Cover

Suffer The Little Children

Pain specialists have Only recently begun to understand how much pain infants can feel

Susan Oh August 16 1999
Cover

Suffer The Little Children

Pain specialists have Only recently begun to understand how much pain infants can feel

Susan Oh August 16 1999

Suffer The Little Children

Pain specialists have Only recently begun to understand how much pain infants can feel

It is the early 1980s and, according to the accepted practice of the day, a baby is undergoing open-heart surgery— without painkillers. It is the same with all medical procedures: the profession believes, erroneously, that babies’ nervous systems are not developed enough to register pain and, even if they can, the episode will quickly be forgotten. Instead of painkillers, doctors use strong paralytic drugs to stop voluntary muscle movement. The tiny patients can feel what is happening, but they are incapable of reacting. At the same time, emerging from infancy does not make things much better. Because risks associated with analgesics are considered too high for toddlers and young children, few receive enough medication—if any—to mask their pain.

Fast-forward just a decade and a half to the present, and much has changed. “Now we know better,” says Celeste Johnston, a nursing professor at McGill University who has worked in pain treatment for infants and children for the past 15 years. She watches as Anäis, a 31-week-old premature baby weighing just 1.2 kg, flails her right arm freely, but carefully keeps her left one close to her body—it has had an intravenous needle in it since her birth. “You can see the reaction to pain in babies as young as 26 weeks,” says Johnston. It is an observation backed by recent research demonstrating what many nonprofessionals would think was obvious—that infants are capable of experiencing pain. Further, it is now understood that painkillers assist the process of healing, rather than interfering with it as had been thought.

The new approach has had profound effects. Nurses at Montreal’s SMBD Jewish General Hospital treat Anäis with mild analgesia even for the minor but frequent pokes and prods that are part of her daily treatment. “The long-term consequences of repeatedly having painful things done to them is that infants’ ability to express pain becomes less,” says Johnston. While it is still understood that painkillers carry some risk, it is also recognized that prolonged pain poses serious health and psychological concerns. Babies can become insensitive to pain, or grow into fearful children

Johnston with who avoid treatment by not telling Anäis: ‘Now we anyone when they are in pain. know better; ’ she It has been 12 years since a landmark

says of formerly British study debunked the myth that

accepted practices babies don’t feel pain. In the past five to

10 years, giving painkillers to babies and toddlers has become standard practice. As doctors continue to unravel the complexities of measuring and treating pediatric pain, they are refining their approach to their young patients. In conjunction with medication, specialists are using techniques ranging from having children focus on and assist in their treatment, to distracting them with play, TV or imaginative thoughts.

Another recent development is a concerted approach to the problem. “The trend is to use a combination of treatments by a multidisciplinary team,” says Halifax pediatric psychologist Dr. Patrick McGrath. “You need to have all those different skills because pain is a complex issue.” Unfortunately, those teams—composed of anesthetists, psychologists, nurses and physiotherapists—are rare outside Canada’s largest centres. “It depends so much on which hospital you go to in terms of how sympathetic they are,” says Denise Sveinson, a registered nurse from Innisfail, Alta. She knows this from seeking treatment for her two sons, Landon, 15, and Joel, 13, both born with a hereditary condition, dislocating patella, that makes them prone to spontaneous dislocation of their kneecaps and subject to frequent surgery. “The good hospitals and doctors actually listen to the kids,” she says, “but not all of them do.”

Doctors confirm that there is an increasing willingness to listen to the patient. “It’s the practice of measuring pain,” says Allen Finley, an anesthetist at Halifax’s IWK Grace Health Centre and co-editor with McGrath of two books on pediatric pain. “Probably the best way is to ask the patient.” And the parents, who knew all along when—and how much— their children were suffering.

Susan Oh