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

Section Editor(s): Goldman, Ran MDZisk, 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

doi: 10.1097/PEC.0b013e318163db77
Pain Sedation

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 Although quiet, withdrawn behaviors were exhibited more frequently, parents provided more analgesia if children exhibited active, loud behaviors.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.

*Yale University School of Nursing; †Center for the Advancement of Perioperative Health, the Departments of Anesthesiology, Pediatrics, and Child Psychiatry, Yale University School of Medicine, New Haven, CT; ‡Henrietta Szold School of Nursing, Hebrew University - Hadassah Medical Organization, Jerusalem, Israel; and §University of Pennsylvania, School of Nursing, Philadelphia, PA.

This research was partially funded by a research grant from Sigma Theta Tau, Xi Chapter, and through postdoctoral support at the Yale School of Nursing (T32NR008346). Z.N.K. is partially funded by a grant from the National Institute of Child and Health Diseases, Bethesda, MD (NIH-2R01HD037007-04A1).

Address correspondence and reprint requests to Rachel Yaffa Zisk, PhD, RN, MPH, Hadassah University Hospital, Ein Karem, P.O.B. 12000, Jerusalem, 91120, Israel. E-mail:

© 2008 Lippincott Williams & Wilkins, Inc.