Focus on Pediatrics: From infancy to teens, pain control is possible

Select method that matches developmental stage

"In conjunction with pharmacological pain management, nonpharmacological techniques can be very effective with children of all ages, even in infancy," says Chris Brown, MS, CCLS, director of child life and education at The Children’s Hospital of Philadelphia. However, the technique must be appropriate for the child’s age. Following are a few suggestions:

Infancy.

Relaxation techniques to ease pain that are appropriate for a baby include soft lighting and music, such as a lullaby. Swaddling an infant is comforting as well. A pain control technique will only be comforting to a child if he or she is used to them. "Playing music for a child who is not used to music will not be relaxing, but if Mom sings to the baby on a regular basis, that could be a good technique for relaxation," says Brown. It’s important to find out what is normal for the child. That’s why a favorite blanket, a teddy bear, or the presence of the parent is comforting as well, she says.

Toddlers.

For this age group, distraction is one of the best techniques for easing pain or helping them through a painful procedure. Relaxation techniques used with infants can be effective such as music, rocking, or holding a favorite blanket. "At that age, they can be verbally assured as well," says Brown.

At the toddler stage, children can be told a little bit about the procedure, and it eases the stress if they are not surprised, she says.

Preschool children.

Preschool-age children can begin using more advanced relaxation techniques. For example, they can follow verbal instructions for deep breathing and take a breath in and blow it out as they are told, says Brown. Distraction techniques such as pop-up books, puppets, or bubbles still work well with this age group.

"At about age 5 or 6 in addition to all of these techniques, we can start adding some positive self-talk," says Brown. This technique actively turns the child’s thoughts from the negative aspects of the procedure to what they can do to get through it. For example, Brown might read the story The Little Engine That Could, and then encourage the child to repeat the words "I think I can, I think I can!"

School-age children.

Children ages 7-12 want information about the procedure even if they don’t have the personality type who wants to watch. "They don’t want surprises or to be told that something doesn’t hurt if it does," says Brown. They also want some control, so it is a good time to get them involved in pain management decisions. This is the age when children can get more involved in the imagery kind of techniques: Imagining that they are at the beach, for instance. They have the cognitive ability to think about something else and consciously change their breathing, says Brown. They can also do progressive muscle relaxation responding to verbal prompts.

Adolescents.

The techniques that are appropriate for school-age children also work with adolescents, however, they need to be presented in a more mature fashion. For example, teens might not choose Disney World as their favorite place when using imagery to ease pain.

Music assisted relaxation works well if teens choose their own style of music. "Teen-agers aren’t going to want to listen to Mozart in the treatment room. They would rather put on their favorite music, and while it may not be technically relaxing in terms of slowing down the heart rate, it might be mind altering in some way and help manage pain," says Brown.

It’s important to remember that most nonpharmacological pain management strategies are learned techniques, and their success depends a lot on the child’s temperament. "If a technique doesn’t work the first time, that doesn’t mean it won’t ever work," says Brown.