Identifying and managing pain in children is a vital role for pharmacists.
Commonly encountered paediatric pain can be categorised as pain associated with infection (e.g. otitis media, pharyngitis and viral infections of the mouth), normative pains (e.g. colic, growing pains), musculoskeletal injury (e.g. sprains) and pain associated with procedures (e.g. injections, laceration repair). Both pharmacological and non-pharmacological interventions can help relieve and decrease paediatric pain. Among the pharmacological interventions, some are accessible over-the-counter (OTC), while others require consultation by a doctor. Pain and fever in children is most commonly treated with OTC antipyretic and analgesic drugs ibuprofen or paracetamol, which are effective and well tolerated in the reduction of paediatric fever and pain.
There has been significant debate about which of these are safer and more effective to use in children. In general, ibuprofen and paracetamol are effective and well tolerated when used at their recommended doses. However, there are a number of situations where one may be more appropriate than the other. Factors to consider when choosing an appropriate paediatric analgesic and antipyretic include:
- the relative efficacy and safety profiles
- the type of pain being treated
- concomitant medicines use
- guideline recommendations.
Inflammation and children’s pain
Ibuprofen is indicated as a paediatric antipyretic and analgesic, with efficacy for teething, toothache, earache, sore throat, headache, strains and sprains, colds and flu, and body aches. Due to ibuprofen’s mode of action as an NSAID, it also possesses anti-inflammatory properties, which may be more appropriate than a non-NSAID for types of pain that often co-exist with inflammation. For example:
- almost all dental pain involves inflammation
- common colds and flu are associated with inflammation resulting in sore throat, headache and muscle pains (among other symptoms)
- inflammation is the body’s first response to acute muscle injury, such as sprains and strains.
It is therefore also important to consider the type and origin of the child’s pain when making a recommendation on the most appropriate analgesic.
This is an excerpt from an Education Extra CPD article previously published in Australian Pharmacist. To learn more about managing children’s pain and fever, and to gain CPD points, read the full article (with all references) at: https://learn.psa.org.au/pluginfile.php/260673/mod_resource/content/18/JUN17-AP-EE.pdf