Send letter to journal:
Re: Pain relief in children in A&E

Dear Editor

Responding to the very infomative third article on paediatric pain relief in Emergency Departments, I would like to point out some aspects of pain reduction we use in our facility.

We have found the presence of parents at the bedside very conducive to minimising the stressful experience of the child, but not in every case. The complex psychology which can build up between child and parent (usually the mother)can sometimes lead to an interaction where both parties are apprehensive, and one can play off against another. I have had situations where it was simply in the child's best interests not to have an anxious parent around, and to replace that person with an experienced and understanding nurse. Luckily, this does not happen very often.

In fact, the attitude of the family to a minor injury within the family is highly variable. Composed families may even joke about the injury, appearing composed. If the child is OK with this, I will often suture with two parents and siblings present. The injured child is able to converse with the entire family, and the event becomes more of an interesting family experience. It may even sow the seeds of a possible medical career.

Distraction is very important, as is highlighted in the article. I believe this has to be coupled with a firm commitment to get the job done. I remember the story of an SHO in A&E who was incapable of suturing a child's face when confronted with a demanding father, who eventually took the child away untreated, with no expectations being fulfilled by anyone. The doctor needs to be compassionate, but gently firm in his/her responsibility to the patient. No amount of soft talk is going to stop an intelligent young child from apprehending the moment of a jab that he/she knows is coming, so its better sometimes to state what will happen. I will often tell a child that they will experience a sting like a bee, but that it will go away much more quickly. Cognisant children are then able to gage what to expect.