Pain is Subjective???

It can be very difficult with a pediatric patient to assess their pain level.

There is a chart, I beleive a Wong Baker Chart, which is 5 faces. The child can point to which face they feel like, happy, a little sad, more sad, and very very sad. It helps them to see the faces so they can tell you where their pain is.

Now, if a child says they hurt, and are grimacing, I wouldnt think twice to give them pain medication, even if its just motrin or tylenol.

An effective way to assess pain besides the chart, is to ask.

"does your tummy hurt?" "can you show me where?" "does it feel like you need to use the bathroom or no?"

As for the effect that parents have on patients, it completely depends on the parent. Some are overly 'protective' regarding pain medications and want their kid to be medicated at the slightest twinge or cramp. Others dont want you giving pain meds unless the child verbalizes pain or is crying. You always need to ask the child, not the parents.

I've never had a child with a PCA pump, I've mainly had appys, RSV's, and gasto Peds patients. I would think a teenager is more likely to use a PCA then a preschool aged child.

I hope that helps! And yes, children are extremly resilient! Thats why I love working with them so much!!

Absolutely that child was in pain:angryfire .

I work peds and "pain is what the patient says it is".

We use 2 scales to measure pain - Wong/baker (the faces) and for the babies the FLACC scale (it measures by crying, consolability, etc). Just because a child cannot verbalize the pain, doesn't mean it isn't there.

The hospital I work at is excellent about providing pain meds (where I worked before - good luck:uhoh3: ).

You were right, and seem to have wonderful instincts. Keep using them.

Thank you for the wonderful reply. The link was very helpful. Your patients are lucky to have such a wonderful, compassionate nurse.

One can see that pain is subjective. Determine whether a PCA would be beneficial to a pediatric patient can be subjective as well. "PCA is prescribed mostly for children 5 years old and older" (Holden & Patt, 1995). "Children selected for PCA should be able to push the injection button and should understand that pushing the button will give them medication to relieve pain" (London, 2003). In another clinical experience I had an eight-year-old patient who had a NG-tube and a PCA. When I assessed his pain on a 0 to 10 scale he rated his pain as a 9. After further questioning I discovered that he correlated the discomfort of the NG-tube to the PCA. He believed that every time he pushed the PCA it went down his throat causing more discomfort. Obviously some patient teaching was needed... And I think it is inorder to say that this patient was not developmentally delayed and would be age appropriate using the Tanner's Stages of Development.

Findings from the article, Patient-Controlled Analgesia for the Pediatric Patient (Orthopaedic Nursing, 2003) concluded that children must be carefully screened for their cognitive and physical ability to manage their pain using PCA. Family-controlled analgesia and nurse controlled analgesia may be considereed in select cases as alternatives to PCA in children with cognitive or physical disabilities.

One can see that there are many obstacles using a PCA with pediatric patients. What is your experience with this? Is it the physician or the nurses responsibility to assess the cognitive ability of the patient? Are 5 year olds able to effectively regulate their pain with a PCA?

I completely disagree that pain is what the patient says it is. I have worked peds and seen patients that are playing video games and having a great time but they and their parents watch the clock for the pain meds in anticipation to avoid having pain they wanted the morphine or nubain so the child would always be completely pain free. The child would say his pain was really bad when I asked but 2 seconds before was playing video games without a hitch. Then I tried explaining to mom that her child would not being going home on morphine and she about couldn't understand why no matter how hard I explained. Working ER with migraines is a whole other story with patients claiming a 10 on 10 scale for migraine pain but laughing it up with their friends in the room.

Absolutely that child was in pain:angryfire .

I work peds and "pain is what the patient says it is".

We use 2 scales to measure pain - Wong/baker (the faces) and for the babies the FLACC scale (it measures by crying, consolability, etc). Just because a child cannot verbalize the pain, doesn't mean it isn't there.

The hospital I work at is excellent about providing pain meds (where I worked before - good luck:uhoh3: ).

You were right, and seem to have wonderful instincts. Keep using them.

Kids are funny little things when it comes to pain. Especially those under ten. You can't always go by what you see.

Part of this post raised a flag for me.

I have worked peds and seen patients that are playing video games and having a great time but they and their parents watch the clock for the pain meds in anticipation to avoid having pain they wanted the morphine or nubain so the child would always be completely pain free.

Playing video games with a parent can provide enough endorphins to give some pain relief, but that doesn't mean it's a good long-term substitute for actual analgesic meds.

Also, providing meds in anticipation of certain types of pain (post op ortho being a prime example) is not only appropriate, in some cases it's the only decent thing to do. If you give the med and the child does not show signs of oversedation (as opposed to being relaxed enough to enter peaceful sleep), then the med was needed. If a child has morphine or nubain prescribed (usually only 24-48 hours post-op), then there is usually a darn good reason for it.

The normal course of pain management is to provide narcotic meds via IV push or PCA for the first 24-48 hours, then switch over to NSAIDs. Often, there is a period of overlap during which narcs are being weaned. It takes a thorough assessment of a combination of factors to arrive at an accurate decision about medicating a particular child.

My daughter has a son with spina bifida. He's nine now and has had more than 30 surgeries, many of which involved serious pain management. We have had to educate the staff about his pain cues. The difficulty with him is that he tries to hide the fact that he is hurting because he's afraid that it means he won't be allowed to go home.

After many frustrating circumstances, the hospital now automatically refers him to the pain team any time he is admitted. According to team members, kids are far more likely to be under medicated than over medicated.

If you are concerned about giving too much pain medication, use whatever sedation scale your hospital uses and assess the results. As I said earlier, if the child is awake or sleeping but rousable, you did NOT over medicate.

How dare anyone minimize anyone's expression of pain! Whether that child truly had physiologic or psycholgic pain he was expressing pain and it needed to be addressed. Your concern should be commended. He may have been afraid or been looking for attention, but our job is to find out if he is in pain and if he is not find a way to distract him. That is what Child Life is for. Please take this experience with you to your practice. Any expression of pain must be believed, until proven otherwise. Our patients are innocent until proven guilty. Sorry for going on, but I am sick and tired of nurses and doctors that don't believe patients that express pain in unorthodox ways.

Good luck in your career.