Poorly managed pain has both long-term and short-term negative effects on children, Denise Ramponi, MSN, CRNP, CEN, DNP-S, said in this Fast Track session presented Saturday. Children who endure numerous painful procedures can develop hypersensitivity to pain and a conditioned anxiety response.
“Even one bad experience can result in a lifelong fear,” Ramponi said.
While numerous nursing groups agree that non-pharmacological agents are usually not enough to effectively manage pain in children undergoing procedures, there has been resistance to using topical anesthetics in the emergency department (ED), said Ramponi. In addition to the argument that it takes too much time and effort, she once had a father tell her his son “needs to feel that stick” in order to build character.
Ramponi, who successfully introduced a resolution on improving pediatric procedural pain management in the ED to the ENA General Assembly earlier this week, offered several options for busy emergency nurses who want to better manage their pediatric patients’ pain during such procedures as IV insertions and stitching and stapling minor wounds.
Establishing trust and giving the child a choice, even over something as minor as what color lollipop the child will receive after, gives the child a sense of control and makes him or her feel less vulnerable, said Ramponi. Positioning is very important in this context; she suggested having infants lie in a parent’s arms, while allowing toddlers to sit in a parent’s lap and giving older children the choice of how to position themselves.
“The words we say must always be positive with children: ‘I want you to hold still, I want you to look at Mom when I put the cream on your hand,’” she said. “Negative words, such as ‘Hold still or this will hurt,’ will invoke fear and cause negative responses.”
Ramponi reviewed several topical anesthetics appropriate for use in children, including gels, cream, sprays and a patch. She also shared a slide on cost comparisons and time to effectiveness for each agent she discussed.
“I want you to be advocates for your pediatric patients to reduce their pain,” she said.
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