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Management of procedural pain in children
  1. Amanda J Harvey1,
  2. Neil S Morton2
  1. 1Mater Hospital, Brisbane, Australia
  2. 2Royal Hospital for Sick Children, Glasgow, UK
  1. For correspondence:
    N S Morton
    Royal Hospital for Sick Children, Glasgow G3 8SJ, UK; nsmorton{at}

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Paediatricians are increasingly involved in performing painful procedures on children in order to diagnose and treat a wide variety of diseases. Despite advances in both pharmacological and non-pharmacological methods of preventing and treating pain, many children still endure unacceptable levels of pain and distress during their hospitalisation.1

Research now shows that poorly controlled pain can have long lasting effects on infants and children. Painful procedures performed during the neonatal period have been shown to produce increasing distress during later procedures such as immunisations.2 In children undergoing frequent painful procedures such as bone marrow aspirates and lumbar puncture for the treatment of cancer, the memory of pain from the first procedure can affect the pain and distress associated with subsequent procedures.3 Anticipatory fear and anxiety are major problems. Untreated pain may also have detrimental effects on the course of a disease.4

It is therefore imperative that physicians performing procedures in children are familiar with best practice for the management of procedural-related pain. This includes a thorough current knowledge of analgesics, age-specific doses, appropriate routes of administration and possible side effects. In addition, it is important to realise that in the paediatric population, pharmacological interventions alone are rarely successful in preventing pain. A family centred approach combining pharmacological methods with psychological and behavioural methods is needed for the optimum comfort of children.5–7


Over the past few years, several guidelines have been published advising on evidence-based practice in pain management and sedation in children.8,9,10,11,12,13 Recommendations include:

  • comprehensive pre-procedural evaluation of children, including past medical history, previous exposure to painful procedures, level of anxiety, allergies and drug reactions; a physical examination including assessment of vital signs, airway and cardiovascular status should be performed,

  • informed consent,

  • adequate documentation,

  • assessment of pain: pain assessment …

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  • Competing interests: None declared.