Pediatric facilities focus on prevention

If a child never feels pain, there's no need to alleviate it later.
That's the tenet followed by some local pediatric facilities, called "atraumatic" care.
"Everything that is available in the country is being done locally, as far as pain relief is concerned," said Dr. Aly Mageed, director of research at Forum Health Tod Children's Hospital and associate professor of pediatrics at Northeastern Ohio Universities College of Medicine.
Everything -- from simple procedures to surgery -- is done in the most atraumatic way as possible, says Dr. Mageed. Atraumatic care begins with the psychological aspect, and children who need care are welcomed into a friendly, nonintimidating environment.
Child-life specialists, who have had college training to interact with children in an age-appropriate way, are present during procedures to play with the child, sing a song or show some tapes.
"The atraumatic concept is making sure children do not have pain to start with rather than eliminating pain once it develops," Dr. Mageed said.
The concept also includes explaining, in a manner understandable to the child, what is going to be done and what to expect to feel.
Whereas in the past children might have been told, "Close your eyes, don't look -- there -- too bad," Dr. Mageed said that honesty is the best policy. It creates trust in the child, and "children who buy into their treatment and work along with it usually do better than those who resist the treatment," he said.
Parents can help, too. Cinda McDonald, a certified child-life specialist, suggests that parents engage in "medical play" with their child before a procedure. McDonald recommends using a doll or stuffed animal as a patient along with a toy medical kit or actual medical items, such as gloves, gauze, hats and hospital gowns.
"During medical play, parents can begin to explain to their child what needs to be done for the doll or stuffed animal, and then transfer that information to explain that the same thing needs to be done for the child," she writes in's "Ask the Experts."
Dr. Mageed said larger procedures such as surgeries are done under full sedation using a drug that will decrease or eliminate pain and prevent the child from remembering the procedure. After surgery, pain medications tailored to the procedure are used liberally.
Michele Hoffmeister, director of public relations at Salem Community Hospital, said Salem Hospital "acknowledges pain as the 'fifth vital sign,' " and an illustrated pain-rating scale helps children communicate their level of pain to caregivers. Nonverbal cues are also examined, and parents, because of their familiarity with their child's habits, aid in caregivers' assessment of their child's pain, Hoffmeister said.
"It should be emphasized that children are complete human beings from the moment of birth, and their experience of pain is just as intense as that of adults," Dr. Mageed said.

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