Pain in babies and young children: how to manage it?

” The pain is both a emotion and an sensation, which can exist even without an apparent cause (injury, organ damage, etc.)”, immediately recalls the Sparadrap association for hospitalized sick children. Do you feel distraught when your child is in pain? You don’t know how to relieve it?

Know that we distinguish three kinds of pain :

• that induced by care,
• that disease-related,
• and that that lasts over time (Chronic Pain).

From simple vaccine to the lumbar puncture passing through the blood test or the laying of stitches : certain invasive procedures can be painful in babies and young children. As Dr. Elizabeth Walter-Nicolet states:

However, this pain is not inevitable and must be prevented and taken care of: MEOPA gas, anesthetic cream, etc.

” The sharp pain is the body warning signal to signal that something is wrong, says Dr. Elizabeth Walter-Nicolet. For example: when the child has a otitis, appendicitis or that he broke his arm in the fall. Warning: pain is not always synonymous with seriousness. Some pain is indeed caused by benign illnesses (migraineotitis) when other serious pathologies do not necessarily hurt (diabetes, renal failureetc.).

The Chronic Pain is a pain that lasts more than three months. “It is more rare in young children. It is found more in adults and adolescents,” says Dr. Walter-Nicolet.

Every child is different when it comes to pain : if some will express it by crying or shouting, others will on the contrary remain prostrate. “Sometimes a child can be in so much pain that he becomes unable to react. We then risk being mistaken and believing that he is simply sad, calm or even wise! However, if he is given pain medication, he will start talking, moving, playing and taking an interest in others, ”confirms the Sparadrap association.

Newborns and babies also feel pain and remember it. Also, it is important to do not trivialize a medical procedure and to take all necessary precautions to relieve painful sensations.

Unlike a child who can say where he is in pain, a baby cannot talk about his pain. Parents should therefore be very attentive behavior changes. “It is important to observe how it behaves,” confirms Dr. Walter-Nicolet. Several criteria such as his interactions with the environment, the expression of his face or his position provide information on his pain. »

• The expression on his face : check if the baby’s face is relaxed or on the contrary if it is tense, if he has tight eyelids, frowning eyebrows, open mouth. “The nasolabial fold can also be accentuated”, specifies the pediatrician.
• Vocal or verbal expression : is the child crying? calls out ? moans or says he’s in pain?
• motor activity : Check if the baby is calm or fidgety. “A child who is too calm must attract attention,” says Dr. Walter-Nicolet. A child who is moving well! »
• The position : Does your child adopt an unusual position? analgesic? Does he protect himself or stay still?
• Interactions with its environment : Does your child communicate with those around him? Can he be consoled? Is he interested in games?

Other criteria like the sleep can also be revealing: for example, a child who sleeps too much or, on the contrary, who no longer sleeps.

For measure a child’s pain, the medical teams will use a evaluation grid. ” Grid Evendol makes it possible to assess pain using behavioral criteria, explains the specialist. Check off a list of signs that can predict pain: if the child grimaces, cry Where on the contrary if he is too calm ; if he adopts frozen/prostrate position or that he plays normally; if he consoles himself in the arms of a relative, etc. The result of this observation gives us a “pain score” which then helps us to adapt the treatment. »

The pain management depends on its origin: whether it is induced by care or caused by a pathology.

“You have to treat the cause of the pain,” confirms Dr. Walter-Nicolet. For example, in the event of an arm fracture, we will immobilize the limb and administer the painkillers appropriate. » The medical teams have a fairly broad therapeutic arsenal which ranges from paracetamol to the morphine passing through the nonsteroidal anti-inflammatory drugs (NSAIDs) to relieve moderate to severe pain.

Blood test, stitches, vaccine: today, the pain caused by treatment or examination must be taken care of. “The baby is unable to understand that when we vaccinate him or take a blood test, it is for his good. He retains only the painful sensation. However, this can be easily warned using an anesthetic cream, says Dr. Walter-Nicolet. As this works less well on infants under three months, you can use a non-pharmacological means as breast feeding. The fact of sucking the breast at least two minutes before the act decreases the pain. Similarly, we know that the administration of a sugary solution associated with the sucking of a pacifier two minutes before a vaccine reduces pain in children under six months. »

your child suffers from otitis ? He has just been tonsil surgery ? Today, everyone range of painkillers relieves pain, from moderate to severe. “While the management of pain is still very heterogeneous both in community medicine and in hospitals, there are solutions to relieve it, insists Dr. Walter-Nicolet. The important thing is that the analgesic is adapted according to the age of the child and the cause and intensity of the pain. »

It is given to babies and children in case of mild to moderate pain. “Prefer the oral route to suppositories which are much less effective,” advises the pediatrician.

This analgesic is used in particular in case of inflammatory pain. ” He is contraindicated in babies under three months, warns the specialist. But can be prescribed afterwards for moderate to severe acute pain. You should know that when certain analgesics used alone are not effective, they can be combined with each other under medical prescription. »

On the other hand, the pediatrician warns parents against risk of overdose.

In case of severe pain (postoperative follow-up, etc.), morphine derivatives – tramadol – or morphine can also be given to babies and children. “Morphine is not reserved for serious situations. For example, it can be given in the recovery room after a tonsil operation, ”confirms the Sparadrap association.

In addition to analgesics, many non-drug means now make it possible to limit the painful sensation in babies and young children. ” The complementarity of means to fight against pain is essential “recalls Dr. Elisabeth Walter-Nicolet.

Be well settled – for example in the arms of a parent – reassure the child and relaxes him. “In toddlers, being breastfed or even being against the skin of his mother causes a state of well-being likely to reduce or even block the painful sensation”, assures the pediatrician.

Distract a child – by making soap bubbles or playing with it, for example – is an interesting solution to fight against pain. In the same way : tell a story, listen to musicplaying a game, reading are effective ways to make him “forget” his pain.

A Canadian study from 2013 (source 1) shows the benefit of using music therapy in pediatric emergency departments. “Hearing music, only during the time of treatment, is good and reduces pain scores during venipuncture: a simple way to implement! “, confirm the experts of Pédiadol.

massage can participate in reducing pain: in the case, for example, of colic in babies. ” The objective is to saturate pain receptors and to drown the painful signals in other more positive ones”, explains Dr. Walter-Nicolet.

Finally, mainly used in hospitals during painful care for babies and children, the MEOPA (nitrous oxide) is an anxiolytic and analgesic gas very effective in reducing pain. It can also be used for dental care.