In episode two of the Great Ormond Street Hospital programmes we see Keano in great pain due to his overwhelming fungal infection. The infection is causing pain all over his body. He is so sore he does not want to be touched.
Children in hospital regularly experience pain, and it is recognised that children’s pain can be very complex as each child is different and how they respond to pain can be very individual. There are a number of research studies that have looked at how to improve the management of children’s pain and different approaches have been used. One of these is to ensure that a nurse uses a tried and tested pain assessment tool that is designed specifically for the child’s age and checks regularly with the child and or their parent about whether the child has pain. Many of these pain assessment tools asks the child to rate their pain out of 10, with 3 or less being mild pain, 4 – 7 being moderate pain and over 7 being severe pain.
These tools help nurses to work out how much pain a child is in, so that they can then give them the right medication to relieve their pain. Researchers have found that the most effective pain assessment tool for children Keano’s age is one that requires the nurse to ask Keano about his pain and to try and rate how severe it is.
But sometimes it is not that simple to decide how much pain a child is in, and looking at Keano he seemed so unwell that he might not want to talk about his pain. In this situation the nurse would have to make a judgement on how severe his pain was by observing Keano, how he is holding himself, his movements and his facial expression, and give him pain medication to reduce his pain.
Another approach is to understand how the child is feeling about their pain, and not just what number they would rate their pain. Such an approach was taken in a recent book by Carter and Simons (2014) in which stories of children’s pain were collected from around the world, from health care practitioners, parents and children themselves.
This is one of the stories from the book, told by a 10 year old girl called Luci:
"It all started on the same bridge that I walk to school on every day and back at 8:30 and 3:00. Me and my friend Loretta were riding double on the scooter across the flat part of the bridge when we hit a rock. I was standing up by that time! In the other hand Loretta was not and went flying down on the bridge. I couldn’t let her go, so I raced after her and cartwheeled over the handle bars.
The pain was not there with me in till the Dettol came out. I felt like someone had got a grater and slit my knee caps off. When Katie (my sister) got home I was just about in agony! She said I was like Bella from Twilight when she got bitten. By the time mum got home with the bandages etc. I was sitting on the couch crying while watching TV.
The worse mistake I made was to let mum put on bandages on my leg, the next four days I spent trying to rip off the bandages it was like trying to rip something off that was stuck on to your leg like a leach. In the end dad took me to the nurse to get it ripped off, the pain was excruciating. Then I had to start again!
PS: Don’t let mums put things on your legs, only if the doctor gave it to you!!"
By Luci Mc Dougall, aged 10 years
You will see from Luci’s story that the pain she suffered from grazing her knee, was not actually what caused Luci the most pain - the worst experience was having the bandage removed. So this short story gives one example of how asking a child about their pain is so important, because if a nurse assumes they know how much pain a child is experiencing, they may get it wrong and a child’s pain could be overlooked. On the other hand asking a child about their pain can provide the necessary information for a nurse to be able to judge how much pain medication is needed to relieve their pain.
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