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Barriers to Optimal Pain Management in Infants, Children, and Adolescents Social Barriers to Optimal Pain Management in Infants and Children

Craig, Kenneth D. Ph.D.; Lilley, Christine M. M.A.; Gilbert, Cheryl A. B.Sc.

Article

Objective: To examine the social barriers that lead to less than optimal management of pain in children.

Design: Recognizing the vulnerabilities of infants and children and their dependence on caring adults, a model of pain communication is proposed. The model examines (a) the pain experiences of children, including social determinants; (b) developmental variations in the capacity to encode the severity and qualities of pain as expressive behavior; (c) adult skills and deficiencies in decoding pain; and (d) the actions of adults predicated on the meaning and significance attached to children's actions. Limitations in care were examined.

Data sources: The current research and professional literature were accessed through searches of the Psyclit and Medline databases for relevant investigations on the basis of our working knowledge of the literature.

Conclusion: Numerous deterrents to optimal care are identified in the domains of commonplace beliefs about the nature of pain in infants and children: failure to recognize the impact of socialization in familial and cultural modes of experience and expression; needs for age-specific assessment instruments; the limited capacity to use available evidence concerning pain; the need to employ clinicians, parents, and other adults more effectively in delivering care; and structural problems in the health care system.

Department of Psychology, University of British Columbia, Vancouver, British Columbia, Canada

Manuscript submitted August 11, 1995; revision received March 14, 1996; accepted May 9, 1996.

Address correspondence and reprint requests to Dr. Kenneth D. Craig, 2136 West Mall, Department of Psychology, University of British Columbia, Vancouver, B.C., V6T 1Z4, Canada.

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