Reducing Pediatric Pain and Anxiety During Emergency Care

Recommendations include pediatric-specific provider education, pain assessment, and new techniques for reducing pain and anxiety.

The American Academy of Pediatrics Committee on Pediatric Emergency Medicine and Section on Anesthesiology and Pain Medicine provide comprehensive recommendations for reducing pediatric pain and anxiety in the emergency department and during out-of-hospital emergency transport. Emphasizing provider education, appropriate pain assessment, and pediatric-specific pain and anxiety-reduction techniques, the authors endorse the following:

• A dedicated child-friendly, calming environment
• Pediatric-specific visual pain scales modified for the developmentally delayed
• A toolbox of pediatric distraction equipment for minimizing anxiety
• Child life specialists to coach and calm children using age-appropriate techniques
• Family presence during painful procedures
• Use of intranasal, mucosal, oral, transdermal, or inhaled analgesia in place of intravenous or intramuscular routes
• Use of vibrating devices applied over cold packs or topical anesthetics to reduce pain associated with necessary needle sticks
• Breastfeeding or giving 12% to 25% oral sucrose solution for infants <6 months of age undergoing minor procedures
• Topical anesthetics for minor laceration repair, lumbar puncture, and abscess drainage
• Warmed buffered lidocaine injected slowly with a small-gauge needle for deeper-tissue analgesia
• Tissue adhesives or steri-strips for low-tension wounds
• Absorbable sutures for higher-tension lacerations
• A quality improvement program for reviewing pediatric pain management practices

CITATION(S):

Fein JA et al. Relief of pain and anxiety in pediatric patients in emergency medical systems. Pediatrics 2012 Nov; 130:e1391.