Not all cries are the same: Understanding pain in children who cannot speak
24 June 2003
Babies and children too young to speak are unable to communicate effectively when they are in pain. The same is true for people who suffer from severe neurological impairment. When these patients are in pain, it is up to the parent or doctor to assess the degree of pain being experienced, and to provide appropriate levels of pain relief. Without clear assessment guidelines, pain management in children has been difficult, until now.
Leading medical charity Action Research has developed a new way of assessing children’s pain. The ‘Paediatric Pain Profile’ scale is intended to help parents and health care professionals to assess and relieve the pain of children who cannot describe how they are feeling. Action Research received a Lottery grant from the Community Fund to finance this project.
In the UK there are around 10,000 children with severe motor and learning disabilities who are cared for by their parents. These children can be particularly prone to pains such as heartburn, earache and hip dislocation, so it is important that their parents and carers know when to intervene to relieve their pain.
Nearly half of the parents who took part in the study said their children experienced pain all of the time, or for periods every day. And about twenty percent of children were reported to have daily pain that was severe or very severe.
Simon Moore, Chief Executive of Action Research said: “This is a huge step forward in the management of children’s pain. Action Research is delighted at the positive results of this important project, which will greatly enhance the lives of some of the most vulnerable children in our community.”
Diana Brittan, Chair of the Community Fund, said: “This is a fantastic example of how the Community Fund is distributing its share of Lottery money to help vulnerable people. Very young children and those with profound disabilities cannot tell us how much pain they are in and this must be very distressing for their parents and carers, as well as for the children themselves. Action Research has done some extremely valuable work in developing the pain scale to help alleviate this problem. The Community Fund is proud to have funded them.”
Dr Ann Goldman, Consultant in Palliative Care at Great Ormond Street Hospital for Children, one of the centres leading the research said: “Children often receive less effective pain management than adults simply because they are not able to articulate how they are feeling. We hope this scale will help parents and professionals to interpret the child’s behaviour and lead ultimately to better management of their pain.”
The pain scale was originally devised using data from a questionnaire survey of 300 parents and from interviews with parents and health care professionals.
The scale has twenty different types of pain cues. These include vocal cues, changes in posture, different movements the child might make, changes in their facial expression and mood, and changes in the way they sleep or eat. Each of the behaviours in the scale is rated between zero and three for the extent to which it occurs within a given time frame. Because the parents’ role in assessing pain in this group of children is so important the scale has been incorporated in to a record that the parent can keep at home.
To enable health care professionals around the world to use the scale it is going to be available from a dedicated website as well as a bound paper record. The developers hope to launch the Paediatric Pain Profile in September at the Royal College of Nursing Conference for nurses working with children and young people.
There is evidence that children receive less effective pain management than adults. One of the reasons for this is the difficulty in assessing pain in children.
For more information about the tool from Dr Anne Goldman or Simon Moore please telephone Louise Brown, Press Officer, 01403 327403 (direct line), Vincent House, North Parade, Horsham, West Sussex RH12 2DP or email email@example.com Andy Proctor, Head of Communications 01403 327423 (direct line) or email firstname.lastname@example.org
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