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Managing Pediatric Pain in the Emergency Department

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Abstract

Far more attention is now given to pain management in children in the emergency department (ED). When a child arrives, pain must be recognized and evaluated using a pain scale that is appropriate to the child’s development and regularly assessed to determine whether the pain intervention was effective. At triage, both analgesics and non-pharmacological strategies, such as distraction, immobilization, and dressing should be started. For mild pain, oral ibuprofen can be administered if the child has not received it at home, whereas ibuprofen and paracetamol are suitable for moderate pain. For patients who still require pain relief, oral opioids could be considered; however, many EDs have now replaced this with intranasal fentanyl, which allows faster onset of pain relief and can be administered on arrival pending either intravenous access or definitive care. Intravenous opioids are often required for severe pain, and paracetamol or ibuprofen can still be considered for their likely opioid-sparing effects. Specific treatment should be used for patients with migraine. In children requiring intravenous access or venipuncture, non-pharmacological and pharmacological strategies to decrease pain and anxiety associated with needle punctures are mandatory. These strategies can also be used for laceration repairs and other painful procedures. Despite the gaps in knowledge, pain should be treated with the most up-to-date evidence in children seen in EDs.

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Acknowledgments

The authors acknowledge Denis Lebel, BPharm MSc, for reviewing Tables 2 and 3, and Dr. Barbara Cummins McManus for reviewing the manuscript.

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  1. Division of Emergency Medicine, Department of Pediatrics, CHU Sainte-Justine, 3175 Chemin de la Côte-Sainte-Catherine, Montréal, QC, H3T 1C5, Canada

    Benoit Bailey & Evelyne D. Trottier

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Correspondence to Benoit Bailey.

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Drs. Bailey and Trottier have no conflicts of interest that are directly relevant to the content of this review/study.

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Bailey, B., Trottier, E.D. Managing Pediatric Pain in the Emergency Department. Pediatr Drugs 18, 287–301 (2016). https://doi.org/10.1007/s40272-016-0181-5

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