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Pediatric Emergency Care:
doi: 10.1097/PEC.0b013e318163db77
Pain Sedation

The Squeaky Wheel Gets the Grease: Parental Pain Management of Children Treated for Bone Fractures

Zisk, Rachel Yaffa PhD, RN, MPH*†‡; Grey, Margaret DrPH, RN, FAAN*; Medoff-Cooper, Barbara PhD, RN, FAAN§; MacLaren, Jill E. PhD†; Kain, Zeev N. MD, MBA, FAAN†

Section Editor(s): Goldman, Ran MD

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Abstract

Objectives: The purpose of this study was to examine parental pharmacological and nonpharmacological pain management practices after extremity fractures.

Methods: Parents of children aged 5 to 10 years who were diagnosed with a fractured limb and treated in an emergency department were recruited and completed pain records at home for 2 days.

Results: The findings demonstrated that on the day after the fracture, 20% of children received no analgesia and 44% received 1 dose. On day 2, 30% received no analgesia and 37% received 1 dose. The correlation between analgesia and child report of pain increased from day 1 (r = 0.4, P < 0.05) to day 2 (r = 0.52, P < 0.05) as did parental impression that increased from day 1 (r = 0.43, P < 0.05) to day 2 (r = 0.6, P < 0.05). Correlations between pain scores, however, decreased from day 1 (r = 0.6, P < 0.05) to day 2 (r = 0.41, P < 0.05). Although most children received analgesia based on exhibiting active, loud behaviors such as crying (r = 0.63, P < 0.001), children exhibited quiet behaviors more frequently than crying (59.4 % vs. 31.2%, P < 0.001).

Conclusions: Based on these findings, it was concluded that children received few doses of analgesia at home after a fracture. Although quiet, withdrawn behaviors were exhibited more frequently, parents provided more analgesia if children exhibited active, loud behaviors. Future intervention should be developed to assist parents in recognizing the unique pain cues children exhibit and instructions for safe and effective pain management.

© 2008 Lippincott Williams & Wilkins, Inc.

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