What To Tell Your Patients

Where does it hurt?

Some simple triggers and treatments for dealing
with pediatric pain

By Julia Cyboran

Cecilia Lopez is worried. Her four-year-old daughter, Margarita, has been complaining about headaches for a little over four weeks. At first, Ms Lopez thought her daughter might be bluffing to get some extra attention, but the tyke's lack of energy and withdrawal from daycare activities had her worried. In an attempt to relieve her pain, Ms Lopez tried kids' Tylenol, but was afraid of over-medicating. She decided it was time to see the doctor to find out how to stop her daughter's pain.

Headaches are just one of the common types of pain that children suffer. Although parents sometimes brush it off as 'only being in your head,' the pain the child is experiencing is often quite real. "To me, this statement doesn't exist," says Dr Steven Brown, director of the Chronic Pain Unit at the Sick Children's Hospital in Toronto. "When a child tells me that they have pain, I believe them."

No parent wants to see their child in pain and more often than not they'll show up at the GP's office looking for a solution. But diagnosing and treating pediatric pain isn't always easy. After all, children aren't adults and cannot describe pain in the same way we do. Physicians and parents need to think about the language they use to describe pain and communicate with the child at their level to find out what the problem is in order to treat it.

WHAT TO TELL PARENTS ABOUT PEDIATRIC PAIN Don't forget to ask "There are two main ways to measure pediatric pain," explains Dr Brown, who's worked in the field for close to seven years, "either through descriptive input or by using various numeric pain scales." Though it's difficult for children to put a quantitative value on how they're feeling, their input � as well as their parents' � is a vital factor when determining pain. "The most important thing is to ask the question," says Dr Patrick McGrath of the IWK and Dalhousie Pain Research Lab. "If you don't ask, you won't know." Get the parents to keep a close eye on the child's behaviour � what they're doing can say a lot about how they're feeling. For instance, if a child suddenly stops playing with friends, that could be a sign of some sort of pain. Practice your scales "One of the biggest challenges we face is with the patient who's developmentally delayed," explains Dr Brown. "They cannot relay what the problem is." This is where numeric value scales to determine the level of pain come in. There are many to choose from, including The Faces Pain Scale, which uses facial expressions to gauge pain levels. Parents will find this scale particularly useful in children under the age of three, children who are too scared to report the way they are feeling, and those who are slower learners. Physical reactions such as elevated blood pressure, sweating and the amount of oxygen or carbon dioxide in the blood can also help to determine if the child is experiencing pain. It's a management thing There are two main methods for helping children deal with pain. "Psychological and medical approaches are both effective," says Dr McGrath. "For recurring pain, stress management is quite effective but not readily available." A few Canadian hospitals have pain management departments that are equipped to teach stress management, but unfortunately most GP offices don't have these resources at their fingertips. But, says Dr McGrath, it's relatively easy to teach a few simple stress management techniques right in the examining room. "I encourage muscle relaxation and deep breathing," he says. Catch a trigger by the toe You might also want to discuss pain triggers with the child and parent. If you can't get to the bottom of the trigger, says Dr McGrath, treat the symptoms. Over the counter (OTC) medications are always an option, and acetaminophens are a good choice. Dr McGrath does advise that parents watch the dose they're giving their child. "When using OTCs, it's important to make sure that parents aren't over or under medicating the child. Both have negative effects. Be sure that they know what the right dose is."