Taking Aim at Pain
Bumps and boo-boos are the stuff of childhood, usually made all better by a bandage and a kiss. But parents sometimes face more serious concerns, some solved by over-the-counter medications, others in consultation with their pediatrician.
Treating Fevers and Colds
Fever and cold symptoms are common causes of children's discomfort. Non-prescription ibuprofen and acetaminophen often bring a fever down without a doctor's visit.
"Acetaminophen and ibuprofen work equally well to reduce fever, and both are effective when administered according to the package directions," says Norb Weidner, MD, associate professor of clinical anesthesia and pediatrics at Cincinnati Children's Hospital Medical Center, and a member of the Pain Management Service at Cincinnati Children's.
"There have been some statements that parents should alternate giving acetaminophen and ibuprofen every four hours," Dr. Weidner says. "This is very confusing, and we don't recommend it. Alternating can cause excessive dosing, especially with acetaminophen, and that can lead to toxicity. Children should receive fewer than five doses of these over-the-counter medications in a 24-hour period."
Offering cold remedies on top of pain killers can also lead to an overdose of acetaminophen or ibuprofen. "Read the label of any cold syrup carefully to look for those two listed ingredients," he warns.
In addition, parents should never give their child aspirin, because of the risk of Reye's syndrome, a rare, often fatal disease characterized by brain swelling and liver enlargement.
Most childhood fevers respond quickly to over-thecounter medications, but for infants younger than 2 months, a fever can indicate a serious infection.
"With a child that young, always call the pediatrician. The doctor might want to ask about other symptoms the child is having, or may want to see the child," he says.
'No More Tears' Immunizations
As a child grows, regular immunizations are part of well baby and child care. New pain management techniques can help there, too.
When a child faces an inoculation, parents can apply prescription EMLA cream to the skin to numb the area in about an hour; non-prescription Elamax works even faster, in about a half-hour. Both topical creams are useful to numb the skin before a puncture for a blood draw or IV placement, too. Be sure to check with your child's doctor to coordinate timing so the numbing effect is still working when it's needed.
Focusing Away From Pain
If a child is at Cincinnati Children's for testing or a procedure, new approaches help keep parent and child closer and the child more focused on thoughts other than discomfort.
"During a procedure that may involve pain, we find that parents and children both do better if they are together," Dr. Weidner explains. "Parents' presence provides comfort, and at Cincinnati Children's, child life experts can teach parents techniques to help refocus their child. Parents can use guided imagery, perhaps relating a very pleasant experience at the beach or Disneyland. Storytelling is a wonderful way to modify a child's response to a painful experience."
Sometimes, tests require that parents be separated from their children, as with an MRI scan. "This can be a new and awkward experience, so we have goggles that create a virtual reality for the child. They can watch movies or video games, and almost step into a video reality," he says.
As late as the 1980s, physicians did not recognize that young children perceived pain the same way that their older siblings or adults do. "That's all changed now," assures Dr. Weidner. "We certainly understand that, and use the same medications in different doses. We work to help parents and children together manage a child's pain."
