Doctors say they children's pain is often undermedicated
Parents, doctors worry about drug overdoses or misuse
Parents encouraged to ask doctors questions before child leaves hospital
Doctors, parents often miss the pain of quiet children
It’s happened so many times that Dr. Raymond Pitetti has lost count: A child comes into the emergency room with, say, a broken leg, and doctors give him strong narcotic painkillers in the ER, but then send the child home with no pain medication at all.
“The pain is just as severe as when they were in the hospital, but they’re sent home with nothing and that broken bone is going to hurt like crap for a while,” he says.”Then we see the kid back in the ER the next day because they’re in horrible pain.”
Pitetti and other pediatric pain experts say children’s pain is often undermedicated, whether that pain is from a broken bone or after a surgery. For example, a study out last week in The Journal of Pediatric Surgery reported that 13% of children had pain that lingered for months after surgeries such as appendectomies.
“Children are not being given enough pain medication, and they’re suffering needlessly,” says Dr. Zeev Kain, senior author of the study and a pediatric anesthesiologist at the University of California, Irvine.
“We really need to get better about this, because we’ve been horrible at it for a long time, adds Pitteti, an associate professor of pediatrics at Children’s Hospital of Pittsburgh.
Doctors and parents both at fault
While physicians often feel comfortable giving a child narcotic pain medication in the hospital, they get nervous about continuing that medication once the child goes home, even if the child is in severe pain.
“They’re worried patients will misuse the drugs, or overdose,” says Pitetti, “But really if you dose the drug right and write the prescription for only a short period of time, there shouldn’t be anything to worry about.”
When doctors do send children home with the right medication, some parents decide not to give it.
Many of these parents have heard news stories about the growing number of people who die after overdosing on prescription narcotics. This week, the Centers for Disease Control and Prevention called prescription drug overdoses an “epidemic,” noting that 15,000 people died in 2008 from prescription drug overdoses – more than died from cocaine and heroin overdoses combined.
Pediatric pain experts say narcotic pain medications are safe for children at the right doses, and there’s little if any risk of addiction if the drugs are taken for a short time.
“If you treat someone with Percocet or morphine for three days, nothing’s going to happen,” Pitetti says. “We worry about people taking these drugs for weeks or months or years, not for days.”
If you don’t alleviate your child’s pain, his or her recovery will most likely be slower, says Kain, pointing to studies that show children walk sooner after surgery, sleep better and get back to school sooner if they’re not in pain.
Advice for parents
Pediatric pain experts have these tips for parents:
1. Ask your doctor about pain medication before your child leaves the hospital
If you think your child is in pain or will be in pain once you return home from the hospital, ask about pain medication.
“And if your child was on something for pain in the hospital, ask why they’re not continuing it when they go home,” Petitti advises.
2. Ask your doctor when to give the medication
Ask if you should give your child medication before the pain starts or only if they’re in pain, or if you should give the medication before your child tries to do a physical activity such as walking.
“You need to be really aggressive in terms of asking questions,” Kain advises.
3. Fill out your child’s prescription before you get home
When you arrive home with a sick child after a surgery or visit to the ER, it’s often tough to leave that child to go get the medication. Kain advises filling the prescription on the way home or at the hospital pharmacy if your hospital has one.
4. Recognize when your child is in pain
Once you get home, remember that a child won’t always cry, scream, or complain when they’re in pain, pediatric pain experts say. Some children in pain become quiet and withdrawn or have trouble eating or sleeping.
Unfortunately, both parents and doctors sometimes miss the pain in the quiet kids.
A 2008 study titled “The Squeaky Wheel Gets the Grease” showed that a day after having a broken limb treated in the emergency room, 20% of children received no pain medication, and 44% received only one dose. The children who were most likely to get medication were those who were loud and cried a lot.
Children in certain ethnic groups may be less likely to say they’re in pain because their culture places a high value on appearing stoic. Some studies have shown that Hispanics, for example, are less likely to talk about pain and ask for medicine.
5. Think about other ways to address the pain besides drugs
Alternative methods such as aromatherapy, acupuncture and music can be extremely helpful for kids in pain, Kain says.
Another technique is particularly powerful: distraction.
“You should definitely acknowledge your child’s pain by saying something like ‘Poor baby, I know it hurts to move, but then you should quickly move on to a solution,” Kain says. “You can say ‘let’s go for a drive’ or ‘let’s read a book’ or ‘let’s plan your birthday party together.’ Don’t just let your child lie there miserably on the sofa.”