Children experience a wide variety of pain including acute, recurrent and chronic and childhood pain has been recorded as one of the top reasons for patient and Dr encounters (Stinson and McGrath, 2007). According to the Royal Australian College of Physicians (2006) pain can have long lasting effects in infants including irritability, depression and poor coping skills, post- traumatic - stress disorder in those who experience extreme procedural pain, needle phobia later in life and pain which has become harder to treat. Untreated pain can also have long term effects on immune functioning, neurophysiology and attitudes and behaviours (Cohen,Lemanek,Blount, Dahlquist, Lim, Palermo, McKenna and Weiss, 2007). The relief of pain has been described as a basic human right by the World Health Organisation (WHO), (Green, Todd, Lebovits and Francis,2006) and the “unreasonable failure to treat pain as an unethical breach of human rights” (Brennen, Carr and Cousins, 2007). But apart from being a humanitarian consideration, effective pain management can improve recovery, decrease mortality and morbidity, decrease fear and anxiety, patient and family distress and the use of human resources. Therefore the relief of pain is a very necessary aspect of patient care (Dowden, McCarthy and Chalkiadis, 2008). In the last 15-20 years significant advances have been made in the management of pain in children with a rapid expansion in paediatric pain services. However, despite a plethora of research and improved practices these standards have not been universally applied with compelling evidence that pain treatment in children is still suboptimal. This essay will examine policies and procedures related to paediatric pain in an area of paediatric practice and review it in relation to current literature and standards. Areas specifically looked at will include procedural pain and assessment and management of special groups including developmentally delayed clients. It will also examine staff responses and knowledge of policy and how these can be improved.
Procedural pain in paediatrics has been identified as an area causing considerable distress and needing major improvement (Dowden et al, 2008). The Royal Australian College of Physicians (RACP) (2006) confirmed this stating that while evidence based guidelines on pain recognition and assessment are available, guidelines on procedural pain are not specifically included in these. The benefits of supportive interventions during a procedure have been well documented. However the use of these measures in children are variable. While in an emergency setting children receiving laceration repair and sutures topical aesthetic, few patients undergoing procedures like venepuncture, intravenous canulation and urethral catheterisation received comfort measures (Czarnecki,Turner, Collins, Doellman, Wrona and Reynolds, 2011). Prospective consultation of clinical staff at specialist paediatric hospitals revealed that staff acknowledged that more consistent pain management practices and guidelines were needed (Bowden et al,2008). In regards to policies and procedures within the current workplace, being a small unit there were not a lot of policies available with no specific policies available for procedural pain. Staff reported that they generally borrowed from larger hospitals if they needed more comprehensive policies or procedures. A lack of easy access to paediatric pain policies may become problematic as staff do not have consistent guidelines to work from which may contribute to inconsistent management of pain in procedures and less effective pain management. The RACP (2006) recognise a lack of recommended policies and procedures for pain relief as a major barrier to effectively and uniformly treating pain. Schechter (2008) confirms this stating that a lack of clear policies can lead to a lack of uniformity in approach and uneven and inconsistent pain control. Samuels and Fetzer (2009) state that