The most difficult task involved in treating pain in children is obtaining an objective and accurate measurement of the pain.
In general, there are three ways in which doctors can assess the level of pain a child is feeling:
- Self-reported measures of pain: Doctors may ask children to rate their pain on a scale of 1-10 or show pictures that reflect different emotions and ask them which best illustrates how they are feeling.
- Behavioral measures of pain: Doctors will evaluate the child's motor responses, facial expressions, crying and behavior (for example, sleep-wake patterns).
- Physiologic measures of pain: Doctors measure blood pressure and pulse changes, as well as take note of palm sweating.
Medications Used to Treat Pain in Children
- Pain medications: Acetaminophen (Tylenol), available over the counter, and opioids (requires a doctor's prescription) are often used to relieve pain in children. Your doctor may recommend over-the-counter or prescription strength nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Motrin, Advil). Aspirin should not be used in children under the age of 19 unless instructed by your doctor, as it can cause Reye’s syndrome if used during or after a viral or fever-causing illness. Opioids are narcotic pain medications that contain natural, synthetic or semi-synthetic opiates. Opioids are often used to treat acute pain, such as short-term pain after surgery. Tramadol should not be used for pain and Codeine should not be used for pain or cough in children under 12 years old. Children under 18 years old should not use tramadol after surgery to remove their tonsils or adenoids.
- Antidepressants: Antidepressants are drugs that can treat pain and/or emotional conditions by adjusting levels of neurotransmitters (natural chemicals) in the brain. These medications can increase the availability of the body's signals for well-being and relaxation, enabling pain control for people with chronic pain conditions that do not completely respond to usual treatments.
- Patient-controlled analgesia (PCA): Children who are four to six years old may be able to use PCA with the help of a parent or nurse. Many children who are as young as six can independently use the PCA pump.
- Epidural analgesia: Epidural analgesia can be performed around major surgeries such as abdominal, lower extremity or spinal surgeries for postoperative pain control. Pain medication is injected into the epidural space of the spinal cord.
While these medications are the same as those given to adults for pain, the dosing is not the same for children. The dose of medicine will likely be smaller for children than for the average adult, because it is based on the patient's weight. It is very important to follow the exact dosing prescribed by your child's doctor.