Doctors Push to Ease Children’s Anxiety, Pain in ER

The American Academy of Pediatrics has issued a new report emphasizing the importance of controlling pain and anxiety in children who receive emergency medical care. “There are a lot of modalities for reducing pain in children, and we’re doing a lot better in terms of kids’ pain than we used to,” said report author Dr. Joel Fein, an attending physician in the emergency department at the Children’s Hospital of Philadelphia. “Parents should advocate for the children for pain and anxiety management” if they feel they aren’t getting adequate control, said Fein, who also is a professor of pediatrics and emergency medicine.

There are several reasons why a visit to the ER may not be pain-free, according to the report. One is a fear of side effects. Another concern is that using pain-relieving medications could make it more difficult or time-consuming to give a diagnosis, which could affect treatment. For example, even topical anesthetics might not be used if doctors believe they may delay a correct diagnosis. Topical anesthetics also aren’t readily available in all emergency rooms, according to the report.

Furthermore, a stigma still lingers with narcotic medications, and doctors may be less likely to use these drugs in children. The report also draws attention to a racial bias in the prescription of these drugs, with black children less likely to receive them for pain relief. The authors believe these obstacles can be overcome, and that pain relief should start even in an ambulance. Once at the hospital, it’s important that the child stays calm. Greater anxiety leads to a greater perception of pain, according to the report.

The report recommends that each family be given a private room, ideally with colorful walls, pictures on the ceilings and a variety of toys to keep the child distracted in this unfamiliar environment. The authors suggest that medications such as acetaminophen, ibuprofen or oral narcotics can help relieve pain, as can topical analgesics. The report also recommends applying topical anesthetics to numb areas before using any IV catheters. “Children have a pretty significant fear of needles,” Fein said. “Topical anesthesia can offer pain protection during IV line placement and [drawing blood].” The report adds that using pain-relieving medications doesn’t seem to alter physicians’ ability to make a timely diagnosis. “For the youngest infants, even just giving sugar water can help reduce pain,” said Fein.

Psych Central

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