Because a child’s expression of pain is dependent on their level of cognitive development and sociocultural, pain assessment can be more difficult among children that adults. Assisting distressed parents whose children are in pain is a daily occurrence in pharmacy. Pain is a common symptom in children of all ages and can be an indication of any number of ailments. But trying to ascertain the source and level of a child’s pain can prove challenging.
“Children older than four years of age can usually talk about their pain, at the age of 6-8 years they can use the visual analogue pain (VAP) scale in the same manner as adults. Nevertheless, their capacity to describe pain increases with age and changes throughout their developmental stages,” explained Prof Natalie Schellack (Associate Professor, Department of Pharmacy, Sefako Makgatho Health Sciences University) in Paediatric pain management (published in S Afr Pharm J Vol 85 No 2).
Universal pain assessment tool
Pain is a multidimensional phenomenon characterised by sensory, physiological, affective, cognitive, behavioural, and spiritual aspects. Factors like fear, anxiety, coping style, and lack of social support can further exaggerate the physical pain children experience. Pain in a child can often be distressing for their parents who may feel powerless to help them. Keeping them calm can prove as challenging as keeping the child calm.
COMMON CAUSES OF PAIN IN CHILDREN
Children can experience a wide variety of painful conditions – from migraine headaches to growing pains
It is estimated that 20% of all pain in children is head pain, with migraine frequency increasing with age, according to Practical Pain Management. “Children with recurrent headache tend to be anxious, hypersensitive, and excessive worriers.” Dr Lawrence Robbins advises a balance of medication, therapy, and lifestyle changes to be the most helpful for children with severe headaches to return them to normal functioning in home, school, and social life.
One of the most common reasons for a parent to seek the help of a pharmacist, the eight most common causes for stomach pain according to MultiCare Indigo Urgent Care are gas, constipation, lactose intolerance, overeating, stomach virus, food poisoning, stress, and appendicitis. “Although most children with acute abdominal pain have self-limited conditions, the pain may herald a surgical or medical emergency,” cautioned Dr David Sigalet et al. in Acute Abdominal Pain in Children (published in Am Fam Physician. 2003 Jun 1). “The most common medical cause is gastroenteritis, and the most common surgical cause is appendicitis. In most instances, abdominal pain can be diagnosed through the history and physical examination. Age is a key factor in evaluating the cause; the incidence and symptoms of different conditions vary greatly over the paediatric age spectrum,” the authors explained. “In the acute surgical abdomen, pain generally precedes vomiting, while the reverse is true in medical conditions. Diarrhoea often is associated with gastroenteritis or food poisoning. Appendicitis should be suspected in any child with pain in the right lower quadrant. Signs that suggest an acute surgical abdomen include involuntary guarding or rigidity, marked abdominal distention, marked abdominal tenderness, and rebound abdominal tenderness. Surgical consultation is necessary if a surgical cause is suspected, or the cause is not obvious after a thorough evaluation.”
“People used to believe that growing pains flared up when a child’s bones grew at a faster rate than their tendons,” said Cleveland Clinic paediatrician, Dr Bradley Weinberger. “Although this theory has been disproven, doctors still don’t know what causes growing pains.” Generally affecting children between the ages of 8-12 years, Cleveland Clinic describes growing pains as deep cramping or aching pain that can be mild or very severe. “Some children feel pain for a couple of minutes and others feel the pain for several hours. Growing pains may be intermittent, with pain-free intervals from days to months. In some children, the pain can occur daily.” Fortunately growing pains are usually harmless pain that children outgrow. Massaging, stretching, and OTC pain-relievers are the best way to ease children’s pain.