Pain management in childrenPain is an issue that needs to be addressed with special sensitivity to protect the physical and psychological health of children. The way children express pain may differ from adults, so it is important that pain is accurately assessed and treated appropriately. Below you will find comprehensive information and practical approaches to pain management in children:

1. Assessment of Pain in Children

1.1 Types of Pain

1. Akut Agri
   • It is caused by a sudden injury, infection, surgery or illness.
   • For example, injuries due to teething, ear infections or falls.
2. Chronic Pain
   • Pain that persists for more than three months and affects the child's daily life.
   • For example, migraines, rheumatic diseases, gastrointestinal problems or musculoskeletal pain.
3. Procedural Pain
   • Temporary pain during medical procedures such as vaccinations, bloodletting or wound care.

1.2 Symptoms of Pain in Children

Children may find it difficult to express pain or may remain completely silent. Therefore, careful observation is necessary to understand the pain:

1. Behavioural Symptoms
   • Crying, restlessness, frequent change of position.
   • Loss of appetite, disturbed sleep patterns.
   • Withdrawal or withdrawal from the game.
2. Physical Symptoms
   • Change in facial expressions (frowning, squeezing the eyes).
   • Restless movements, constant grasping or rubbing an area.
   • Discolouration (pallor or redness), sweating, rapid breathing.
3. Verbal Expressions (for older children)
   • They can express the situation with words like "it hurts", "it stings", "it burns".

1.3 Pain Assessment Tools

Assessment methods appropriate to the age and condition of the child should be used:

1. Faces Pain Scale
   • The child is shown different facial expressions and asked to choose which face represents his/her pain (usually used with children aged 3 years and older).
2. Numerical Scales
   • Older children may be asked to give a pain rating of 0-10.
3. Behaviour Scales
   • For infants and non-verbal children, pain is scored by monitoring crying, facial expression and movements (e.g. FLACC Scale: Face, legs, activity, crying, consolidation).

2. Pain Management Methods in Children

2.1 Pharmacological (Drug) Methods

1. Paracetamol (Acetaminophen)
   • It is frequently used in mild and moderate pain.
   • The correct dose should be calculated according to age and weight.
2. Ibuprofen (Non-steroidal Anti-inflammatory Drug)
   • It is effective in pain and inflammation, but should be used with caution in children with stomach problems.
3. Local Anaesthetics
   • Local anaesthetic creams (e.g. Emla cream) can be applied to reduce pain before procedures such as blood collection or injections.
4. Opioids
   • Can be used with caution and under expert supervision in severe pain (e.g. after surgery or cancer pain). Requires close monitoring due to the risk of addiction and side effects.
5. Other Medicines
   • Supportive medication can be used for conditions such as nausea, vomiting, anxiety or muscle spasm accompanying the pain.

2.2 Non-pharmacological (Non-pharmacological) Methods

1. Relaxing Techniques
   • Deep Breathing: The child can be taught to breathe deeply and relax.
   • Relaxation Exercises: The child can be taught to relax the body by tightening and relaxing the muscles.
2. Distraction
   • You can distract the child from the pain with a favourite toy, video, fairy tale or music.
   • For older children, storytelling or play can be effective.
3. Touch and Massage
   • Lightly massaging or rubbing the painful area can provide relief.
   • The use of a warm cloth or a thermofoam can be effective, especially for abdominal pain.
4. Play Therapy
   • Play therapy can be applied to reduce the child's anxiety in the hospital environment or during medical procedures.
   • With toy doctor sets, the child can be prepared for a medical procedure.
5. Hot and Cold Applications
   • Cold Application: In cases of injury or swelling, cold compress can be applied to the painful area.
   • Hot Application: A hot compress can be used for muscle pains or abdominal cramps.
6. Physical contact with the mother or carer
   • For young children, cuddling, hugging and comforting touches from the mother or carer provide emotional support and relieve pain.
7. Cognitive Behavioural Techniques
   • Older children can be taught positive thinking and coping skills. For example, imagery methods such as imagining the pain as a balloon and letting it fly can be applied.

2.3 Procedural Pain Reduction Methods

1. Preparation
   • Explain the procedure to the child in advance in an age-appropriate manner. Uncertainty can increase anxiety.
2. Positioning
   • It is recommended that the child sits on the parent's lap or is held in a comfortable position during the medical procedure.
3. Distraction
   • During the procedure, the child can be distracted with a toy, music or video.
4. For Children with Needle Phobia
   • Local anaesthetic creams can be applied before the injection. In addition, technological methods such as virtual reality glasses can be used to distract attention.

3. Family Duties in Pain Management in Children

1. Empathise
   • Take your child's pain seriously and let him/her know that you understand.
   • Instead of saying "There is nothing to be afraid of in this", it would be more effective to say "I understand you, this is a difficult situation".
2. Providing a Relaxing Environment
   • Creating a quiet, peaceful environment can reduce the child's perception of pain.
   • It can be comforting to be near the child with a favourite blanket, toy or a story book.
3. Keeping a Pain Diary
   • Monitor your child's pain regularly. Record information such as the location, intensity, duration and triggers of the pain. This will be useful for visits to the doctor.
4. Knowing when to apply for a doctorate
   • If the pain is severe, does not go away for days or if there are additional symptoms such as fever, vomiting, change in consciousness, consult a doctor.

4. Long Term Approaches

1. Balanced Nutrition and Fluid Consumption
   • A healthy diet strengthens the immune system and can reduce the triggers for pain.
2. Regular Sleep
   • Good quality sleep supports the child's overall health and improves pain tolerance.
3. Regular Physical Activity
   • Light exercise can reduce the risk of pain by supporting musculoskeletal health.
4. Psychological Support
   • Especially in children with chronic pain, it is helpful to seek help from psychologists or paediatric therapists.

Summary

Pain management in children requires special approaches appropriate to the needs and age of children. In addition to pharmacological methods, it is possible to alleviate pain with non-pharmacological methods such as distraction, relaxation, massage, play therapy. Family support, empathy and accurate assessment of pain make it easier for children to cope with pain. If the pain persists for a long time or is severe, a health professional should be consulted. A holistic pain management strategy should be adopted, taking into account both the physical and emotional needs of the child.