Pediatric Hematology, Oncology and Bone Marrow Transplant

Pain Management Tips for Parents

Our Services
Boy getting immunizationAt American Family Children's Hospital, we believe that all children need and deserve good pain control.
 
Pain is a very complex, individual reaction. It is often difficult to describe and impacts many areas of a person's life.
 
Good pain control provides relief but allows the child to participate in activities. We believe that the majority of patients can achieve good pain control through a balanced approach that uses a combination of techniques.
 
A Balanced Approach to Treat Pain
 
Given the complexity of pain, it is safe to assume that pain cannot be completely managed by a single drug or technique. By using medications that work in different ways, we are able to provide better pain relief. But, by using a combination of medications and non-drug techniques, we can provide even better pain relief.

You can help your child control their pain or at least help them cope with the pain when it is not controlled well, by using some non-drug therapies. Non-drug therapies are strategies other than medication that can decrease pain and help your child feel more comfortable.
 
In addition to relieving pain, some of the following strategies help to relieve anxiety, promote sleep and provide a sense of control over their pain. 

Distraction
 
Distraction uses another activity to direct your child's attention away from their pain, such as blowing bubbles while they're receiving a shot.
 
When the child becomes engaged in the activity, their brain is no longer able to interpret the pain signals. The more engaged the child is in the activity, the less likely they are to notice the painful procedure.
 
You should choose an activity that the child is interested in and is appropriate for their age. Children who are too tired or not alert will not be able to actively participate in this type of activity. Distraction is useful for short procedures.
 
Some examples of distraction activities based on age include:
 
 
Infant
Birth to 18 months
Toddler
1 - 3 years old
Pre-School
3 - 5 years old
School Age
6 - 12 years old
Adolescent
13 - 18 years old
  • Light up toys
  • Sound toys
  • Rattles
  • Soft music
  • Singing
  • Breastfeeding or pacifier
  • Light up toys
  • Books with flaps and buttons
  • Counting or singing a song
  • Music
  • Bubbles
  • Singing
  • Videos/DVDs
  • Interactive toys or books
  • Counting or singing a song
  • Music
  • Bubbles
  • Videos/DVDs
  • Humor/Jokes
  • Music
  • Talking about topic of interest to them
  • Deep breathing
  • I-Spy books
  • Singing
  • Videos/DVDs
  • Humor, Jokes
  • Talking about topic of interest to them
  • I-Spy books
  • Music
  • Deep breathing
  • Video/DVDs
  • Guided imagery
 
Child Life Specialists are very experienced in all forms of distraction and are often available for painful or anxiety producing procedures.
 
If you have not seen a Child Life Specialist or have not heard that they are included in an upcoming procedure, don't hesitate to ask the nurse to page or call them. If they are not available, they may be able to provide suggestions or tools for another person in the room to use during the procedure.

Cold Application
 
Cold can be very beneficial after a procedure, surgery, or for areas that are swollen, muscle spasm or stiff joints.
 
An ice pack or cold gel pack can decrease the intensity of the pain sensation or numb an area on the body depending on how cold it is and how long it is held to the area.
 
To apply cold:
  • Place ice in a bag or use a cold gel pack and wrap in several layers to prevent that "shock" to the system
  • As the child gets used to the temperature, unwrap a layer to expose more of the coolness
  • Continue the process as they are able to tolerate it

Ice should not be left on the skin for more than 20 minutes and can provide significant relief after that period of time.

You can place the ice pack at the site of the pain or swelling, above the site, below the site or on the opposite side of the body and still provide benefit for some people.

Alternating ice and heat can also be beneficial depending on the type of pain. If you are unsure, your child's nurse can help.

Cold application is not appropriate for everyone. Some examples in which cold application may not help is people experiencing nerve pain or neuropathic pain.

Children with sickle cell anemia should avoid cold application for pain relief.

Heat Application

Heat can also be beneficial after a procedure or surgical intervention, but is more commonly used for muscle tension, cramping, joint stiffness and to promote general relaxation.
 
Heat decreases the pain intensity by decreasing the sensitivity to the pain, increasing blood flow to the area and releasing muscle tension.
 
Moist heat is even more beneficial than dry heat by penetrating deeper.
 
You can apply moist heat by placing a towel in hot water. Be careful not to get it too hot.
 
The same process that was used for ice can be used for heat - apply the hot towel wrapped in layers and unwrap the layers as it cools.
 
Heat can also be applied for 20-30 minutes, although some people will see benefit in as short as 5 minutes. Heat application can provide relief for some time after it is removed. Alternating heat and cold can also be beneficial.

Massage
 
Massage is defined as rubbing or kneading, tapping or manipulating the tissue. It can be gentle or deep massage.
 
Massage provides benefit by decreasing muscle tension and increasing blood flow to the area. It can reduce swelling to an area and provides relaxation.
 
The depth and duration of the massage should be based on how it makes the child feel.
 
While massage can be very relaxing and beneficial to most people, deep muscle massage should be avoided in children with low platelet count (less than 50,000).

Environment
 
Environment can have a huge impact on comfort.
 
A room that is too hot or too cold, bright lights or foul odors can increase the stress response and prevent relaxation.
 
Helping your child get comfortable, lie in a comfortable position, elevate areas that are swollen, have warm dry clothes and linens help improve comfort.
 
If your child is coming to the hospital to stay for a period of time, remember to bring any comfort items – blanket, stuffed animal, pictures of family and friends or other comfort items.

Parents are an essential part of the team caring for their child. You can advocate for the child when they cannot, or when they are not being heard. You, the parent, know that child best. You know what has worked well for them in the past and what has not worked well. You know which medications have resulted in unwanted side effects and which have provided the best relief.
 
We rely on you for information to provide the best possible care to your child. We encourage you to use these tools and take a more active role in your child's care.
 
Inpatient Pain Care Service

When a patient's pain is not well controlled, the team can consult the Inpatient Pain Care Service (IPCS). IPCS is staffed by advanced practice nurses and pharmacists during business hours (Monday - Friday, 8am - 4:30pm) to coordinate and address inpatient referrals for pain management issues.
 
Services include assistance with assessment, management, and triage for patients with acute, chronic, or cancer pain.
 
Clinical Nurse Specialists and Pharmacists will work with the patient's primary treatment team to address acute pain problems, coordinate secondary consultations, and promote continuity of care.
 
Peggy Riley, RN, MN, MPH is one of the Clinical Nurse Specialists; she has 15 years pediatric and pediatric ICU experience. She works with the pediatric teams to improve pain management in the pediatric population she can be contacted by telephone at 262-1423, email: priley@uwhealth.org, or pager 7645.