Pain with Suturing Toolkit

Last modified by Lisa Stromquist on 2017/09/15 15:53

Welcome to the toolkit about how pain and anxiety with suturing can be minimized or avoided for children. Current best evidence supports the use of these techniques for children aged 0 to 18 years.


The importance of providing optimal pain treatment has been echoed by several national and international policy statements. In addition to the mandate by the World Health Organization (WHO) that adequate pain treatment should be a fundamental human right, the American Academy of Pediatrics (AAP) recently reaffirmed its position that adequate analgesia be provided for children.Moreover, untreated pain in childhood has been reported to lead to long-term negative outcomes such as anxiety, hyperesthesia, and needle phobia.” (Poonai et al., CJEM, 2016). 

Physical and psychological interventions can also be used in conjunction with pharmacological pain management. Links to recommendations and resources for these techniques can be found through the main webpage for the CAPHC acute procedural pain toolboxes. 

The purpose of this toolkit is to make the adoption of pain-minimizing techniques while suturing children easier in your clinical practice. The contents, which have been provided by your clinical colleagues around the country, can help you move these interventions into your regular practice, help create a policy for use their use in your organization, support clinical education in pain minimizing techniques for suturing, and provide clinical resources to make these techniques easier to use. Use as many of the resources as you need and modify them to fit your organizational context. 


In this kit you’ll find:

  • Clinical resourcesincluding a quick tip sheet to make pain minimizing techniques for suturing children more accessible to you and your patients. 
  • An example of hospital policy for the use of topical anesthetic gel for the treatment of laceration-related pain. This policy can be used to create your own organizational policy based on your needs and context.
  • Clinical PowerPoint presentations (in both English and French) developed by your clinical colleagues to support education about using pain minimizing techniques when suturing children. These slides can be modified and delivered for your needs and context
  • Background articles outlining the current best research evidence to support using various techniques (including topical anesthetic gel, dermal adhesive glues, and buffered anesthetics)

Examples of policies are provided for reference purposes, only. We encourage all users of the toolbox who wish to adopt a similar policy at their institution to review, adapt, and modify the examples, as needed. The providers of these examples do not endorse their use outside of the institution for which it was originally created.

If you have any comments, questions or additions for the box, please contact CAPHC at 

Thank you for supporting the CAPHC Pain Community of Practice’s mission to improve health outcomes for infants and children by reducing pain experienced during medical procedures, healthcare interventions and chronic conditions, disease or disability. 

Clinical ResourcesSuturing Fact Sheet
TREKK Bottom Line Recommendations: Procedural Pain (Translating Emergency Knowledge for Kids
Hospital PolicyExample of Application of LET topical Gel to Pediatric Patients - AHS
Clinical PowerPointComfort in pediatric minor procedures Pain free laceration repair for Esteban and Elsa - PowerPoint
Comfort in pediatric minor procedures: Pain free laceration repair for Estaban and Elsa - PDF

Confort lors des procédures mineures pédiatriques: Les Lacérations d’Esteban et d’Elsa - PowerPoint
Confort lors des procédures mineures pédiatriques: Les Lacérations d’Esteban et d’Elsa - PDF
 VideoDeveloper: Christine Chambers, PhD
From: Centre for Pediatric Pain Research IWK Health Centre and Dalhousie University
Title and video link: It Doesn’t Have to Hurt: Strategies for Helping Children with Shots and Needles
itle and video link: Ça n’a pas besoin de faire mal – Conseils pour aider les enfants à recevoir une piqûre
Background Documents List of background articles PDF

Tissue adhesives for traumatic lacerations in children and adults.Farion K, Osmond MH, Hartling L, Russell K, Klassen T, Crumley E, Wiebe N.Cochrane Database Syst Rev. 2002;(3):CD003326. Review.PMID: 12137689

Tissue adhesives for traumatic lacerations: a systematic review of randomized controlled trials.Farion KJ, Osmond MH, Hartling L, Russell KF, Klassen TP, Crumley E, Wiebe N.Acad Emerg Med. 2003 Feb;10(2):110-8. Review.PMID: 12574007

Adjusting the pH of lidocaine for reducing pain on injection.Cepeda MS, Tzortzopoulou A, Thackrey M, Hudcova J, Arora Gandhi P, Schumann R.Cochrane Database Syst Rev. 2010 Dec 8;(12):CD006581. doi: 10.1002/14651858.CD006581.pub2. Review. Update in: Cochrane Database Syst Rev. 2015;5:CD006581.PMID: 21154371

Efficacy of pain control with topical lidocaine-epinephrine-tetracaine during laceration repair with tissue adhesive in children: a randomized controlled trial.Harman S, Zemek R, Duncan MJ, Ying Y, Petrcich W.CMAJ. 2013 Sep 17;185(13):E629-34. doi: 10.1503/cmaj.130269. Epub 2013 Jul 29.PMID: 23897942

Relief of pain and anxiety in pediatric patients in emergency medical systems.Fein JA, Zempsky WT, Cravero JP; Committee on Pediatric Emergency Medicine and Section on Anesthesiology and Pain Medicine; American Academy of Pediatrics.Pediatrics. 2012 Nov;130(5):e1391-405. doi: 10.1542/peds.2012-2536. Epub 2012 Oct 29.PMID:23109683

Acute wound management: revisiting the approach to assessment, irrigation, and closure considerations.Nicks BA, Ayello EA, Woo K, Nitzki-George D, Sibbald RG.Int J Emerg Med. 2010 Aug 27;3(4):399-407. doi: 10.1007/s12245-010-0217-5.PMID: 21373312 
Created by Lisa Stromquist on 2015/12/23 21:05