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opinion: why children’s pain must be treated as a patient safety incident
when a child’s pain is ignored or inadequately treated, it can lead to measurable, preventable harm
3 minute read
children in canadian hospitals undergo an average of six painful procedures per day, or fourteen procedures for babies in neonatal intensive care.
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when we bring our children to the hospital, we expect that they will receive the best available care. we believe that their pain will be seen and addressed. we hope they will come home feeling better. but too often, the place that’s meant to heal them ends up causing harm.
research has shown that pain in children is more than a symptom. it is a safety issue. when a child’s pain is ignored or inadequately treated, it can lead to measurable, preventable harm.
no one understands the depth of harm more than jill lawson, whose premature baby underwent open-heart surgery without the use of anesthetics. paralyzed with pavulon and unable to cry, baby jeffrey was fully awake and conscious as doctors cut open his neck, back and chest, pried apart his ribs and tied off an artery near his heart. the procedure took ninety minutes. jeffrey died five weeks later.
this horrific example is not medieval history. it took place in a world-class u.s. children’s hospital in 1985. many of us born around that time are now parents ourselves. and while advances have been made, not enough is being done to protect our kids from unsafe care experiences that lead to lifelong harm.
we now know that untreated or poorly managed pain can cause delayed healing, heightened pain sensitivity, neurodevelopmental issues, trauma, healthcare avoidance and chronic pain syndromes. childhood pain is directly linked to depression, anxiety, suicidality and harmful substance use. yet despite the evidence, children’s pain remains largely ignored.
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children in canadian hospitals undergo an average of six painful procedures per day, or fourteen procedures for babies in neonatal intensive care. two thirds of those procedures are performed without any pain management. that omission of care is a silent safety failure for kids.
access to quality pain management can also differ across care settings. for example, nurses at children’s hospitals can apply over-the-counter numbing creams before performing procedures like blood draws or iv insertions. but in many community hospitals, those same creams require a physician’s prescription. as a mother, it’s faster for me to buy the cream at the local drug store than wait for an unnecessary script. this equity gap is a small illustration of how healthcare is failing kids in pain. but there are more serious examples, too.
around twenty-eight per cent of children who undergo a major surgery develop chronic pain. let that statistic sink in. one in four kids who come off the operating table will leave the hospital with a lasting, debilitating condition because their pain was not properly managed. this is a preventable outcome that should be tracked as a patient safety incident.
we have the evidence, the tools and the techniques to reduce children’s pain and improve their care experiences. when we choose not to use them, we aren’t just failing to treat pain, we are causing pain.
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canada is poised to lead the world in children’s pain management. in a collaborative effort between the health standards organization (hso) and solutions for kids in pain (skip), canada was the first country to publish a national pediatric pain management health standard, setting clear criteria to make children’s pain a priority in canadian hospitals. among its most transformative benchmarks is the classification of unmanaged, delayed or untreated pain as a patient safety incident.
a patient safety incident occurs when care is provided or omitted in a way that could lead to, or has already caused, unnecessary harm. omitting topical analgesics before a child’s vaccination or iv insertion, or delaying appropriate pain medication after a major operation, are just two common examples of poorly managed pain that qualify as patient safety incidents.
as we reflect this canadian patient safety week, and look ahead to national pain awareness week, we need to do better for canada’s kids by urgently addressing the harm caused by poor pain management practices. hospitals already track falls, medication errors and equipment failures as safety incidents. it’s time to add children’s pain to that list. every child deserves care that sees their pain, treats it seriously, and prioritizes their comfort as a measure of safety. anything less is a broken promise to the children and families who trust canadian hospitals to make them feel better.
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dr. kathryn birnie is a clinical psychologist and associate professor in the department of anesthesiology, perioperative and pain medicine at the university of calgary, and the associate scientific director of solutions for kids in pain (skip).
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