In our series designed to help pharmacists train their OTC teams, we cover a range of healthcare topics that are important for patient consultations and product recommendations at the OTC counter. Thanks to the team at totalhealth and Haven Pharmacies for this month’s topic: Pain in Children.
What is a ‘child’?
For the purpose of this article, a child refers to anyone aged 12 or under. An infant is a child from birth to the end of the first year. While the ingredients of pain relief products for children are similar to those for adults, children react to medicines in very different ways. It is therefore crucial that medicines suitable for children are recommended and that clear dosage instructions are communicated according to the age of the child. Gather all necessary information by following WWHAM protocol at all times.
Types of Pain in Children
Pain in children should always be treated. If it is not, it can cause anxiety or emotional distress. Some of the most common types of pain that we will be asked about in the pharmacy are:
• Teething
• Colic
• Dental
• Growing/Joint Pain
• Injury
• Cuts and Scrapes
• Sunburn
• Sore Throat
• Earache
• Headache
• Stomach-ache
• Post-Immunisation Pain.Assessing Pain in Children
Every child will experience pain differently and assessment of pain may be difficult, especially in infants and children who have difficulty describing pain. Where children can
communicate, always aim to identify the source of the pain, e.g., tooth, knee, ear. Non-verbal indications that a child is in pain may include:
• Changes in crying pattern or behaviour – prolonged or more intense
• Squeezing eyes shut or grimacing
• Visible signs (flushed cheeks, red gums, dribbling, bruising, swelling)
• Withdrawal or lack of usual responsiveness
• Holding or rubbing a particular part of the body
• Irritability or acting out.
It may also be difficult to ascertain the severity of pain, even if the source is clear. The Wong-Baker Face Pain Scale is a helpful tool in discovering how much pain the child is experiencing, using smiley faces to help the child point to how bad they are feeling.
OTC Pain Relief for Children
Products containing paracetamol or ibuprofen are the only pain-killers suitable to recommend for children’s pain in the pharmacy. They are both effective and generally safe, and available in different forms for children.
Paracetamol is suitable for babies and children from 2 months of age and who weigh at least 4kg. Use in children under that weight or age, or who are premature, must be under doctor supervision. Paracetamol is available in suppository, liquid and meltable tablet form. There are different dosage guidelines and products for children aged from 2 months and for those aged 6 years and older. Parents should be reminded of the importance of reducing the risk of paracetamol by ensuring only one paracetamol-containing product is used at any time.
Ibuprofen is suitable for use in children aged 3 months and older. It is available in liquid, chewable tablet and suppository form. Again, dosage guidelines and products vary for children aged from 3 months, those aged 6 and over, and those aged 7 and over. Ibuprofen should be used with caution in children with asthma.
Concurrent use of paracetamol and ibuprofen may be suitable for more severe pain. It is helpful to remember the importance of clear explanation of dosages to parents, who may be experiencing stress or upset due to their child’s pain. Try to explain directions as if explaining to a family member, making sure they understand the instructions thoroughly.
Other products and advice for pain relief
Depending on the type of pain, there are additional medicated and homeopathic products which may relieve symptoms, including colic drops, teething gels, and teething granules.
Additional relief may be gained from cooling teething rings, applying cold compress to painful body parts, applying heat or giving a warm bath, and best of all, ensuring that children in pain are comforted and reassured.
Referral to Pharmacist
Using WWHAM questions, refer to the pharmacist if the child:
• Is under 2 months or under 4kg
• Has a head injury
• Is in severe distress
• Is experiencing persistent pain with no known cause
• Has unexplained swelling, bruising, or bleeding
• Has lost their appetite or is losing weight
• Has persistent vomiting
• Has had no relief from OTC pain products.
Consider:
Reflect on the following in assessing your own knowledge and your team’s training:
• Is your knowledge up to date on children’s pain and treatments?
• Do you know what patients should be referred to a GP?
• Does the team follow WWHAM protocol at all times?
• Are all staff confident and comfortable explaining the varying instructions and dosages for all children’s pain products?
• Are all staff aware of age limits on aspirin use in children?
• Are product instructions explained in easyto-understand language?
Key Points:
Ensure your team understands and is confident explaining the following:
• The various types of pain that may be experienced by children
• The products available and the dosages and ages for each one
• The additional products that may further relieve symptoms
• The warnings and precautions associated with all products
• The additional advice that should be given for non-drug relief of pain
• WWHAM protocol and which patients must be referred to the pharmacist
• All patient conversations are conducted with discretion, sensitivity, and appropriate tone.
Actions:
Your action plan for Children’s Pain should include the following:
• Your own knowledge is up to date, on types of pain, treatments, and GP referral
• You are up to date with post-immunisation guidelines on pain-relief products
• The appropriate training has been provided to all team members, and assessed, for example through observation or role play
• You have the appropriate range of products available
• WWHAM Protocol forms the basis of all interactions at the OTC counter
• Update your CPD record.
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