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Saturday, September 18, 1999 Published at 00:40 GMT 01:40 UK


Health

Cracking the code of child pain

Assessing pain in babies is notoriously difficult

Scientists have developed a way to measure pain more effectively in children.

Until now techniques for measuring pain levels in new-borns and children under four have proved to be unreliable.

But the observation scale developed by the Medical Sciences Council in the Netherlands appears to provide a much more accurate way to assess physical distress in the under fours.

Pain slows down recovery, interferes with sleep and appetite, prevents children playing and going to school, and impedes proper development.

A more effective way of evaluating discomfort can improve the way young children are cared for when they are ill.

The new method, called APocis, allows doctors and nurses to record seven types of behaviour which are related to pain.

Staff observe the child unobtrusively, noting a score for:

  • Whether it is crying
  • How it breathes
  • The way it moves its arms and fingers
  • How it moves its legs
  • The posture of the back and body
  • Facial expression

For instance, if a child is in pain it is likely to clench its fists, kick out and wrinkle up its nose.

The total scale gives a measure of discomfort, ranging from no pain (0), mild pain (1-2), pain (3-4) or severe pain (5-7).

The method is intended to be carried out initially every half hour after a painful medical intervention, for example having the tonsils removed.

On the basis of the scores, a nurse can determine to what extent it is necessary to treat the pain with medication.

Promising results

A test involving 300 toddlers after medical intervention - ranging from the painless insertion of ear tubes to the painful removal of tonsils and adenoids - has shown that the scale is reliable and valid and that it is easy to use to evaluate acute or chronic pain.

Some 60 Dutch hospitals with a paediatric pain group are to receive the set, which includes an instructional video.

Professor Imti Choonara, an expert in child health from Nottingham University, said: "It is difficult to assess pain in children who have not developed the brain power to be able to say 'I am in pain'.

"I would welcome any new pain assessment tool for child of this age."

Professor Choonara said a child who was treated properly for pain was more likely to make a quick recovery and to be discharged from hospital at an earlier stage

He said: "There is also some evidence that newborns in pain are more agitated, and more prone to complications which can have a long-term effect."





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Internet Links


The Netherlands Organisation for Scientific Research (NWO)

Royal College of Paediatrics and Child Health

Pain management


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