Two non-profit groups have published Canada’s first-ever standard for managing pain in children and adolescents, an area of medicine they and other experts say has been overlooked for too long.
The new standard, released on Monday, is not mandatory for health care providers to follow, but it is the country’s only existing detailed set of recommendations for treating and reducing pain in pediatric patients. The non-profits that developed it are the Health Standards Organization, an Ottawa-based group that creates health guidelines, and Solutions for Kids in Pain, an advocacy organization with hubs around the country.
Pain in children has traditionally been ignored or minimized; babies were undergoing surgery without anesthesia as recently as the mid-1980s. While research into pain management strategies for pediatric patients has vastly improved since then, the new standard’s creators say those techniques often aren’t applied.
“There are still incredible instances of poorly managed pain with relatively simple solutions, but traumatic consequences from not being managed well,” said Katie Birnie, a clinical psychologist and associate scientific director of Solutions for Kids in Pain. She chaired the working group that developed the standard.
“What kids in Canada actually receive is outdated compared to what we know works,” she added.
Dr. Birnie cited a number of examples, such as health care providers or parents holding children down during uncomfortable procedures instead of using medication or other proper pain management tools. She said the standard could lead to much-needed change.
The new guidelines highlight the fact that young people from socially or economically disadvantaged backgrounds – including Indigenous and racialized children, children with mental illnesses and those with disabilities – are more likely to experience pain, and to face challenges in accessing pain-management tools.
For instance, a study published in June in the journal Academic Emergency Medicine found that pediatric patients who were Asian, Black or Hispanic, or who spoke a language other than English, were much less likely to receive strong intravenous drugs for migraine-related pain compared with white pediatric patients with similar pain scores.
The standard offers 34 detailed recommendations for health care organizations and providers. They are meant to be used widely, both by children’s specialty institutions and at community hospitals.
The standard says health care institutions should have, at minimum, organization-wide pediatric pain management strategies. Clinicians, it says, should be able to assess pain in children. Each institution should have tools to prevent pain, such as sedation, numbing cream and oral sucrose, which can be used in babies. And it calls for mechanisms for reporting safety incidents, such as untreated pain.
Experts who helped create the new standard say improving the management of pain in young people is vital. They argue outdated ideas about the ability of babies and children to feel or remember pain still permeate some aspects of patient care.
Samina Ali, a pediatric emergency physician and member of the working group that developed the standard, said untreated pain can lead to negative outcomes, including chronic pain. And she said it is linked to poorer long-term health outcomes, sometimes stemming from fear of the medical system related to painful experiences early in life.
“When we undertreat children’s pain, we pay for it our entire lives – as an individual, as a country,” Dr. Ali said.
Rithesh Ram, a family physician in Drumheller, Alta., who was not involved in the creation of the new standard, said he and his colleagues in rural medicine have made great strides in recent years using a variety of techniques to ensure children are spared as much pain as possible during procedures. The tools they use include medication and distraction methods, such as allowing children to watch favourite TV shows.
Still, there are many improvements that could be made, Dr. Ram said. For instance, when children come to the emergency room for triage, the first nurse they see should offer them pain management when appropriate, he said.
The importance of pediatric pain management is increasingly being recognized by the medical community. Last year, the Canadian Paediatric Society issued a position statement on the importance of treating pain in children and adolescents, and offered a series of best-practice tips to help clinicians assess and manage pain in their young patients.
The Globe and Mail, April 3, 2023