Non-Pharmacologic Pain Management Strategies, by Catherine Dowling.
Hi.
My name is Catherine Dowling.
I'm a nurse at Children's Hospital Boston in the cardiac ICU.
The objective of this presentation is to discuss non-pharmacological pain management strategies.
Introduction.
Although we tend to focus on pharmacological mechanisms to control pain in the intensive
care unit, there are non-pharmacologic techniques that can be very helpful in alleviating pain
and encouraging coping in the pediatric patient.
Parents should be involved in their child's pain management and should be taught to recognize
the signs of pain.
Oftentimes, the parents' presence is enough to calm the child and decrease their level
of stress.
The environment the patient is in should be kept as calm and relaxing as possible, with
minimal stimulation.
Distraction techniques also work to decrease pain in the pediatric population.
In the infant population, oral sucrose and cuddling with a parent have been shown to
decrease the level of pain.
Holistic therapies refer to caring for the whole patient-- body, mind, and emotions.
Therapies such as Reiki, massage, acupuncture, and acupressure can help with pain management.
Age Appropriate Coping Strategies.
Coping is what a person does in order to avoid, remove, minimize, or to get through a stressful
situation.
The age of the child will determine the best way to go about managing coping skills.
Children at different developmental stages have different coping abilities.
Younger children often worry about being separated from their parents, whereas school aged children
may be worried about waking up during the operation and experiencing pain.
Strategies for the Infant.
Infants feel pain but do not express it in the same manner as older children or young
adults.
Studies indicate that the majority of parents do not know how to recognize the signs of
infant pain.
Excessive acoustic and visual stimuli in neonates should be avoided.
Simple comfort measures-- such as swaddling, use of a pacifier, and positioning-- should
be used for minor procedures.
Oral administration of sucrose reduces pain associated with painful procedures.
These interventions alone may not alleviate moderate to severe pain, and pharmacological
treatment should be used as indicated.
Strategies for the Toddler.
Sources of comfort for the toddler include parent presence, positioning, familiar objects,
such as a pacifier, blanket, and toys.
The use of distraction is important to minimize the stress and anxiety of hospitalization,
and to strengthen the coping skills of the child.
Strategies for the Preschool-aged Child.
Hospitalization has the potential for being a very traumatic experience for children and
their families.
In the preschool population, parent presence, pre and post procedural play, positioning,
distraction techniques, familiar objects, and music help the child to cope.
Often, games or role playing exercises are used to allow the child to express their concerns
or emotions.
This can give the staff and parents valuable information about a child's anxieties and
misconceptions.
Strategies for the School-aged Child.
In the school-aged population, parent presence still plays an important role in providing
comfort.
Pre-and-post procedural play, imagery, relaxation, and distraction enable the child to cope effectively
with procedures.
At Children's Hospital Boston, we have a pet therapy program which screens and trains dogs
for bedside visits.
Strategies for the Adolescent.
Detailed explanation of procedures is vital.
Imagery, relaxation, and distraction techniques will help the adolescent cope more effectively.
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