More children are complaining of pain, but physiotherapists and colleagues can help them to manage, reduce and even get rid of it. Andrew Cole reports.
Pain can be acute or chronic, nagging or all-consuming. But handling it successfully poses challenges to all healthcare professionals, including physios – especially when the patient is a child or adolescent. The problem seems to be on the rise.
Treating the 'whole family'
Chronic fatigue syndrome
Avoiding distress and pain: British Psychological Society guidelines
- Be aware that the more negative the experience for the child, the greater the subsequent anxiety, distress and lack of co-operation
- Try to create the right environment for a procedure. Avoid disturbances and keep numbers to a minimum.
- Use techniques such as relaxation, distraction, guided imagery and graded exposure. Communication needs to be simple but honest. Look for non-verbal cues
- Allow children to participate as much as practicable – give permission to cry or shout
- Encourage the active participation of the child’s parents or carers – outcomes tend to be better when parents are present
- If a problem arises, take a break. Consider whether the procedure could be postponed. If not, you may need to consider sedation or even, briefly, restraint – according to agreed guidelines
- Afterwards, document what has been tried and what worked well. Consider lessons for future procedures and, if there has been a problem, look at whether team members might benefit from debriefing or further training.
Tips on handling children’s pain
- Listen carefully to the young person’s story and believe what they say. Acknowledge the pain they report and don’t dismiss it because it appears to be disproportionate
- Try to explain how pain works – and how this can have a knock-on effect on mood, fitness and activity levels
- Be patient. Activity baselines will need to be lower for children with chronic pain and the steps to increase activity smaller
- The overall aim is to achieve functional recovery where the child can do the things they want to, despite some pain. Eliminating the pain may not be possible
- Know the limits of your competence. Don’t be afraid to seek specialist help or refer a case on if you don’t have the skills to deal with it
- British Psychological Society Good practice guidelines: Evidence-based guidelines for the management of invasive and/or distressing procedures with children.
- Sheffield Children’s NHS Trust pain management team. Tel: 0114 2717 397
- Association of Paediatric Chartered Physiotherapists (a CSP professional network)
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