The Ouchless Place: No Pain, Children's Gain

Schechter, Neil L.; Blankson, Victor; Pachter, Lee M.; Sullivan, Caroline M.; Costa, Laura Maria de Amorim Santana

doi:10.1542/peds.99.6.890

Cited by 69 publications

(30 citation statements)

References 25 publications

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“…6,96 Multidisciplinary pain management teams that promote pain management education, formulate and implement protocols, identify and remove barriers to effective pain management, carry out quality improvement exercises, and work to keep prevention and treatment of pain a high priority should be created. 97,98 This approach will be much more successful than expecting individual health care providers to spontaneously learn new pain-management techniques and implement them on their own.…”

Section: A Change In the Ed ''Culture''mentioning

confidence: 99%

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Pediatric procedural pain

Young¹

2005

Annals of Emergency Medicine

273

233

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Section: A Change In the Ed ''Culture''mentioning

confidence: 99%

“…Venipuncture, when feasible, may be less painful than heel lance. 155 Hospitalized children 96 Use a treatment room; keep the patient's room/bed as a ''safe place.'' Give hospitalized children a predictable ''safe'' time when procedures will not occur and a predictable time for procedures.…”

Section: Nonpharmacologic Interventionsmentioning

confidence: 99%

Pediatric procedural pain

Young¹

2005

Annals of Emergency Medicine

273

233

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“…Because members of the Pain Relief Program at Connecticut Children's Medical Center have had long-standing interest in this topic, 9,16 we applied for and received a grant from the Mayday Fund to host a consensus conference to more formally review the existing literature and to generate from it recommendations regarding best practices for reduction of injection pain. Initially, we separated the immunization process into multiple components (eg, preparation, technique, location, needle length, and local anesthetic use).…”

mentioning

confidence: 99%

Pain Reduction During Pediatric Immunizations: Evidence-Based Review and Recommendations

et al. 2007

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The pain associated with immunizations is a source of anxiety and distress for the children receiving the immunizations, their parents, and the providers who must administer them. Preparation of the child before the procedure seems to reduce anxiety and subsequent pain. The limited available data suggest that intramuscular administration of immunizations should occur in the vastus lateralis (anterolateral thigh) for children <18 months of age and in the deltoid (upper arm) for those >36 months of age. Controversy exists in site selection for 18- to 36-month-old children. A number of studies suggest that the ventrogluteal area is the most appropriate for all age groups. Longer needles are usually associated with less pain and less local reaction. During the injection, parental demeanor clearly affects the child's pain behaviors. Excessive parental reassurance, criticism, or apology seems to increase distress, whereas humor and distraction tend to decrease distress. Distraction techniques vary with the age, temperament, and interests of the child, but their efficacy is well supported in the literature. Sucrose solution instilled directly into the mouth or administered on a pacifier reduces evidence of distress reliably in children <6 months of age and should be used routinely. Although there is no perfect topical anesthetic available at this time, selective use for children who are particularly fearful or who have had negative experiences in the past is highly endorsed. Pressure at the site, applied with either a device or a finger, clearly reduces pain. Finally, in the era of multiple injections, it seems that parents prefer that multiple injections be given simultaneously, rather than sequentially, if there are enough personnel available. Immunizations are stressful for many children; until new approaches are developed, systematic use of available techniques can significantly reduce the burden of distress associated with these procedures.

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“…3 Finally, because of a fear of adverse effects, the undertreatment of pain (ie, giving too little medicine) has been reported. 4,5 Lapses in the treatment of children's pain have been attributed, in part, to the following: systematic and logistical barriers within institutions providing pediatric care, 6 knowledge-based barriers including insufficient knowledge of pain assessment and treatment in children, 7 and inadequate pediatric pain management (PPM) educational requirements for residency programs. 8 These inadequacies have also been shown to be widespread across a variety of pediatric settings such as cardiac surgery,…”

Section: Introductionmentioning

confidence: 99%

Balancing Knowledge Among Resident Specialties: Lecture-Based Training and the OUCH Card to Treat Children's Pain

Saroyan¹,

Schechter²,

Tresgallo³

et al. 2010

Journal of Graduate Medical Education

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There are unique concerns for residents and fellows treating hospitalized children in pain. Some children cannot necessarily communicate their pain, 1,2 and the dosages for children differ dramatically by age and weight.3 Finally, because of a fear of adverse effects, the undertreatment of pain (ie, giving too little medicine) has been reported. 4,5 Lapses in the treatment of children's pain have been attributed, in part, to the following: systematic and logistical barriers within institutions providing pediatric care, 6 knowledge-based barriers including insufficient knowledge of pain assessment and treatment in children, 7 and inadequate pediatric pain management (PPM) educational requirements for residency programs.8 These inadequacies have also been shown to be widespread across a variety of pediatric settings such as cardiac surgery, AbstractBackground There are well-established deficiencies in residents' knowledge of acute-pain assessment and treatment in hospitalized children.

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The Ouchless Place: No Pain, Children's Gain

Cited by 69 publications

References 25 publications

Pediatric procedural pain

Pediatric procedural pain

Pain Reduction During Pediatric Immunizations: Evidence-Based Review and Recommendations

Balancing Knowledge Among Resident Specialties: Lecture-Based Training and the OUCH Card to Treat Children's Pain

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