Helping Kids Cope With Pain

When her 6-month-old son had surgery, lawyer Kathryn Babin argued her way into being allowed to hold him beforehand, but was denied permission to wait for him in the recovery room.

Baby Roger shrieked as an intravenous tube was inserted in his arm and was crying again when she finally was allowed to pick him up later.

"This is crazy," Babin thought. "Isn't there some other way?"

Now nearly 3, Roger has undergone several more medical procedures, but thanks to an innovative program at the Children's Hospital at Dartmouth, both he and his parents are much more relaxed. Instead of being held down and poked with a needle, he played in the hospital's "Comfort Corner," surrounded by ocean-themed murals and colorful kites, then snuggled with his mother while a mask delivered anesthesia.

"This last time, he told me, 'I'm ready to go to sleep now,"' Babin said.

The medical community appears to have heeded the American Academy of Pediatrics' policy statement on childhood pain. Issued in 2001, the policy urges doctors to relieve needless suffering by better anticipating and assessing pain, creating soothing environments in their offices and getting parents more involved.

The Pain Center at Akron Children's Hospital in Ohio uses everything from acupuncture to aromatherapy to soothe children undergoing medical procedures or recovering from surgery. The Children's Hospital and Research Center in Oakland, Calif., has a "Child Life" team dedicated to making hospital stays as comfortable as possible. And at Texas Children's Hospital, relaxation and distraction techniques used by pediatric anesthesiologists include blowing bubbles and letting children ride tricycles to the operating room.

The staff at Dartmouth's Pain-Free Program still sees plenty of tears, but the reason is different: Patients don't want to leave because they're having so much fun. Whether they're performing scary diagnostic tests or repeated treatments, the program's team of specialists uses technology and creativity to reduce the pain and stress of medical procedures.

"The hardest thing to do is relinquish your child to someone else," Babin said. "When they're doing something to them and you can't be there, it's very hard and nerve-racking. ... the way the Pain-Free clinic approaches it is so much more of a relaxed environment."

A generation ago, many health care providers bought into the misconception that children don't feel pain as adults do. But youngsters deserve -- and parents now expect -- better, said Dr. Joe Cravero, an anesthesiologist and medical director of the program.

"There's no reason a kid needs to be crying and screaming in the hospital," he said. "If you or I come in for an appendectomy, we get the anesthesia we need. It comes down to how interested you are in doing this right."

Though many hospitals offer clinics for helping children deal with chronic pain, the Dartmouth program works with all children, even those undergoing routine - but still sometimes frightening - procedures.

The Pain-Free team consults with parents and offers tips to prepare children for their appointments. By the time the children arrive, staff members know how to put them at ease, by asking about their pets by name or having their favorite movies cued on individual DVD players.

One of the first patients when the program started two years ago was a teenage girl with severe developmental disabilities who hadn't received needed medical care - just being approached by a doctor traumatized her. But when the Pain-Free team discovered she loved to dance, it arranged to have music playing when she walked through the door.

"We were all dancing, and she jumped right in," said team member Kristin King, a child life specialist. Moments later, the girl was calm enough to be sedated.

"She has not fallen asleep in my arms since she was a baby," the girl's tearful father told King.

At the Pain-Free Program, stocking up on the latest animated movies is just as important as keeping up with the latest medical advances. Some techniques are complicated, such as figuring the correct dose of fast-acting, short-term anesthesia. Others are as simple as letting children wear their own clothes and sit on their parents' laps during sedation.

Older children who can stay still long enough for 45-minute MRI brain scans are helped by visualizing a trip into outer space: hospital workers count down to blastoff and explain the thumps and bumps they hear as passing planets.

To practice at home, some parents are told to have their child lay underneath a blanket-draped coffee table to get a feel for the machine's enclosed space.

On a recent Tuesday, 3-year-old Izabella Gyurcsan was one of half a dozen children scheduled for MRIs. Around 9:30 a.m., she was led to a cupboard of toys and then offered her choice of sedation mask - pink, purple or red. A few minutes later, she was wheeled down to the MRI room, her tiny socks peeking out from under the sheet. By 10:45, she was awake, nestled against a stack of pillows, clutching a stuffed animal and watching "Finding Nemo."

Her parents drove two hours from Milton for the test, which they hoped would rule out any serious problem connected to their daughter's hand tremors. They worried about whether Izabella could handle the test - she woke up scared in the middle of the night and then threw up on the way to the hospital.

Paula Gyurcsan said she couldn't bear to watch Izabella get loaded into the imposing MRI machine, but the toddler seemed unfazed by the experience.

"It was fun for her," she said.

Dr. Joseph Hagan, a Vermont pediatrician who co-wrote the policy on childhood pain, said things have improved so much that pain has become "the fifth vital sign."

"When I was in medical school you always presented the patient's temperature, blood pressure, pulse and respiration rate - you didn't say they were in distress or no distress," he said. "That was something we knew but we didn't approach it as directly, and we should."

In the past, too many doctors assumed parents would treat their children's pain at home.

"We probably thought that kind of nurturing was the role of moms or dads," Hagan said. "But we're now taking responsibility for the fact we need to help them do that properly."

The Pain-Free Program isn't curing any children, but it is taking away their suffering, Cravero said.

Parents eventually come to terms with what the diagnosis is. What they can never come to terms with is watching their child suffer repeatedly in a hospital," he said. "We can stop that part of it."

By Holly Ramer