There are several myths that are currently circulating when it comes to pain response in the paediatric population. A very common myth is that young children, such as neonates, cannot experience pain due to their immature central nervous system.

Along with that is the belief that children, therefore, have no memory of pain. These are unfortunate myths as children are fully able to display the appropriate response to pain. They are also able to experience it, even if they may not fully understand what pain is. Hence, there is a need for appropriate analgesia or anaesthesia in paediatric patients.

Restraining a combative child an outdated practice


It is exceptionally challenging in the ER setting to deal with a paediatric patient who needs to undergo even a minor procedure. The ER physician or surgeon on duty is faced with the challenge of trying to calm the child or even having to restrain movement. There may also be the need for other health personnel, or the parents of the child, to hold or wrap the child in a blanket.

These actions are taken so that the procedure can be performed more smoothly. However, the overall experience tends to be traumatic not only for the child, but for the parents as well.

When the visit to the doctor is a traumatic one, meeting the medical needs of the child in the future will be even more challenging. The child will associate future visits to the doctor, to a clinic or to a hospital as something negative. This will make it difficult to bring them for the necessary check-ups.

It is no longer recommended to restrain a combative child. This is an outdated practice as the effects on medical staffs, the patient and relatives are unfavourable.

Factors to consider before sedating a child


Fortunately, sedating a child for minor procedures has shown pleasing outcomes. In fact, it is recommended that younger patients, as well as paediatric patients who cannot be talked into the medical procedure, are sedated. 

In making the decision to sedate the child, there are several factors to take into consideration. Internal factors would include the age of the child, the child’s level of development and any negative prior experiences with medical procedures. If the child had negative experiences before, this would raise the level of anxiety and prompt the need for sedation.

External factors on the other hand would include how the parent deals with the child, the ability of the healthcare provider to deal with the child and the set up of the environment. Healthcare practitioners should note that building rapport with the child is important, as it helps in reducing anxiety.

Ultimately, older children are easier to console, but this does not mean that younger children cannot be talked to. It requires patience as well as experience on how to deal with children in such situations. There is no one sure-fire way to talk to a child, but in general, maintaining honesty is the most helpful.

Children tend to have a high level of anxiety when it comes to clinical procedures. Hence, to avoid causing a traumatic experience, it is recommended to sedate the child under such circumstances. MIMS

Read more:
Plastic surgeon Dr Chia Hui Ling on common deformities among children in Singapore
Why some patients refuse to be sedated under the knife
Childhood cancers on the rise, says a new study
World Anaesthesia Day: The realities of consciousness during surgery

Sources:
http://emedicine.medscape.com/article/804045-overview?pa=vwGB6DVSpARguMrTZJvkckG50QTlwJHuEe
UO%2F0Yw5J3KMnyxMAdyCEHs8i%2BC58nAcFrqow%2Bf2%2F37XuRaZT6JAA%3D%3D#a1
http://emj.bmj.com/content/21/3/286
http://pedsinreview.aappublications.org/content/37/5/203