From the Guidelines
Acute pain management in pediatric patients should prioritize a multimodal approach, combining pharmacological and non-pharmacological interventions, with a focus on weight-based dosing and regular reassessment, as recommended by the most recent guidelines 1.
Key Considerations
- For mild pain, acetaminophen (10-15 mg/kg every 4-6 hours, maximum 75 mg/kg/day) or ibuprofen (5-10 mg/kg every 6-8 hours, maximum 40 mg/kg/day) are first-line options.
- For moderate pain, consider combining these medications or adding codeine (0.5-1 mg/kg every 4-6 hours) for children over 12 years.
- Severe pain may require stronger opioids like morphine (0.05-0.1 mg/kg IV every 2-4 hours).
- Non-pharmacological approaches, such as distraction techniques, cold/heat therapy, and comfort positioning, should always complement medication.
- Pain assessment tools like FLACC (Face, Legs, Activity, Cry, Consolability) for younger children or numerical scales for older children help quantify pain levels.
Procedural Pain Management
- Consider topical anesthetics like EMLA cream applied 60 minutes before procedures or intranasal fentanyl (1-2 mcg/kg) for rapid onset in emergency situations.
- For neonates with epidermolysis bullosa, use sucrose, paracetamol/acetaminophen, and/or oral morphine/oxycodone as first-line medications for pain relief, and refer to the acute pain team for complex and ongoing pain management if necessary 1.
Family-Centered Care
- Encourage family presence during painful procedures and involve them in pain management decisions.
- Educate parents on non-medication-based pain relief strategies, such as swaddling, patting, rocking, calm music, and singing, to support implementation after discharge.
Regular Reassessment
- Regular reassessment is crucial as children may not verbalize pain effectively.
- Use validated pain assessment tools and adjust treatment plans accordingly. By prioritizing a multimodal approach to acute pain management in pediatric patients, healthcare providers can improve outcomes, reduce morbidity, and enhance quality of life for these young patients 1.
From the Research
Acute Pain Management in Pediatrics
- Acute pain in children is a significant issue, with many children experiencing pain during emergency department (ED) visits 2.
- Nonpharmacological interventions, such as distraction, positioning, sucrose, and cold application, have been shown to be effective in managing pediatric pain in the ED 2.
- A multidisciplinary approach to pain management, incorporating both pharmacological and nonpharmacological therapies, can be beneficial for pediatric patients with acute and chronic pain 3.
Nonpharmacological Interventions
- Nonpharmacological interventions, such as cognitive behavioral therapy, personalized psychosocial follow-up programs, hypnotherapy, music therapy, and digital tools, have been shown to be effective in managing pediatric chronic pain 4.
- These interventions can lead to significant reductions in pain severity, improvements in emotional and physical well-being, and high patient satisfaction 4.
Opioid Prescribing Guidelines
- The American Academy of Pediatrics has released a clinical practice guideline for opioid prescribing for acute pain management in children and adolescents in outpatient settings 5.
- The guideline recommends a multimodal approach to pain management, including nonpharmacologic therapies, nonopioid medications, and opioid medications when necessary 5.
- Opioids should not be prescribed as monotherapy for children or adolescents with acute pain, and clinicians should prescribe immediate-release opioid formulations and start with the lowest age- and weight-appropriate doses 5.
Practical Approach to Acute Pain Management
- A practical guide to acute pain management in children has been developed to provide clinicians with a useful tool for the safe and effective treatment of pain in children 6.
- The guide includes an overview of commonly used pain management modalities and their potential pitfalls, and is intended for institutions with a pediatric acute pain service or those considering initiating one 6.