Pediatric medicine – pain in children is often not taken seriously enough – knowledge


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One in four children suffers from chronic pain. Often not treated or diagnosed. Because experts fail to understand the suffering of little ones.

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Pain in children was not an issue for a long time. Until the late 1980s, babies were operated on without anesthesia. It was believed that newborns could not feel pain. Her nerves are not yet sufficiently developed.

Screaming, crying or defensive movements are just reflexes. Children were therefore not given painkillers, but rather drugs that paralyzed their muscles.

Jeffrey Lawson’s death – a turning point in history


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In February 1985, Jill Lawson suddenly felt contractions. Three months too early. Her son Jeffrey weighed almost 700 grams and was sick. Two weeks after birth, he underwent open-heart surgery at a children’s hospital in Washington. His upper body was cut open, the ribs spread, tissue and blood vessels separated and then sewn back together.

Jeffrey felt every cut and every stitch. He had only received a paralyzing substance, no anesthesia or painkillers. He died five weeks later. It was only shortly before his death that Jill Lawson learned from the anesthesiologist that she had not induced anesthesia. It didn’t even occur to her to anesthetize Jeffrey. Because it has never been proven that babies feel pain.

So Jeffrey was not an isolated case. Jill Lawson went along her story to the New York Times. Jeffrey’s death was a turning point in the history of medicine. A study at the time found that one in three babies operated on without anesthesia died. The stress on the entire organism increased the inflammation levels of the affected children and thus led to their death. While the mortality of the anesthetized children was zero. Two years after Jeffrey’s death, the American Pediatric Society declared surgery on newborns without anesthesia unethical.

Then parents began to fight back – with the support of researchers who no longer wanted to ignore the little ones’ pain. Since then, knowledge about the pain of little ones has made great leaps.

The rocky road from research to practice

The simplest remedies often help to relieve the pain. Premature babies have to endure a lot of procedures every day, such as blood samples. Skin contact or sucking on a water-sugar solution can have a calming effect. But unfortunately this knowledge is not always implemented in all hospitals, says pain researcher Helen Koechlin from the Zurich Children’s Hospital: “The most common argument is that the measures are too complex and there is not enough time or staff for them.”

Helen Koechlin

psychologist


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Helen Koechlin specializes in child and adolescent health psychology. She works as a pain researcher at the Zurich Children’s Hospital, at the University of Zurich and as a private lecturer at the University of Basel. Her research is supported by the Swiss National Science Foundation.

Image: SNF

Early pain shapes life

Pain and pain relief are not yet a priority in many people’s minds, even though such early pain experiences can shape an entire life. “Constant and recurring pain makes the nervous system more sensitive to stimuli, the pain threshold drops and the risk of later chronic pain is drastically increased,” says Koechlin. It is important to interrupt this dynamic as early as possible. Also because physical pain is often linked to psychological pain such as anxiety or depression and in youth also with increased suicidality.

Physical and emotional pain are connected


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Chronic pain is often accompanied by anxiety and depression. The pain cycle is very closely related to the emotional cycles. It is not always clear whether physical pain precedes psychological pain. Recent studies show that anxiety and depression often arise first and later the pain comes. But it can also be the other way around, that the pain is there first and then the psychological symptoms.

The blind spot of pediatricians

The knowledge of the small but very active research community has hardly yet reached outpatient pediatric practices. A survey by Helen Koechlin showed Pediatricians underestimate the proportion of their patients who are in massive pain.

They said that about three percent of their young patients had chronic pain. In fact, it is almost ten times more. “That was frightening,” says pain researcher Helen Koechlin. 80 percent of respondents reported feeling unsafe dealing with chronic pain in children.

The long way to the pain consultation

Chronic pain such as the classic stomach ache, but also headaches and the bone and muscle pain typical of young people are often dismissed as purely psychological. Therefore, it takes on average two years until a child with chronic pain ends up in a specialized pain clinic.

That is late. At this point, the pain has become embedded not only in the brain, but also in everyday life. The child has missed school material, lost friendships and given up hobbies.

Pain consultations for children and young people


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Chronic pain in children doesn’t just go away. You need tailor-made treatment. The specialists approach pain from a biopsychosocial perspective – i.e. from different disciplines. For example, a child with back pain receives physical therapy and, if necessary and useful, medication. In accompanying psychotherapy The child learns strategies on how to best deal with pain in everyday life.

Pain education is also included. The child learns more about their own pain and realizes that chronic pain – unlike acute pain after an operation or a broken bone – does not necessarily have to do with tissue damage.

The child is allowed to play or move, even if it hurts. The body is not damaged. In German-speaking Switzerland, four hospitals offer special consultation hours for children and young people:

Pain research does not yet understand well how acute pain becomes chronic pain. How chronic pain is best treated, however, does exist. But studies show that it takes an average of seventeen years for research results to reach everyday clinical practice. “That’s far too long,” says pain researcher Helen Koechlin: “Seventeen years, that’s as long as an entire childhood.”

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