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Fears of Bodily Injury and Pain

Fears of Bodily Injury and Pain. Common fears among children May persist into adulthood and result in avoidance of needed care. Infant’s Response to Pain. Generalized response of rigidity, thrashing Loud crying Facial expressions of pain (grimace)

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Fears of Bodily Injury and Pain

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  1. Fears of Bodily Injury and Pain • Common fears among children • May persist into adulthood and result in avoidance of needed care

  2. Infant’s Response to Pain • Generalized response of rigidity, thrashing • Loud crying • Facial expressions of pain (grimace) • No understanding of relationship between stimuli and subsequent pain • Withdrawal from painful stimuli • Loud crying • Facial grimace • Physical resistance

  3. Young Child’s Response to Pain • Loud crying, screaming, kicking, biting, spitting, trying to grab equipment or push away stimulus • Verbalizations: “Ow”, “Ouch”, “It hurts”. May also be verbally abusive and even curse • Toddlers may react to all procedures negatively whether painful or not • Toddlers can localize pain by pointing to it, but cannot describe it • Preschoolers have a great fear of mutilation and of “insides leaking out” • Preschoolers can localize pain and can describe severity by using Faces Pain Scale

  4. School-Age Child’s Response to Pain • Stalling behavior (“wait a minute”) • Muscle rigidity, clenching teeth or fists • May use all behaviors of young child • May try to act brave; “grin and bear it” • May be more concerned with disfigurement or death than with pain itself • Psychosomatic complaints may be related to school or home problems • Can describe pain much like an adult

  5. Adolescent • Less vocal protest, less motor activity • Increased muscle tension and body control • More verbalizations (“it hurts”, “you’re hurting me”) • May be more fearful of disability, disfigurement especially if it may cause physical changes • Psychosomatic complaints may be related to home or school problems, or initial sexual relationship • Usually describes pain as adult would

  6. Preventing or Minimizing Fear of Bodily Injury and Pain • Prepare child for pain if developmentally ready • Give choices if possible • Allow child to express pain • Reward bravery • Ask child for his perception of illness or procedure, then dispel myths • Proper pain management, both pharmacological and nonpharmacological

  7. Pain Facts and Fallacies (Box 44-10, p. 1316) • FALLACY: Infants do not feel pain • FACT: Children are undertreated for pain • FALLACY: Analgesia should be withheld because it may cause respiratory depression in children • FACT: Analgesia is withheld for fear the child becoming addicted • See Evidence-Based Practice p. 1315

  8. Principles of Pain Assessment in Children: QUEST • Question the child—are you hurting? (may deny for fear of shot) Where? • Use a pain rating scale appropriate to age • Evaluate behavioral and physiologic changes • Secure parent’s involvement • Take action and evaluate results-oral meds are preferred, but IV is more predictable

  9. Pain Scales • FACES pain rating scale • Numeric scale • FLACC scale • Facial expression • Legs (normal relaxed, tense, kicking, drawn up) • Activity (quiet, squirming, arched, jerking, etc) • Cry (none, moaning, whimpering, scream, sob) • Consolability (content, easy or difficult to console)

  10. Nonpharmacologic Interventions • Based on age • Swaddling, pacifier, holding, rocking • Distraction • Relaxation, guided imagery • Cutaneous stimulation

  11. Anesthetics & Analgesics • Major advancement for atraumatic care • EMLA (must be applied to skin approx one hour before injection) • Lidocaine for IV and IM sticks—need MD approval • Non-opioid—acetaminophen, NSAIDS • Opioid—morphine, fentanyl • Sedatives—midazolam, chloral hydrate

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