Pediatric pain management in the emergency department

Emergency care for children and adolescent patients accounts for about one third of the nation's emergency department (ED) visits each year [1]. Many of these pediatric visits are related to painful injuries from trauma and accidents. Children also frequently present to emergency departments having painful medical and surgical conditions that are not related to trauma. Therefore, emergency physicians and the entire emergency care team should be proficient in the assessment and safe management of pain in children. Yet effective, compassionate pediatric pain management can be challenging, because there are many special considerations when providing pediatric analgesia. Choosing the most appropriate method in a given patient and situation entails assessment of the child's acute medical condition, emotional and cognitive capabilities, and an understanding of his or her baseline chronic anatomic and physiologic state related to chronic medical conditions and age. Because the provision of effective pain relief in children also often requires a team effort to provide anxiolysis or sedation, emergency physicians need to understand their resources and ensure that the ED staff is adequately trained, and that the ED is appropriately equipped for the team effort of close monitoring during sedation with analgesia. Over the past 25 years, pediatric emergency medicine research and literature have progressively augmented our knowledge of safe and effective pediatric pain management strategies. Yet there is still much more we need to do to understand the painful experiences of children and to develop optimal safe ways of addressing those needs within the system and context of a busy pediatric ED. In this article, the authors review the history of ED pediatric pain management and sedation, discuss special considerations in pediatric pain assessment and management. review various pharmacologic and nonpharmacologic methods of alleviating pain and anxiety, and present ideas to improve the Culture of the pediatric ED. so that it call achieve the goal of becoming pain-free.