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Last updated January 1, 2014

Pain Undertreated in Toddlers

© Reuters 4/25/2003

NEW YORK (Reuters Health) - Very young children may not be getting adequate treatment for pain, if the findings of a study conducted at one hospital are any indication.

"Children younger than 2 years of age receive disproportionately less analgesia than school age children, despite having obviously painful conditions," according to Drs. John Alexander of Maine Medical Center in Portland and Mariann Manno of the University of Massachusetts Medical School in Worcester.

In the current study, reported in the Annals of Emergency Medicine, Alexander and Manno sought to better understand how pain medication was doled out to infants and children treated for burns or fractures in a pediatric emergency department.

In a review of the medical charts of 180 children aged six months to 10 years, the investigators found that 65 percent of the youngsters younger than two years old went without pain medication compared to only 48 percent of older children.

And when the youngest children were given pain medication, they were usually given less potent drugs than older children.

"When analgesia was administered, very young children were more likely to receive over-the-counter medications and less likely to receive narcotic analgesic agents when compared with their older counterparts," the authors write.

Alexander and Manno speculate that the inability of very young children and infants to verbalize their feelings of pain may cause healthcare providers to overlook the pain relief needs of the very young.

What's more, the fear of sedating young children and infants too much may make physicians reluctant to use painkillers. Another reason for this reluctance, the authors suggest, is that some doctors may not be knowledgeable about guidelines for selecting the proper dose of pain medication for children.

The researchers did not identify any complications associated with the use of pain medication among any of the children, regardless of age. All drug prescribing followed established weight-based guidelines for all of the children, they report.

In 2001 the American Academy of Pediatrics and the American Pain Society called on pediatricians to do a better job of managing children's pain during medical treatments such as routine vaccinations.

For a variety of reasons, doctors have long tended to be less aggressive in treating the short-term pain children experience during illness or following an injury or medical procedure.

For instance, babies have long been believed to not experience pain the way adults do and to suffer no long-term consequences as a result of pain. However, studies in the 1980s produced the first physiological evidence that infants do indeed experience pain.

Another reason doctors have been reluctant to treat children's pain is concern about the effects of pain medication on children's bodies, and concern about whether the best dosages are known.

SOURCE: Annals of Emergency Medicine 2003;41:617-622.




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