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Am Fam Physician. 2005;71(4):810

Pain and Anxiety Treatment in Children During Emergencies

The Committee on Pediatric Emergency Medicine and the Section on Anesthesiology and Pain Medicine of the American Academy of Pediatrics (AAP) has released a clinical report on emergency pain and anxiety treatment in children. “Relief of Pain and Anxiety in Pediatric Patients in Emergency Medical Systems” appears in the November 2004 issue of Pediatrics and is available online at

Relief of pain and stress for children receiving emergency medical treatment is a vital, and readily available, component of care. Advances in the recognition and treatment of pain in children over the past 20 years have led to improved pain management for acutely ill and injured children. However, such care still lags behind adult pain management.

Severe pain and stress can have long-lasting implications for children. For example, a newborn infant who undergoes a procedure with inadequate pain relief may have permanent changes in his or her response to, and perceptions of, pain. Post-traumatic stress disorder also can occur after painful procedures and medical experiences. However, there is no evidence that pain management masks symptoms, clouds mental status, or in any way prevents physicians from making adequate assessments and diagnoses, according to the report.

Summary of Recommendations

  • Training and education in pediatric pain assessment and management should be provided to all participants in emergency medical systems for children.

  • Simple methods for creating favorable environmental conditions for infants and children in the emergency medical services (EMS) setting should be advocated by caregivers.

  • Incorporation of child life specialists and others trained in nonpharmacologic stress reduction should be encouraged.

  • Family presence should be offered as an option during painful procedures.

  • Pain assessment for children should begin at admission to EMS and continue until discharge from the emergency department (ED). On discharge, patients should receive detailed instruction regarding analgesic administration.

  • Painless administration of analgesics and anesthetics should be practiced when possible.

  • Neonatal and young infants should receive appropriate pain relief.

  • Administration of pain medication has not been shown to hinder the evaluation of a possible surgical patient in the ED, and pain medication should not be withheld on this account.

  • Sedation should be provided for patients undergoing painful or stressful procedures in the ED. A structured protocol for pediatric sedation, based on recommendations of the American Academy of Pediatrics, American Society of Anesthesiologists, American College of Emergency Physicians, and Emergency Medical Services for Children, should be followed for all children who receive sedative medications in the EMS setting.

Immediate pain assessment for children, including newborns, should occur on emergency department (ED) admission, the report states, and every opportunity should be taken to use available methods of pain control during treatment, even for minor procedures. The recommendations in the report are summarized in the accompanying box.

More research and innovation on child pain and stress reduction techniques are needed, according to the report. As medications and technology evolve, EDs must continue to ensure that safe protocols and practices are in place for child pain management.

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