SCOPE OF PROBLEM

Pain relief for children in the emergency department (ED) is an essential component of care. Improvements in the recognition and treatment of pain in children have led to changes in the approach to pain management for acutely ill and injured pediatric patients.

There is certainly evidence that inadequate pain control can have long-term negative implications for children. Neonates who undergo procedures with inadequate analgesia have long-standing alterations in their response to and perceptions of painful experiences. Inadequate pain control during oncology procedures leads to significantly increased pain scores for subsequent painful procedures. Posttraumatic stress disorder can occur after procedures or stressful medical experiences that are not accompanied by appropriate pain control or sedation.

Venous access is one of the most common procedures performed on children in the ED and induces an extraordinary amount of fear in many children. Although it is never certain how an individual child will respond to this procedure, the majority of children, especially those under the age of 12, will find these procedures significantly painful and anxiety provoking.

Children frequently view venous access procedures as more anxiety provoking than major surgeries with the child's initial interaction with a medical caregiver being colored by the question “am I going to get a needle?” Finally, when a child has a painful and/or anxiety-provoking experience with venous access, this experience may set the tone for the entire ED encounter for both the child and its parents.