If these are not enough, Dr. Friedrichsdorf said, “the answer is nitrous gas” and, rarely, when necessary, forms of deeper sedation.
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Dr. Chambers leads the “It Doesn’t Have to Hurt” initiative in Canada, which provides parents with evidence about children’s pain control so they can advocate for their children. An article she wrote in September in the journal Pain Reports summarizes developments in the field of pediatric pain research.
She told a story of one mother who took her baby to the emergency department and asked if she could breast-feed while the baby was having a procedure done. The initial response was no; “there’s a lot of misconceptions, the baby will associate pain with feeding, or the baby will choke,” Dr. Chambers said. But the mother persisted and finally prevailed, and “eventually the resident said, go ahead, and then said, this was one of the best procedures I’ve ever done.”
Pediatric pain specialists speak with real passion about their ability to shield kids from even the “routine” pain of shots and blood draws. But they acknowledge that change in medical practice can be slow, and that parents are their most important partners in advocacy. “Simply asking the question, ‘What can be done to manage my child’s pain,’ just bringing that possibility up,” often starts doctors and nurses thinking about better pain management, Dr. Chambers said.
And of course, children are not the only ones out there who are frightened. “We don’t talk about how many adults are afraid of needles or avoid getting needles,” Dr. Chambers said. “We’ve had many parents in our initiative say, these strategies have worked not only for my kids but for me.”
So what gets in the way? Dr. Friedrichsdorf points out that veterinary medicine requires much more training in how to handle pain “before you can operate on a hamster” than is required of pediatricians and even of surgeons. And the logistics of providing this kind of pain management for routine shots and blood draws can be very daunting for institutions or busy practices: all those topical anesthetics to be applied, all those distraction techniques to be taught and practiced.
An international initiative, ChildKind, certifies hospitals that meet standards for pediatric pain control, attempting to build in both standards and a strong incentive for the best evidence-based practices. And Minnesota is working with five other children’s hospitals in the United States and Canada to replicate its comfort promise initiative, while others are implementing these changes independently.
More Info: nytimes.com