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Some Parents Aren't Giving Kids Pain Meds Post-Surgery
Date:9/9/2009

Fears of addiction or underestimation of child's discomfort may be to blame, experts say

WEDNESDAY, Sept. 9 (HealthDay News) -- Twenty-five percent of children aren't getting sufficient pain medication from their parents after common surgical procedures, such as having their tonsils out, a new study finds.

It's not clear at this point what the ramifications of the finding are, or the reasons for it.

In a worst-case scenario, kids who don't get enough medication may not be able to swallow enough water, leading to dehydration and even hospitalization, said Dr. Kenneth Goldschneider, director of the division of pain management at Cincinnati Children's Hospital. He was not involved in the new study.

Another expert, Dr. Patricia Cantwell, professor and chief of pediatric critical care medicine at the University of Miami Miller School of Medicine, agreed that many young patients at her facility end up back in the emergency room as a result of unresolved pain issues.

Under-medication could affect large numbers of children. According to background information in the article, published in the October issue of Pediatrics, upwards of 5 million children in the United States undergo surgery each year, with three-quarters having significant pain afterward.

Tonsillectomy and adenoidectomy (to remove the adenoids) are among the most widely performed procedures in younger people.

As hospital stays get shorter and more procedures are done on an outpatient basis, medication is given more often in the home.

"The typical way in which pain medicine is given, I would say, is the surgical team giving the family a prescription, then you go out the door and fill it," said Cantwell.

The study authors, from the University of California, Irvine and the Children's Hospital of Orange County, Calif., looked at 261 children aged 2 to 12 who had undergone one of these two procedures.

On the first day home, parents reported that 86 percent of their children were experiencing "significant overall pain." Despite that, one in four children received minimal pain medication: zero or one medication dose that day.

Three days after surgery, two-thirds of the children still had significant pain, with 41 percent getting minimal medication, according to the study.

The study authors speculated that under-medication could be due to parents' fears that their child will become addicted to medications such as Tylenol with codeine. Parents might also not realize how much pain their children are in, especially if the child is too young to communicate verbally.

"There's a lot of nervousness on using pain medications," Goldschneider said.

The study also found that parents with less education and with children who were "more reactive" were less likely to give pain medications, while parents with impulsive children were more likely to follow dosing instructions.

Children may also just have trouble swallowing the pills, raising the issue of whether other "delivery systems," such as a patch, might be more useful, Cantwell said.

"We need to educate parents on how to use these medications," Goldschneider said.

A second study in the same issue of the journal found a 70 percent jump in venous thromboembolisms (VTEs) -- blood clots that usually occur in the veins of the legs -- diagnosed at children's hospitals between 2001 and 2007.

In 2007, 58 cases of VTE per 10,000 hospital admissions were recorded, versus 34 per 10,000 in 2001. Almost two-thirds of the children had underlying medical conditions, most commonly cancer, the study found.

The authors, from the University of Pennsylvania and the Children's Hospital of Philadelphia, could not say if the increase was the result of more actual cases or better detection.

More information

There's more on pain and pain management in children at the University of Michigan Health System.



SOURCES: G. Patricia Cantwell, M.D., professor and chief, pediatric critical care medicine, University of Miami Miller School of Medicine; Kenneth Goldschneider, M.D., director, division of pain management, Cincinnati Children's Hospital; October 2009, Pediatrics


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