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Doctors urged to heed children’s pain

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CHICAGO — Infants usually cry when they get circumcised. Children often wince when they get shots. Some young cancer patients dread giving blood samples.

Children feel pain as much as adults, and doctors should do more to relieve their pain from injuries, illnesses and medical procedures, the American Academy of Pediatrics and the American Pain Society declared Tuesday in a new joint policy statement.

"Children are needlessly suffering," said Dr. Michael Ashburn, APS president and director of pain programs at the University of Utah. "Poorly treated pain following a procedure can lead to prolonged healing and make children at a higher risk for adverse side effects."

Doctors need to re-evaluate their routines to better anticipate and assess pain in children, create a soothing environment in their offices and involve parents in preventive measures, the statement said. It also recommended that pediatricians press for child-specific research in pain management and urge the Food and Drug Administration to evaluate pain relievers for children.

Even during minor procedures such as getting a shot, most children do not have the same ability as adults to calm themselves when they feel pain, Ashburn said.

"If you wait until you start poking the child with needles, it's too late," he said.

The statement appears in the September issue of the journal Pediatrics.

While there is extensive literature describing how to evaluate and treat acute pain in children, doctors have not done as much as they should to prevent or relieve that discomfort for several reasons, including a misconception that youngsters don't feel pain as adults do, the statement says.

Other factors cited include doctors' lack of training to evaluate pain in children, fears about side effects of pain medication, and the belief among some health-care workers that pain builds character.

The two groups began working on the statement in 1995, after health-care professionals realized children's pain was undertreated and after new techniques to assess pain were developed, said Dr. Joseph Hagan, a Vermont pediatrician and chairman of the AAP committee that wrote the statement.

Pain in children with long-term illnesses can cause stress that weakens their immune systems, resulting in a slower recovery, said June Dahl, a professor at the University of Wisconsin Medical School and a pain specialist. But when a youngster has cancer, for example, the focus often is on keeping the child alive, she said.

"The pain gets lost in the shuffle," Dahl said.

A child who needs blood drawn weekly, for example, would feel less pain if a cream were used to numb the skin and if the youngster were reassured by parents and doctor during the procedure, Ashburn said.

Doctors are treating pain more frequently than they were about 30 years ago, said Dr. Joseph Zanga, chairman of pediatrics at Ronald McDonald Children's Hospital of Loyola, which is part of Loyola Medical Center in Maywood, Ill.

He said children who were cut with a piece of glass in the 1970s might have been given a shot of an anesthetic before stitches. Today, doctors have more options, such as thinner needles that hurt less, lollipops that release anesthetics when sucked and glue that can be used instead of stitches.

"By simply telling a child, 'We're not going to have to sew that. We're going to glue it back together,' you can see the fear melt off their faces," Zanga said.

Also, he said most pediatricians' offices and hospitals are now decorated with images such as clowns to entertain and distract children in pain.

Still, Zanga also said pediatricians have been hampered because the FDA has not approved potent pain relievers for youngsters.

"That's a terrible indictment in this country for the treatment of pain in children," he said.

On the Net: American Academy of Pediatrics: www.aap.org

American Pain Society: www.ampainsoc.org