Case of the Month #25: Procedural pain management in children by Dr Eveline Matthews

Published: 28/02/2023


A nine-year-old female, T, sustained third-degree burns to her right chest and right upper limb (13.5% total body surface area) due to an accidental scald injury, requiring debridement and split-thickness skin grafts under general anaesthesia. She is due for her dressing to be changed.  She is anxious and upset about the prospect of pain during this procedure. The plastic surgery team have requested advice on procedural pain management.

The pain team assess T the day before her procedure. Using the Numerical Rating Scale, T reports a pain score of 4/10 at rest and 7/10 when someone touches her arm. She is prescribed regular oral weight-based dosing of paracetamol 15mg/kg QDS and ibuprofen 10mg/kg TDS and 200mcg/kg of oramorph 4 hourly as required, of which she has received 600mcg/kg in the last 24 hours (3 doses). She reports a good effect from the oramorph, although it only works for a few hours. Despite T being engaged with the assessment and answering all questions independently, she appears anxious. T’s parents report that she is very protective of her arm, not wanting to mobilise it or for anyone to touch it. T reports fear that having her dressings changed will be painful. Her mother also appears uneasy and consistently asks T about her pain during the assessment.

  • What patient and parental factors would influence your procedural pain management strategy?
  • Describe methods of procedural pain management in paediatric patients.