Acute Procedural Pain: Paediatric Recommendations and Implementation Toolkits

Last modified by Ann Watkins on 2017/04/21 16:08

  1. Introduction:
    1. About Us
    2. Acknowledgements
  2. Evidence Summary:
  3. Recommendations and Implementation Toolkits


The CAPHC Pain CoP works to improve health outcomes for infants and children by reducing pain experienced during medical procedures, healthcare interventions, and both acute and chronic conditions, disease or disability.  

About Us

The CAPHC Pain Community of Practice (CoP) represents a group of professionals, informally bound to one another through exposure to a common class of challenges and common pursuit of solutions. We have a focus on nurturing new knowledge, stimulating innovation, sharing knowledge and quality improvement. Possible outputs could include leading practices, guidelines, knowledge repositories, technical problem and solution discussions, working papers, and strategies.   The Pain CoP has chosen acute procedural pain as its first area of focus. Results of a  systematic review and other research has resulted in 6 key acute procedural pain management recommendations.  


We would like to acknowledge the following individuals for their leadership and expertise in the development of the Tool Kits:

Paediatric Pain Community of Practice(CoP) Co-Chairs:  

Dr. Samina Ali MDCM, FRCPC(PEM) Assistant Dean (Professionalism) Associate Professor, Pediatrics & Emergency Medicine, Faculty of Medicine & Dentistry, University of Alberta

Ashleigh Townley  BSc., MA.Knowledge Broker, Evidence to Care Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario

Tool Kit leads

Intranasal Fentanyl:  Dr. Melissa Chan, MD, FRCPC Pediatric Emergency Physician, Stollery Children's Hospital, Edmonton, Alberta, Assistant Program Director, General Pediatrics, University of Alberta, Edmonton, Alberta

Pain with Suturing:  Dre. Evelyne Trottier MD, FRCPC Pediatric Emergency Physician, CHU Ste. Justine Universite de Montreal, Montreal, Quebec

Topical Anesthetics (Venipuncture):  Kathy Reid RN,MN,NP Nurse Practitioner Pediatric Chronic Pain Services, Stollery Children’s Hospital Edmonton, Alberta

Oral Sucrose:  Geri St. Jean RN Clinical Nurse Educator, Emergency Department Stollery Children’s Hospital Edmonton, Alberta

Pain Assessment:  Dr. Naveen Poonai MSc MD FRCPC Paediatric Emergency Physician, Children's Hospital, London Health Sciences Center Associate Professor Paediatrics and Internal Medicine, Schulich School of Medicine & Dentistry, Associate Scientist, Child Health Research Institute, Research Director, Division of Paediatric Emergency Medicine

Distraction:  Elana Jackson, MA, CCLS, RECE Certified Child Life Specialist, Emergency Department, McMaster Children’s Hospital, Hamilton Health Sciences 

Non-nutritive sucking, breastfeeding and positioning:  Dr. Denise Harrison (RN, PhD)Associate Professor and Chair in Nursing Care of Children, Youth and Families, University of Ottawa and Children's Hospital of Eastern Ontario (CHEO)

Evidence Summary:

"Children experience pain for multiple reasons in the healthcare setting; short painful procedures to help with diagnosis and treatment are one of the most common. Pain in children is stressful for the child, family and caregivers and effects of under-treatment can be negative and long-lasting. The experience of pain for a child is complex and is usually accompanied by anxiety, fear and behavioural changes. While research into the best management of children’s pain is improving, much work is still needed.

This overview is intended to summarize the systematic reviews of interventions studied to decrease paediatric pain that are currently available in the Cochrane Library. Given their unique physiology, research relevant to the management of newborns in the first month of life is not reviewed here. Four reviews relevant to the management of children’s pain are currently available."
Several approaches can help to decrease the pain experienced by children in the hospital or clinic setting. Topical numbing creams can reduce the pain from needles for tests or treatments. Specifically, amethocaine was found to be more effective with quicker onset of effect than eutectic mixture of local anaesthetics(EMLA), although new topical anaesthetics warrant further study. Oral sucrose can help ease the pain of skin-piercing procedures for neonates and young infants. Behavioural therapies such as distraction and hypnosis are effective, inexpensive and can be used in conjunction with pharmacological analgesics with minimal resource use. Further research is required to study the additive effects of medical and psychological therapies in the treatment of children’s procedural pain, as it stands to reason that combining the therapies might confer further benefit.

~ adapted from: The Cochrane Library and procedural pain in children:an overview of reviews, Sarah Curtis, Aireen Wingert and Samina Ali,  Evid.-Based Child Health 7: 1363–1399 (2012)Published online in Wiley Online Library ( DOI: 10.1002/ebch.1864

Recommendations and Implementation Toolkits

Intervention  Tools, Education, References 
AssessmentWESST_Toolkit_Logo 50.jpg
DistractionWESST_Toolkit_Logo 50.jpg
Intranasal FentanylWESST_Toolkit_Logo 50.jpg
Breastfeeding, Non-nutritive Sucking, & Positioning WESST_Toolkit_Logo 50.jpg
Oral SucroseWESST_Toolkit_Logo 50.jpg
Pain with SuturingWESST_Toolkit_Logo 50.jpg
Topical Anesthetics (Venipuncture)WESST_Toolkit_Logo 50.jpg
Implementation StrategiesWESST_Toolkit_Logo 50.jpg
Created by Lisa Stromquist on 2015/12/01 19:36