My niece, Zoe, traveled with her mom and dad from Miami to our house last weekend because the 4-year-old was scheduled for craniofacial surgery at a local hospital.
Zoe was born with a couple of problems, including craniosynostosis, a condition in which the sutures of the skull fuse too early and cause the skull to grow abnormally. She needed surgery when she was only 4 days old, again at age 2, and now, at 4.
I knew my sister was concerned about pain management because the neonatal intensive care unit (NICU) had done such a poor job with that aspect when Zoe was just a few days old. After the little baby came out of surgery the first time, the nurse forcibly held a pacifier in her open mouth, explaining that they used “comfort measures” only for infants.
Some comfort: “Basically,” my sister says, “she was gagging the baby and calling it pain control. That was their idea of pain management.”
That was four years ago. Since then, pain management for babies has been getting more attention. In 2006, the American Academy of Pediatrics called for a reduction in painful procedures in the NICU, when possible. But a major new study suggests that pain relief is still a low priority in many neonatal intensive care units, and only 20% of babies get some sort of comfort relief—such as skin-to-skin contact—during potentially painful procedures.
Other pain relievers proven to help babies and children include giving infants a sugar solution before a procedure, using pacifiers, and applying topical anesthetics and sprays (for older children).
Since Zoe’s earlier procedures, my sister had gotten savvier about making sure pain relief methods and medications are used when necessary. Still, it’s been a challenge, and she has found it important to request a clear pain plan, with written orders in Zoe’s chart.
“If at all possible, have those orders written when you leave the operating room,” she says. “You want that in the medical chart—whether it’s Tylenol, or Tylenol with codeine, or something else.”
You should also have a backup plan in case a child is nauseous and vomiting and can’t take a pain pill; ask the surgeon about intravenous or other pain relief delivery methods if necessary.
My sister aims to have a pain plan in place before night falls on surgery day.
“Anesthesia wears off at night,” she says, but nighttime staffers may have less experience with pain management. “Who’s going to dare call [the doctor] on a Friday night or, worse, at 1 a.m.?” she says. “Communicate clearly and loudly, and consistently make sure that you have a clear-cut and organized plan for dealing with pain management.”
Luckily, Zoe came through surgery with flying colors this weekend and felt well enough to play with her cousins and catch a movie.
(PHOTO: FOTOLIA)
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Comments (1)
Good points and so true…especially as many of us are intimidated by the medical process. I was furious when my husband took my daughter to the ER for a broken arm when she was 5 and all she was given was over-the-counter ibuprofin for pain management. My orthopedist immediately prescribed codeine for her pain when we saw him two days later…wish I had made my husband speak up then.