Nursing Component Task
Nursing procedures & clinical learning

Pain Management (PM)

MANAGEMENT OF PAIN IN CHILDREN AND YOUNG ADOLESCENTS

This is the process of managing pain in children and young adolescents using both pharmacological (multi-modal) and non-pharmacological (hypnosis, distraction, play, guided imagery) strategies to improve their quality of life.

Purpose

  • Assess pain in children and young adolescents
  • Manage pain using various strategies (pharmacological and non-pharmacological)
  • Prevent poor pain tolerance in adulthood
  • Provide comfort
  • Prevent complications

Indications

  • Pharmacological
  • Non-pharmacological

Equipment

  • Patient’s folder (electronic or manual)
  • Pain assessment tools: (Oucher Scale, Wong-Baker FACES Pain Scale, Children Hospital of Eastern Ontario Pain Scale, Non-Communicating Children Pain Checklist, Numeric Rating Scale)
  • Medication tray
  • Weighing scale
  • Pain management strategies (medications, Sucrose, cold compress, pain patch, play dolls, balloons, pictures, videos, colour pencils)
  • Vital signs tray
  • A tray containing the following
  • Patient Treatment chart (Electronic or Manual)
  • Spoon
  • A cup
  • A saucer
  • A jug/bottle/sachet of water
  • A pair of scissors
  • Tissue paper/napkin
  • Prescribed pain medication and other adjuvant medications
  • Pain management strategies (medications, Sucrose, cold compress, pain patch)
  • Syringes and needles
  • IV set (when necessary)
  • Cotton wool swabs
  • Receiver
  • Sharps box

Procedure steps

  • Introduce yourself and explain procedure to child/young adolescent and parent/guardian
  • Assess the cognitive level of the child/young adolescent (non-verbal, verbal, unconscious, cognitive impairment)
  • Use language that child/young adolescent and parent/guardian understand and can express themselves
  • Educate parent/guardian on how to support during the pain management process
  • Prepare requirements and take to bed side
  • Practice five moments of hand hygiene
  • Assess pain using Precipitating factors, quality, radiation, severity, time (PQRST) (parent or child if verbal)
  • Use the age-specific pain scale (Oucher Scale, Wong-Baker FACES Pain Scale, Children Hospital of Eastern Ontario Pain Scale, Non-Communicating Children Pain Checklist, Numeric Rating Scale)
  • Make child/young adolescent comfortable when assessing pain
  • Check contraindications of pain medication (age, co-morbidities, route of administration, allergies)
  • Check baseline vital signs when necessary, before administration of some medication (opioids)
  • Check weight of child/young adolescent to calculate the dosage of medication
  • Provide appropriate pain medication as prescribed (Acetaminophen, NSAIDS, Opioids)
  • Administer medication through the appropriate route (topical, oral, parenteral, intra thecal)
  • Provide non-pharmacological strategies that can distract the child/young adolescent (Making bubbles, drawing, blowing balloons)
  • Prepare pain chart to monitor progress of management in chronic/palliative pain
  • Identify non-pain symptoms that can affect the severity of the pain (fatigue, drowsiness, dypsnoea)
  • Observe the therapeutic effect of the medication administered
  • Educate child/young adolescent and parent/guardian to report any adverse reactions after administration of medication
  • Monitor vital signs especially respiration if medication includes opioids
  • Reassess pain to check changes in pain intensity, medication and behaviour of patient
  • Congratulate and thank child/young adolescent parent/guardian
  • Protect the painful site by repositioning, protective handling. reduce pressure from beddings
  • Nurse neonate in a calm environment
  • Dispose off, decontaminate equipment, and clean items
  • Document findings and report on the pain management strategy used and the effect (manual/electronic)

Precautions

  • Pain assessment is part of vital signs
  • Provide patient and family with adequate information and education on pain management
  • Assess the pain using objective scales such as 0-10 Numeric Pain Rating Scale, Wong-Baker Faces Pain Scale, Colour-Circle Pain Scale etc. and document
  • Treat each patient as an individual and involve the patient and family in the pain management
  • Employ evidence-based contemporary recommendations for pain management such as:
  • Pre-emptive analgesia (analgesic given before a painful stimulus)
  • Multi-modal analgesia (using two or more forms of analgesic concurrently)
  • Time-scheduled analgesic administration (giving the analgesics according to the time prescribed regularly)
  • Non-pharmacological methods of relieving pain such as early mobilization, passive mobilization, positioning, and other appropriate measures should be used as adjuncts to analgesic administration for pain management

References and further reading

Educational resource only. Follow current Nursing and Midwifery Council guidance, local institutional protocols, scope of practice, and clinical supervision.

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