Simple explanatory diagrams and soothing words can be powerful tools for health professionals working
with a child in pain, according to a new book by clinical psychologist Leora Kuttner.
Published last month, A Child in Pain: What Health Professionals Can Do to Help follows Kuttner’s successful 1996 book for parents and several award-winning documentary films on pediatric pain management. The new book outlines the latest scientific discoveries on pain management and provides practical strategies for physicians, dentists and hospital personnel who care for children.
“Pain is one of the least understood and most neglected domains of health care, especially for children,” says Kuttner, a pediatric clinical professor in UBC’s Faculty of Medicine who in 1983 established the first pain and anxiety management program in North America at BC Children’s Hospital’s Oncology Department.
“Pain is the most common reason for children to seek a medical consultation – and the most common reason for avoiding it,” says Kuttner.
Blending research findings with numerous clinical examples from her 30 years of practice, Kuttner suggests ways health professionals can better communicate with children and help them become part of their own pain management team.
“There’s been a long history of underestimating the children’s capacity to understand what’s happening to their body and to participate in their care,” says Kuttner. “Health professionals tend to talk to parents, but even a three-year-old can, with the help of diagrams, models and simple and clear words, develop a cognitive grasp of what this scary thing called ‘pain’ is, and how to help make it better.
“Once they understand, they can start participating and report more accurately what’s affecting them – which ultimately contributes to better diagnosis and improved treatment outcome.”
Kuttner cites an example of administering morphine to a child who is recovering from surgery. “You could just give it and not say anything,” says Kuttner. “Alternatively, you could give it and say ‘see how quickly this eases your pain.’
“Or for a younger child you could say: I am going to give you some really powerful medicine that will not only make the hurt go away but may even make you feel silly and laugh!”
In this process, the power of words and imagery can engage the child and calm her anxiety.
In addition to the child’s verbal report of pain, health professionals should note the non-verbal behaviours of both child and caregivers, says Kuttner.
“Parents bring their own upbringing into their handling of the child’s pain – they may have a ‘grin and bear it’ or ‘tough it out’ attitude and that would impact how – and how much – the child expresses pain,” Kuttner adds.
“On the other hand, family members may fear or exaggerate the pain through their own discomfort or inability to deal with what the child is going through. Health professionals need to catch these nuances that can add to the pain.”
In general, says Kuttner, children are highly reliable witnesses of their own pain; they need to be listened to, believed and their concerns need to be addressed.
“The last thing we should say when pain will occur is ‘this won’t hurt a bit,’ because that’s a blatant lie and a breach of trust,” says Kuttner. “We need to acknowledge the pain and help by providing good analgesics, skilled psychological techniques and sound physical interventions.
“These three facets of pain management can – and should –work synergistically together providing the child with comprehensive relief.”