8 (SD 2.2) and children: NRS=5.5 (SD 2.4). The overall child–parent agreement was moderate (Cohen's weighted κ=0.55), but low between child–physician (κ=0.12) and parent–physician (κ=0.17). Physicians significantly underestimated pain in all paediatric patients ≥3 years old and in all categories of medical conditions. However, the difference in pain assessment between child and physician was significantly lower for fractures (NRS=1.2; 95% CI 0.5 to 2.0) compared to wounds (NRS=3.4; CI 2.2 to 4.5; p=0.001), infections (NRS=3.1; CI 2.2 to 4.0; p=0.002) and soft tissue injuries (NRS=2.4; CI 1.9 to 2.9; p=0.007). The physicians’ pain assessment improved with increasing levels of pain, but only 42.1% of children with severe pain (NRS≥7) received pain relief.ConclusionsPaediatric pain was significantly underestimated by ED physicians. In the absence of a self-report from the child, parents' evaluation should be listened to. Despite improved pain assessments in children with fractures and when pain was perceived to be severe, it is worrying that barely half of the children with severe pain received analgesics in the ED.

Conservative treatment may still be regarded as the gold standard for closed paediatric fractures of the distal radius. In the present series, the remodelling capacity was excellent.

In 1998 the authors conducted a prospective registration of children younger than 16 presenting with a new traumatic fracture in the city of Bergen, Norway. In this epidemiologic study, the authors registered a total of 1.725 fractures in children; the fracture incidence was 245 per 10,000 children below the age of 16. One fifth needed reduction, and the distal radius was the most common fracture site (27%). Activities associated with fracture were mostly soccer and bicycling, but compared with the total number of injuries associated with each activity, we found a doubled risk of fractures during rollerblading/skating or snowboarding (60%) compared with playing soccer (38%) or bicycling (33%). Scaphoid fracture, an infrequent fracture in children, was seen in 9% of all fractures due to rollerblading/skating. There was a doubled risk of fracture in boys aged 13 to 15 compared with their female peers. To make fracture prevention more efficient, it should be targeted at this risk group and these high-risk activities. Protection of the wrist region might prevent the most common fractures.

The prevalence of osteoporosis in patients with distal radial fractures is high compared with that in control subjects, and osteoporosis is a risk factor for distal radial fractures in both women and men. Thus, patients of both sexes with an age of fifty years or older who have a distal radial fracture should be evaluated with bone densitometry for the possible treatment of osteoporosis.