Pediatric pain in hospitals - undertreated?

[Laffydaffy]

Currently in hospital with a teen. Just started a new treatment for ataxia (movement disorder) and one of the side-effects for him is a severe headache, which he says he has never had so bad. The management of the headache has been extremely poor, and I remember something similar happening with my daughter last year, and I swore I would speak up if something similar happened. Just the administration of ibuprofen and paracetamol together has nurses saying it cannot be done, and that DS has to wait four more hours, while his pain stays at an 8. I am a paed nurse, and darn it, there is nothing wrong for a combination of the two, especially when a child's pain is not well controlled.

Why is pain-management for children still such a problem? I know as adults, that when we have pain that is not controlled, we seek help. I take paracetamol and ibuprofen together if I need it, with caffeine tablets for extra help for severe headaches (not migraines). I remember kids after their tonsillectomies weeping in pain and being forced to swallow pain relief every few hours with raw, open wounds and a cannula in the arm that was still available to use for pain relief. And then I remember the midwife apologizing to me after my emergency caesarean for being a bit late with my morphine syringe-driver.

Has anyone else experienced this?

Oooft that’s horrendous. I’m so sorry to keep trauma dumping, but my infant son had six attempted lumbar punctures (doctors couldn’t cite the needle) one after the other without any pain relief. Two doctors tried three times each and then my (two week old) son was placed back in my arms. A third doctor came along and insisted on trying and my son had to be prised out of my arms while they tried again. The lumbar puncture was essential for treatment, but that was one of the most traumatic experiences of our lives. Again, no pain relief in sight before, and after once he’d had the lumbar I was told to just breast feed him for pain relief. Argh!

(again, so sorry for trauma dumping. This has been quite therapeutic!!)

I was told they only bring the medicine cabinet round every 4 hours, so it doesn’t matter where you are up to with yours (if transferred from another ward or just arriving), you end up having to fit in with the ward routine.
I waited hours for pain relief after surgery once on a normal ward.

Please do trauma-dump, especially if it helps. This thread has been a little cathartic for me, too.

The thing I have to keep reminding myself is that if we don't advocate for our children, no-one else will. And also, if pain is being managed by non-opiates, it should not really be the problem that it seems to be.

I think with children there is a generalised attitude that they don't experience pain the same way adults do, will 'bounce back' and get over it, or will quickly forget about it. It's all wrong, it's as if children aren't considered to be full people. It's not all staff, of course, but enough that it's a problem.

One of my DC needed a lumbar puncture at six months of age. No pain relief, was literally pinned to a bed by two members of stAff while a third did the puncture. DC shrieked the entire time and then just went absolutely silent staring into space for around an hour after, clearly traumatised.

Other DC needed surgery. At pre-op, surgeon agreed due to DC being nervous that they'd have a pre-med for relaxation and no cannulas sited until after they'd had the gas. DC has neurological disability and surgeon wanted it all to be as calm as possible so as not to cause distress. Day of the op, ward decide to prep them by fitting the cannula and got me to agree by saying that the op would be cancelled if they weren't allowed to do it. They refused to provide numbing cream or spray because "it's faster to just do it rather than draw the process out by waiting for them to work". When DC is frightened, they are amazingly strong and dextrous, imagine an octopus on meth. We ended up in a situation where DC had wriggled away from the two staff members and was attempting to climb over the head of the bed, had slapped the needle tray out of their hands, and was screaming. Surgeon walked in on her pre-op rounds and put a stop to it all. When DC came back the ward afterwards, nurse attempted a telling off for "the ridiculous fuss". I asked to move hospitals and made a formal complaint.

Same DC had their appendicitis written off as constipation and fussing right up until it burst.

My experience at 15 with appendicitis was interesting. I didn't communicate well enough about the pain, rating it as 4/10 because of how I'd interpreted '10' as the 'worst pain you can imagine'. Nowadays and even pretty soon after that I'd say 'bad enough I can't do x' or similar.

So worth looking at how well your teenager is communicating with the staff and intervening if they're trying to use childish face/pain scales or similar that doesn't match his intellectual functioning.

I was given pethidine and nobody told me it would make me sleepy. I was pretty cross about that as it happened when I was finally feeling awake from the general anaesthetic. (Also, yes I now know to ask about side effects).

Pain relief was a mixture of pethidine, paracetamol and ibuprofen.

Is it because they're only allowed to administer jist ibuprofen and paracetamol at a certain age? With severe pain these can barely touch the sides and adults are given stronger medication. Xx

This - that doctor should be struck off.
I would like to see how he would react if it was him left in agony

Yanbu I've seen children being given bloody heat packs when crying in pain instead of actual pain relief too. For properly diagnosed horrific conditions. I dont get it.

Maternity pain relief is also horrendous. It’s like gas and air costs come out of the midwives salary!

I was in A&E having fallen from height. Suspected fractures and a smashed face. No one gave me any pain relief. It's not just paed.

One place I have to give a shout out to is Watford A&E. They are fabulous for giving pain relief at triage to all who needs it. And my son got given a pain relief pessary at 16. He yelled but apparently the instant pain relief was totally worth it.

There’s nothing that pisses me off more than health care professionals being stingy with analgesia. When I teach paramedic students I emphasise the point to them over and over again. If someone tells you they are in pain, your job is to treat it and try your hardest to eliminate it using all of the tools at your disposal. It is not your job to make judgements/decide whether people are telling the truth or whether they ‘deserve’ it. Just treat them properly.