What do I need to know about medical procedures and pain?
Procedures are invasive medical treatments. They may be mildly invasive—like stitches, shots, and blood draws, or they may be more invasive—like lumbar punctures (spinal taps) or surgeries. Medical procedures can cause kids emotional distress and varying degrees of pain. Information about procedure pain in children is growing as there is increased interest and awareness among health care providers [1] . It is important to think about pain control before the procedure begins, not after your child has become increasingly fearful and difficult to calm.

How does anxiety make pain worse?
Research shows that managing both the anxiety of anticipating a procedure as well as the pain caused by the procedure itself is the best way to keep pain under control.

The simplest thing you can do to help your child keep anxiety at bay is to stay with them.  Your presence alone can actually reduce the amount of pain your child experiences by reducing their anxiety. One study found that children who were prepared for a blood draw had less distress before and during the procedure than those children who were unprepared [2]. This study used simple preparation including a numbing medicine (EMLA cream) applied by parents, followed by children reading a story with their parents about both the numbing medicine and blood draws.

How do I keep my child from becoming overly anxious about medical procedures?
You can play an important role in decreasing your child's anxiety and comforting your child before, during and after a painful procedure [3]. Often a parent can hold a child in a comfort position during the procedure.In fact, when kids are anxious before a surgery, they are more likely to have problems after the operation [4].

• Read Preparing Your Child for Procedures for quick, targeted suggestions on how to help kids prepare for painful tests or treatments.

Here are more tools to help you and your child lower anxiety levels by preparing for procedures, surgeries and hospital stays:

• Preparing your Child for the Hospital and Surgery
• Preparing for Surgery and Other Procedures offers helpful activities parents can do with their child during a stressful procedure—for infants through teens.
• For kids: Going to the Hospital
• For kids: What Happens in the Operating Room?
• For kids:  WORD!  Anesthesia
• For teens: What’s It Like to Stay in the Hospital?
• For teens: What’s It Like to Have Surgery?
• Resource list on going to the hospital includes books for kids of all ages and a recommended book for parents.
• MEDLINEplus has an illustrated online medical encyclopedia that allows you look up all kinds of procedures, so you and your child will know what to expect.
• St. Jude Children’s Research Hospital has information on several procedures, tests, and on sedation.

What kinds of pain control are available for medical procedure pain?
Your child’s doctors and nurses know the distress and pain that procedures can cause. That is why they take action to prevent pain and keep kids comfortable. These actions can be as simple as distraction and relaxation or can involve medication, like conscious sedation or local, regional or general anesthesia.

When medications are used to manage pain your child’s health care providers will weigh the risks and benefits to your child. For example, medications that provide deep sedation require careful monitoring and support, because they slow breathing significantly [2] . This risk may be greater than the pain control needed for a minor procedure like a blood draw.

Will my child become addicted to pain medication?

If your child is in the hospital for a longer time, you may worry about them becoming addicted to the pain medicine.  Don't worry: your child will not become addicted. If your child needs pain medications and sedatives for a long time, physical dependence may occur.  Physical dependence is not the same as addiction—addiction is a psychological problem.  Because of this physical dependence, medication doses will be decreased slowly to prevent possible withdrawal symptoms that can occur if the medicine is stopped suddenly. Nurses and doctors will watch your child carefully for signs of medication withdrawal. Comfort measures as discussed below can be helpful when doses of pain and sedation medications are being decreased.

What about non-medication strategies for treating and preventing pain?
It works best to use a combination of interventions—both psychological/behavioral and medication for procedure pain. [3] [5]

• Find out more about how self-hypnosis can help.
• How to use relaxation techniques, including relaxed breathing, progressive muscle relaxation and autogenic relaxation.
• YourChild: Pain and Your Child and Teen and YourChild:  Pain and Your Infant go in-depth on lots of other non-drug pain control techniques.

What about vaccine shots?
Children receive a series of shots in childhood to vaccinate them against dangerous childhood illnesses. The shots usually hurt only briefly, but can be very anxiety provoking for both kids and parents. Toddlers benefit from having their parents nearby, providing comforting touch and distraction with familiar toys, music, or songs. In preschoolers, deep breathing or blowing bubbles reduces both the pain and anxiety they experience with these routine shots. [6]

• This online brochure about preparing for immunizations provides resources so you can help your preschool or school-aged child decrease their pain and anxiety.
• How to make immunizations easier—by reducing your child's fear.

Where can I find out more about pain control measures and medical procedures?
Here are some good resources:

• Parents' role in easing the pain of medical procedures.
• Medicines for pain relief—includes dosage instructions for acetaminophen (Tylenol) and ibuprofen (Motrin or Advil).
• Reducing Pain from Surgery:  What a Parent Should Know
• Postoperative Pain Control
• EMLA cream and lidocaine cream are useful medications for many medical procedures. They are local, topical anesthetic creams that are applied 30 to 90 minutes before a needle stick, shot, blood draw, spinal tap, starting an IV or other invasive procedure. The cream numbs the area. Parents can apply it at home before going in for the procedure.  It can also be used in hospital. One study found that the EMLA patch reduced pain from shots in four- to six-year-old kids [7].

Where can I find related topics on YourChild?
YourChild: Pain and Your Child and Teen will teach you all the basics about pain, and discusses pain medicine and goes in-depth on lots of non-drug pain control techniques.
YourChild: Pain and Your Infant discusses how to help your baby cope with the pain of medical procedures, circumcision, and teething.
YourChild: Hypnotherapy
YourChild: Biofeedback
YourChild: Chronic Conditions
YourChild: Siblings of Kids with Special Needs

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References

Written and compiled by Kyla Boyse, R.N.  Reviewed by faculty and staff at the University of Michigan

January 2007

U-M Health System Related Sites:
Department of Psychiatry
U-M Pediatrics

Our editorial policy
The information and links we provide are reviewed by University of Michigan developmental and behavioral pediatricians and child psychologists who are experts in child behavioral health. In choosing the links we provide, we use strict criteria to ensure that the information is accurate, and the source is reputable. As much as possible, we focus on information that is based on research. In areas where there is inadequate research, we include information compatible with prevailing expert opinion.

This website is updated regularly, but because of the dynamic nature of the Internet, we cannot be responsible for misinformation that may be accessed through the links provided. As always, this website is not a tool for self-diagnosis, and is not a substitute for professional care.

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