The challenges of managing paediatric pain

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Patients under the age of 2 are generally considered to be at high risk of having their pain undermanaged by healthcare clinicians.
The assumption that children cannot feel pain until they are at least 18 months old is likely to be accurate.
Level 1 evidence is considered more reliable to inform practice than evidence obtained from level 2 or 3 studies.
Strong analgesia should be avoided in children, as it can mask symptoms, and make subsequent assessment in hospital almost impossible.
Even though the Wong Baker pain assessment tool is not validated for prehospital use, it may well be a useful prehospital adjunct in the assessment of a child in pain.
In a 4-year-old child with a superficial burn approximately the size of a 50p piece, morphine would routinely be considered the first treatment of choice.
Prehospital analgesia can often be omitted, as evidence shows that children receive analgesics very quickly upon their arrival at A&E.
Morphine can be administered intraosseously.
Tetracaine gel should not be considered prehospitally if the child’s pain is managed well with paracetamol and ibuprofen.
It is often best not to involve parents in managing a child in pain, as they will find it upsetting and stressful.
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