Pediatric Pain Management
Every hospitalized child has the potential for procedural/surgical/injury/disease related pain that can be addressed by our Pediatric Pain Management Team. As with adults, children can suffer from a variety of pain problems and their experience varies, based on several factors such as: child's previous experience with pain; personality; expectations and their cognitive maturation. The Pediatric Pain Management Team at Yale-New Haven Children's Hospital works in collaboration with pediatricians, surgeons, and other clinicians to manage hospitalized children's pain after surgery, injury, or pain caused by cancer, sickle cell disease or other illnesses. We use a multidisciplinary team approach to control pain with both medication and non-drug techniques.
Who We Help?
We are available for consultation for any child admitted to Yale-New Haven Children's Hospital whose pain is not adequately controlled.
Who Are We?
The Pediatric Pain Management Team at Yale-New Haven Children's Hospital oversees the care of more than 400 infants and children each year. Our team consists of: 4 full time pediatric anesthesiologists, 2 pediatric anesthesia fellows, 4 anesthesia residents, 2 nurse practitioners and a massage therapist. Once consulted, our goal is to design individual treatment plans that fit into the overall care plan of the primary team (surgeons, pediatricians), keep the children safe and reasonably comfortable, allow the child to participate in activities intended to expedite recovery, and decrease the undesirable side effects of pain medications.
- Haleh Saadat, MD FAAP (Pediatric Anesthesiologist, Medical Director of Pain Management)
- Dorothy Gaal, MD (Pediatric Anesthesiologist, Clinical Director of Pediatric Section)
- Renate Schoenfelder, MD (Pediatric Anesthesiologist)
- Arlyne Thung, MD (Pediatric Anesthesiologist)
- Rae Ann Kingsley, APRN (Pediatric Pain Management Services)
How We Help?
Our consult team visits children, at the request of the primary physician or surgeon, who require pain management. Our team offers many different services, some using medicine (pharmacological treatments) and some non-medicine options. Here are some of the medicine-based services we commonly use for children:
1) Patient-controlled Analgesia Pump, also known as PCA or "pain pump" or "pain button":PCA pumps are set up so that when your child wakes up after surgery the button is ready to be used when pain is felt. This pump delivers pain medicine through an intravenous (IV) line. The dose is based on the child's weight and condition. When the child needs more pain control, he or she pushes a button to deliver a dose. The pump then locks so the child cannot get another dose for a certain amount of time. This type of pump can be used by children as young as 4 years old. Sometimes an infusion (a little bit of medicine that runs constantly) is set up as well. When your child hurts he or she should press the button. No one else should press the button. This is a safety issue. If a child is asleep then they have enough pain medicine in their system. Pressing the PCA button while the child is asleep is dangerous as it risks causing an overdose and possibly severe harm o the child. So, if your child receives a PCA after surgery, please DO NOT push the button when your child is asleep.
2) Epidural/Caudal:Many people know this treatment best as one used for women during labor and delivery. An epidural catheter is one that is placed in a space between the bones of the spine and the spinal cord. The catheter allows the continuous infusion of pain medications to keep your child comfortable after surgery. This device can deliver a steady dose of medicine constantly, or it can be patient controlled, like the pump described above. Epidurals are most often placed under anesthesia, after the child is asleep. The continuous infusion of medication through your child's epidural catheter usually starts in the operating room. This may allow the anesthesiologist to use less anesthetic, which, in turn, may allow your child to wake up faster. Adjustments are made in the recovery room. Depending on the surgical care plan, the epidural medication is continued for the 1 to 4 days following the operation.
3) Continuous IV Infusions:For children who cannot use a push-button device (because they are too young or too ill), doctors may use an IV line that delivers medicine at a pre-set rate. This can be increased or decreased by the child's pain management team, depending on what the child needs.
Non-medicine options can be used along with medicines or instead of medicines. Here are some of the non-medicine services that the team commonly uses for children:
- Hypnosis - This technique helps a patient relax and cope with stressful and painful situations more effectively. Health care professionals that are certified provide instruction on hypnosis.
- Physical Therapy - Licensed physical therapists help children stay mobile and strong in ways that make sense for their current health.
- Visits from Child Life Specialists - These specialists at Yale-New Haven Children's Hospital are trained to help distract children from their pain, help them learn to cope with their pain and increase their sense of power. This can lower their need for pain medicine.
- Visits from Massage Therapists
- Visits from Volunteers - Child Life volunteers at Yale-New Haven Children's Hospital can spend time doing fun activities with your child, like reading or playing games, to distract them and lower their feelings of pain.
How Do We Assess Your Child's Pain?
We work with a child's health care team and parents to assess your child's need for pain control. Sometimes children do not know how to express or describe their pain. Occasionally they don't say anything because of fear, their culture or their age. We assess children's pain by looking into:
- Child's verbal, behavioral and physical signals
- Listening to
a. Child's parents' concerns
b. Other health care professional's input
Documentation of frequency and intensity of pain provides us with a child's pain profile and his/her response to the treatment plan. It helps us to accurately adjust medications. It is important for us to now if the child is using any other methods to control pain, such as any herbal medications. Some herbs (or other methods) may interact with the methods used in the pain management.
How To Find Us?
Parents can start by asking their child's surgeon or primary care physician if the child's condition might benefit from involvement of the Pediatric Pain Management Team or pain control. We are always available and willing to help if our service is required. Consultation by the Acute Pain Service can be arranged by calling the Advanced Practice Registered Nurses (APRN) at (203) 785-3611, or by paging the Pain Specialist on-call (203) 370-0076.
1) For Surgical Procedures:
- Prior to Surgery
A member of a team will visit parents and their child to discuss reasonable options based on child's medical history and the type of surgery for keeping him/her comfortable after the operation. Some of the treatments are explained in the above section of "how do we help".
- After Surgery
A member of the Pain Team is available by phone to take care of problems 24 hours a day, seven days a week. Every day we will visit the child to make sure pain is safely and effectively controlled and to answer questions.
2) For any other illnesses, such as cancer pain, sickle cell disease, injury, etc.
If your child is n the hospital with a painful medical condition, the primary care physician/surgeon can call the Pain Service to see the child while hospitalized.
The Pediatric Pain Management Team participates in the educational programs for residents at the Department of Anesthesiology and Pediatrics and interested medical students at Yale University.
The Pediatric Pain Management Team has also developed an annual didactic program on different aspects of pain management in infants and children for pediatric nurses. The program consists of 2 hour didactic material and interactive interventions such a small group discussion weekly for 8 consecutive weeks.
The Pediatric Pain Management Team at Yale-New Haven Children's Hospital maintains active ongoing research programs on new medications well as novel behavioral modalities for treatment of acute and chronic pain in children.