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Topic 1: Optimizing Pain Management in Pediatric Procedures

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Why This Article is Relevant or Important:
Pain, fear, and emotional distress related to treatment experiences can lead to ongoing psychological sequelae after pediatric injury.

The article presents a useful brief overview of concepts relevant to helping children cope with procedures, and links these to practice and training recommendations. One caveat is that the article does not fully convey the strong empirical evidence supporting use of distraction to reduce anxiety and pain during pediatric procedures. With assessment of the patient experience becoming a key metric for hospital performance in the US and elsewhere, the authors point out that addressing procedural pain and fear in the context of family-centered care is likely to improve these metrics.

Leroy, P. L., Costa, L. R., Emmanouil, D., van Beukering, A., & Franck, L. S. (2016). Beyond the drugs: nonpharmacologic strategies to optimize procedural care in children. Current Opinion in Anesthesiology, 29, S1-S13. PMID: 26926330

Abstract (from PubMed)

Painful and/or stressful medical procedures mean a substantial burden for sick children. There is good evidence that procedural comfort can be optimized by a comprehensive comfort-directed policy containing the triad of nonpharmacological strategies (NPS) in all cases, timely or preventive procedural analgesia if pain is an issue, and procedural sedation.

Based both on well-established theoretical frameworks as well as an increasing body of scientific evidence NPS need to be regarded an inextricable part of procedural comfort care.

Procedural comfort care must always start with a child-friendly, nonthreatening environment in which well-being, confidence, and self-efficacy are optimized and maintained. This requires a reconsideration of the medical spaces where we provide care, reduction of sensory stimulation, normalized professional behavior, optimal logistics, and coordination and comfort-directed and age-appropriate verbal and nonverbal expression by professionals. Next, age-appropriate distraction techniques and/or hypnosis should be readily available. NPS are useful for all types of medical and dental procedures and should always precede and accompany procedural sedation. NPS should be embedded into a family-centered, care-directed policy as it has been shown that family-centered care can lead to safer, more personalized, and effective care, improved healthcare experiences and patient outcomes, and more responsive organizations.