Pain-free pediatrics

When I was a lad, my Uncle Max was my dentist. (Uncle Max was a no-nonsense guy. His family-famous perspective on life was, "You fill a few, you pull a few, and the years go by.")

Uncle Max was a great dentist, but he was heavy of thumb and relentless of drill. He had no thought, nor offer, of anesthesia -- local or otherwise. Throughout my childhood I grimly endured his filling every dental cavity known to man. I remember walking up the stairs to his 2nd floor office, seeing a large stain on the wall, and thinking, "The next time I see this stain, it'll all be over." But, between now and then - Hell.

Having known no other manner of dental care, when I got older and moved away I was stunned to see the care and sophistication some dentists took to minimize pain. Now, of course, my first question about a possible new dentist is: how good is s/he at pain-free dental care?

****************************************

Turns out that many pediatricians were (and are) just like Uncle Max, with nary a thought of mitigating the pain of common procedures (like immunizations, stitches, circumcisions, post operative pain, etc.).

A relatively new movement -- called "pain free pediatrics" at my home hospital * -- is acquiring sophistication and momentum. Using some well-established (and some not-so-well-established) techniques to diminish the experience of pain, the screaming of kids in our emergency room and offices has markedly decreased.

(FYI: One intriguing study suggested that babies who were denied anesthesia for their circumcision in the newborn period showed more distress with later painful procedures, such as immunizations at 2 and 4 months, than did those who had analgesia. The theory is that the early intense stress response to the unrelieved pain during circumcision somehow got physiologically ingrained and then resurfaced in all its intensity when the experience of pain recurred.)

**************************************

Here are some of the things a pediatrician can do to make the experience less painful:

In the newborn period pain is lessened by:

• A taste of glucose water or being fed.
• Experiencing skin-to-skin contact with the mother during the painful procedure.
• Local anesthesia (dorsal penile block or anesthetic cream) for circumcisions.
  

The pain of immunizations can be lessened by:

• Sugar water or milk during the procedure.
• Using an anesthetic ointment or cream (like "EMLA") or a "vapo-coolant" (a blast of cool spray which temporarily numbs the area) prior to the shot.
• Distracting the infant/child with an exciting display or by having him blow bubbles or a pinwheel.
• Having a reassuring parental presence (most important, in my view) to distract, to soothe, and to comfort.

Your emergency room should be well versed in conscious sedation (medications which keep one awake but only dimly aware of the pain) which, in experienced hands, goes a long way to minimizing the psychic trauma of various procedures.

Inpatient facilities can provide anything from aromatherapy to pet therapy to, in one hospital, allowing the child to ride his tricycle to the operating room, to the use of patient-controlled analgesia (PCA) with a computerized pump for post-operative pain.

****************************************

How do your pediatric practice, your ER, and your inpatient facility stack up? Ask! Are we talking Uncle Max redux here, or have they joined the "pain-free pediatrics" movement?

Final note to parents: I beg of you: please, please, please, do not say to your misbehaving child: "Be good or Dr. __ is going to give you a shot!" Every pediatric provider cringes when s/he hears that invocation of pediatric care as torture chamber. Better to enjoin your pediatric provider to get with the pain-free program and to say to your kids: "Finish that book and I'll take you to Dr. __, who will give you a new one to read."

***************************************

*For more on Pain Free Pediatrics:
Boston Medical Pain-Free Pediatrics

For some good resources for you and your pediatric provider:
Pediatric Pain Management Toolbox (HRSA)

Related Topics:

• Include Dads in Kids' Doctor Visits
• WebMD Video: Kids and Needle Anxiety

Technorati Tags: pain-free pediatrics, pediatrics, children, health and wellness, parenting