Postoperative Pain Management in Children, Parental English Proficiency, and Access to Interpretation

Abstract

BACKGROUND AND OBJECTIVE Patients with limited English proficiency (LEP) are at risk for undertreated pain. The goal of this study was to examine the association between parental language proficiency, interpreted care, and postsurgical pediatric pain management. METHODS This was a retrospective matched cohort study among children <18 years of age. Children of LEP and English-proficient (EP) parents were matched according to age group, surgical procedure, and admission date. Mean number of daily pain assessments and mean daily pain scores were compared between language groups. We also compared the association between pain scores and type of medication given (opioid versus nonopioid). Within the LEP group, similar analyses compared pain assessment and treatment of children whose families received ≥2 professional interpretations per day versus those who received lower rates of interpretation. RESULTS A total of 474 children (237 LEP and 237 EP) were included in the study. Children of LEP parents had fewer pain assessments (mean: 7 [95% confidence interval: 2–13] vs 9 [95% confidence interval: 4–15]; P = .012), and higher levels of pain recorded before receiving opioid analgesics, compared with children of EP parents (P = .003). Within the LEP group, children with ≥2 interpretations per day had lower pain scores after medication administration (P < .05) and were more likely to receive opioids at pain levels similar to those of EP families. CONCLUSIONS Children of LEP parents received fewer pain assessments and were less likely to receive opioid analgesics for similar levels of pain compared with children of EP parents. More frequent use of professional interpreters when assessing pain may aid in reducing the gap in pain management between LEP and EP pediatric patients.

Availability of Outpatient Rehabilitation Services for Children After Traumatic Brain Injury

“…Despite regulatory requirements that health care settings provide access to language services at no cost, 30,31 recent studies of pediatricians demonstrate that many report routinely using non-professional interpreters such as family members. 9, 32-35 Evidence-based standardization of care transitions from acute care to outpatient rehabilitation for moderate to severely injured children with TBI will be important to address service inequalities. Understanding cultural needs and potential barriers to service access are also important next steps.…”

Pain and Health-Related Quality of Life After Pediatric Inpatient Surgery

“…In addition, children of Hispanic ethnicity had greater odds of deterioration in HRQOL after surgery admission, however this was not statistically significant. Hispanic ethnicity has been shown to correlate with poorer postsurgical pain treatment in children 14 , which may have contributed to poorer recovery of HRQOL.…”

What Do Clinicians Caring for Children Need to Know about Pediatric Medical Traumatic Stress and the Ethics of Trauma-Informed Approaches?

“…For example, one study showed that black children in the ED were less likely than white children with similar levels of abdominal pain to receive analgesic medication [31]. In another study, children whose parents had limited English language proficiency had their pain assessed less frequently during postsurgery care and experienced greater pain levels before receiving analgesic medication [32]. And a growing body of research demonstrates that physicians and other health care professionals exhibit implicit (i.e., unconscious) biases based on race [33,34].…”