UK guidelines aim to improve pain management in children

New guidelines for pain management in children

Nurses and pain specialists in the United Kingdom have developed guidelines to improve the management of acute pain in children. The clinical guidelines are the result of a collaboration between the Royal College of Nursing and the charity Action for Sick Children and have taken on board the views of parents, anaesthetists, nurses, and children.

The guidelines emphasise the need to assess children's pain regularly by asking them how they feel and using pain assessment tools appropriate for their age. The authors argue that pain can be assessed even in premature infants, based on factors such as the way babies cry. Interviews with 162 children aged between 2 and 18 years who were undergoing medical care in hospitals formed the basis for the guidelines. The children were asked about their own experiences of pain and how they would like it to be managed. Most children and young people interviewed said that the anxiety they felt before undergoing a medical procedure was the most distressing aspect of their illness. The project coordinator from the Royal College of Nursing Institute, Lesley Duff, said: “The guidelines should help nurses recognise and assess pain in children better so that they can negotiate effective management with doctors.” An implementation guide is now being produced to accompany the guidelines. The impact of the guidelines on pain management in children will be assessed in two years' time.

The guidelines and implementation guide can be obtained from RCN Publishing, PO Box 1, Portishead, Bristol BS20 9EG.

Nursing staff should be vigilant for pain—assessing and recording it regularly, especially watching for unexpected intense pain

Children's behaviour, appearance, activity, and vital signs are a good indication of severity of pain

Children react to and report pain in different ways

Children should be given ample opportunity to talk about their pain

Pain can be assessed in premature infants

Children aged over 4 years can usually use self report tools such as graphs to describe their pain provided they have enough time

Older children and adolescents should select the pain assessment tool that they feel most comfortable with

Parents should be encouraged to contribute to the pain assessment, but their opinions should not override what the children say

Health professionals should be trained to recognise and assess pain

Pain can be assessed even in babies

(Credit: BRUCE GARDNER/TONY STONE IMAGES)