Thrane Susan E, Wanless Shannon, Cohen Susan M, Danford Cynthia A
College of Nursing, Ohio State University, Columbus, OH.
School of Education, University of Pittsburgh, Pittsburgh, PA.
J Pediatr Nurs. 2016 Jan-Feb;31(1):e23-32. doi: 10.1016/j.pedn.2015.09.002. Epub 2015 Sep 28.
The 2011 IOM report stated that pain management in children is often lacking especially during routine medical procedures. The purpose of this review is to bring a developmental lens to the challenges in assessment and non-pharmacologic treatment of pain in young children.
A synthesis of the findings from an electronic search of PubMed and the university library using the keywords pain, assessment, treatment, alternative, complementary, integrative, infant, toddler, preschool, young, pediatric, and child was completed. A targeted search identified additional sources for best evidence.
Assessment of developmental cues is essential. For example, crying, facial expression, and body posture are behaviors in infancy that indicate pain: however in toddlers these same behaviors are not necessarily indicative of pain. Preschoolers need observation scales in combination with self-report while for older children self-report is the gold standard. Pain management in infants includes swaddling and sucking. However for toddlers, preschoolers and older children, increasingly sophisticated distraction techniques such as easily implemented non-pharmacologic pain management strategies include reading stories, watching cartoons, or listening to music.
A developmental approach to assessing and treating pain is critical. Swaddling, picture books, or blowing bubbles are easy and effective when used at the appropriate developmental stage and relieve both physical and emotional pain. Untreated pain in infants and young children may lead to increased pain perception and chronic pain in adolescents and adults. Continued research in the non-pharmacological treatment of pain is an important part of the national agenda.
2011年医学研究所在报告中指出，儿童疼痛管理往往不足，尤其是在常规医疗程序中。本综述的目的是从发育的角度审视幼儿疼痛评估和非药物治疗中的挑战。
通过在PubMed和大学图书馆进行电子检索，使用关键词疼痛、评估、治疗、替代、补充、综合、婴儿、幼儿、学龄前儿童、年幼、儿科和儿童，对研究结果进行了综合分析。有针对性的检索确定了更多最佳证据来源。
评估发育线索至关重要。例如，哭泣、面部表情和身体姿势在婴儿期是表明疼痛的行为；然而在幼儿期，这些相同的行为不一定表明疼痛。学龄前儿童需要观察量表结合自我报告，而对于年龄较大的儿童，自我报告是金标准。婴儿的疼痛管理包括襁褓包裹和吸吮。然而对于幼儿、学龄前儿童和年龄较大的儿童，越来越复杂的分散注意力技术，如易于实施的非药物疼痛管理策略包括阅读故事、看卡通片或听音乐。
采用发育方法评估和治疗疼痛至关重要。在适当的发育阶段使用襁褓包裹、图画书或吹泡泡等方法既简单又有效，可缓解身体和情感上的疼痛。婴幼儿期未经治疗的疼痛可能会导致青少年和成人的疼痛感知增加以及慢性疼痛。疼痛非药物治疗方面的持续研究是国家议程的重要组成部分。
