Perception Regarding Pain Management in Hospitalised Children: A Cross-Sectional Study among Children and Their Parents

INTRODUCTION

Pain is a disagreeable emotional and sensory experience that is linked to or defined in terms of actual or potential tissue damage. Children of school age can establish their view and how they will express their grief because of their cognitive development.^[1] A child with congenital abnormalities or chronic illnesses can suffer greatly as medical interventions advance. Children who are nearing the end of their lives will be less tolerant of chronic illnesses because they are weary of the interventions used in diagnosis and therapy.^[1]

Children in hospitals are dealing with a variety of problems, including bodily and psychological ones, as well as numerous adaptations, mostly brought on by pain. The physical, social, and psychological functioning of the hospitalised children is impacted or diminished. Their quality of life appears to be impacted by their apparent stress and depression.^[2]

One of the most complicated human stressors is the way that children experience pain, which can have an impact on how they behave and perceive suffering in the future. Research on children’s pain has increased, but studies continue to show that hospitalised children are in excruciating agony.^[3,4]

Even with advancements in medicine, people who have had invasive surgeries or who have long-term medical issues continue to experience pain. For children with acute or chronic illnesses, pain is a multifaceted, common sensation that can vary in intensity and pose a serious health risk.^[5]

For both parents and children, acute or chronic pain is a major issue that has detrimental short- and long-term effects on day-to-day living. Effective pain management requires a precise assessment, and pediatric nurses must understand how children and their parents experience and communicate pain.^[6-9]

Children who are in pain also show higher anxiety levels.^[10] Children who experience chronic pain may continue to be impacted throughout adulthood, especially in the areas of everyday living, work, and health.^[11] It appears that many chronic pain-related conditions are being treated at home instead of in hospitals.^[12]

The primary duty of pediatric nurses is pain management. In pediatric settings, pharmacological and nonpharmacological therapies are commonly used in trauma care. Despite this, how the parents and kids feel about pain management is crucial since it can help kids develop pain tolerance. Children’s perceptions of pain treatment may vary according to their developmental stage and age.

Parents’ perceptions of pain management are also influenced by parental circumstances. According to studies, parents with lower levels of education are generally more afraid of analgesics than parents with greater levels of education.^[13]

When it comes to managing children’s pain, parent aspects are crucial. One of the most important duties of healthcare providers is to assess and manage pain in children who are in hospitals. Children’s pain is managed with a variety of pharmacological and nonpharmacological techniques.^[12] Assessing the parents’ and child’s perceptions of pain treatment while in the hospital is crucial. Their perception may lead to enhanced cooperation, which facilitates patient care.

MATERIAL AND METHODS

RESULTS

The study results showed that the majority of children (58.3%) belonged to the age group of 11-15, the majority (61.1%) were males, 59.3% were studying in classes of 4-7. The majority (70.6%) were diagnosed with fracture, 56.5% of children underwent cannulation as a recent painful procedure, 73.1% had no history of previous hospitalisation. Regarding the demographic details of the parents, the majority (47.2%) belonged to the age group of 36-4, 77.8% were mothers who accompanied children during hospitalisation, 50.9% had completed primary education, 82.4% had a monthly income of < Rs 25,000, 55.6% were residing in urban area, 76.9% belonged to nuclear family, 83.3% did not have any history of hospitalisation, and 84.3% did not have any history of hospitalisation of any family member or they have accompanied during hospitalisation.

As per the data in Table 1, the assessment of total perception scores revealed a high level of satisfaction with pain management practices among both children and their parents. The mean perception score for children was 70.76 ± 7.77 (82.3% of the maximum possible score), while parents reported a significantly higher mean score of 76.75 ± 10.02 (89.2%). Although both groups utilised the full upper range of the scale (reaching a maximum of 90), the higher mean and median scores were seen among parents.

Data in Table 2 provides a comprehensive look at how children navigate the experience of pain within a clinical setting. The most striking finding is the children’s overwhelming desire for autonomy. With 98.2% agreeing that they should be asked about their pain and 96.2% stating that only they can truly understand their own suffering, the data reinforces the clinical principle that the patient is the primary authority on their pain. 88% of children identified play, videos, or mobile phones as effective tools for pain reduction, 92.6% reported feeling more comfortable when caregivers talked to them. The data highlights a hierarchical preference in emotional support. While the presence of the mother is more frequently desired (77.8%) than that of the father (52.8%), the optimal state for the child is dual-parental presence (92.6%). Most (68.6%) of children incorrectly believe that being small means their pain is inherently less or requires less medication, and 85.2% believe they must bear pain alone.

Table 3 presents the perceptions of parents regarding pediatric pain management. The data reveal a strong parental desire for involvement, a high reliance on distraction techniques, and an overall positive view of the healthcare team, alongside some concerning misconceptions about children’s pain thresholds. A significant majority of parents (96.3%) believe they should be actively consulted regarding their child’s pain, with 68.6% asserting that they possess a unique, subjective understanding of their child’s distress. This aligns with a widespread endorsement of distraction techniques, as 92.6% of parents felt capable of managing pain through cognitive refocusing and 91.7% agreed that such methods effectively minimise procedural suffering. While trust in healthcare providers remained high, with 97.2% agreeing that doctors and nurses do their best, a notable 63.9% expressed a perception that their child’s pain is occasionally ignored. Furthermore, the data highlights critical gaps in pediatric health literacy: 66.7% of parents harbour the misconception that younger children experience less pain intensity due to their smaller physical stature, and 83.3% believe that children do not retain long-term memories of painful medical episodes.

The study also showed that there is a highly positive correlation between the perception of children and their parents regarding pain management during hospitalisation. (r = 0.755, p <0.001) Further, the Chi-square test (χ²) was computed to assess the association of perception scores with selected demographic variables. It was seen that there was a significant association of perception scores with a history of hospitalisation among children (χ² = 4.28, p = 0.03) at p <0.05. The study also showed that there is a significant association between perception scores of parents with age (χ² = 17.56, p = 0.001), gender (χ² = 4.22, p = 0.04), education (χ² = 17.56, p = 0.001), family type (χ² = 4.66, p = 0.03), and history of hospitalisation (χ² = 4.63, p = 0.031) at p <0.05.

DISCUSSION

Children’s perceptions of pain management during hospitalisation are multifaceted and influenced by their developmental stage, previous experiences, and the hospital environment. It’s crucial to understand their perspectives to provide effective and child-centered pain relief. Understanding children’s perceptions and utilising appropriate assessment tools are vital for healthcare professionals to provide effective, compassionate, and child-centered pain management during hospitalisation. By addressing their fears, communicating clearly, involving them in their care, and ensuring adequate pain relief, we can improve their overall hospital experience and promote better outcomes.

Parents play a crucial role in the pain management of their hospitalised children. Their perceptions and attitudes significantly influence how they interpret their child’s pain, advocate for their needs, and participate in pain relief strategies. Understanding these parental factors is essential for healthcare professionals to provide effective and family-centered pain management. Parents’ confidence in their ability to comfort their child and utilise non-pharmacological pain management techniques (e.g., distraction, positioning, and emotional support) affects their active participation in care. By understanding and addressing parental perceptions and attitudes, healthcare professionals can build stronger partnerships with families, leading to more effective pain management and improved outcomes for hospitalised children.

The current study was an attempt to obtain the perspective of hospitalised children and parents on pain control in the pediatric unit. Results indicated that children and parents had favourable views of pain management. These findings emphasise the role of communication and comprehensive pain management within a pediatric clinical setting.

In the present study majority (58.3%) of the children were in the age group of 11–15 years, and the majority (71.1%) were males. A similar study was conducted where 27.5% were in the age group of 13–18 years, and the majority (60.6%) were males.^[14]

All the parents in the study had a positive perception of pain management. Majority (68.5%) parents felt that their child’s pain was promptly managed by giving pain medication, 71.3% said, as a parent, they feel that they are able to manage their child’s pain by distracting his/her mind, 62% opined that as a mother she feels that her child is more comfortable when his/her father is beside, 46.3% said that as a parent she feels that her child is getting less dose of pain medication as they are small and their pain is also less, 51.9% reported that as a parent she feels that the nursing interventions are really helpful to reduce child’s pain and 61.6% said that doctors and nurses do their best to keep my child in less pain. Literature gives data on the perception and knowledge of parents regarding pain management.

A study that was conducted among 180 parents of hospitalised children showed that, of the participants, 80.6%, 78.3%, and 71.7% had low-to-moderate scores for knowledge, general attitudes, and use of pain relief strategies, respectively. Moreover, 93.9% of parents had moderate-to-high scores for negative attitudes toward medication, despite 89.5% of them reporting moderate-to-high pain intensities in their children (median proxy-report of pain intensity, 7.0 [3.00]). Multivariate linear stepwise regression showed that parents’ use of pain-relief strategies was related to their general attitudes, knowledge, and sex.^[15]

Another similar study, which studied 102 parents of hospitalised children, showed that about 78% of parents agreed that children always express pain by crying or whining. The majority of parents (75.6%) believe children who are playing are not in pain. Regarding parental attitudes about pain medications, the majority of parents (61%) believe that children should be given pain medication as little as possible because of its side effects. According to about 26.8% of parents, giving children pain medication for pain might teach them to use drugs for other issues. On the other hand, 63.4% of parents say that giving children pain medication as little as possible is the most effective way to manage their pain.^[16]

Yet in another study, the parents of children treated at a multidisciplinary chronic pain clinic reported high satisfaction with treatment team members and with the treatment plan. Parents also reported appreciation of multidisciplinary structure, the high level of expertise of the team members, and the team members’ genuine interest in treating their children. This increase in satisfaction when compared to previous treatment is significant since increases in satisfaction may correlate with a reduction in experiences of chronic pain. Parents reported high satisfaction with interactions with treatment team members and with the treatment plan provided for their children. Parents had an appreciation of multidisciplinary team structure and the high level of expertise of the team members.^[17]

A study on parents of children suffering from chronic pain who were visiting the pain management services showed similar findings that of the current study, but there were distinct differences between parents whose children had received inpatient vs. outpatient pain management treatment. The mechanisms underlying this parental disenchantment are offered, and findings are discussed in light of the wider chronic pain literature. Recommendations for practitioners working in the field of chronic pain management are presented. Conclusions: Parents are important contributors to the success of pain management interventions, but they may find pain management principles counterintuitive and incongruent with their perceived goals and needs.^[18]

A research study explored children’s and parents’ perceptions about the quality of postoperative pain management. It is found that most children experienced moderate to severe pain postoperatively. Children reported being asked about their pain, receiving pain medication, and using nonpharmacological methods of pain relief. A lack of preoperative preparation was evident for some children. Most parents indicated they had received information on their child’s pain management. Generally, participants were satisfied with care.^[19]

CONCLUSION

The evidence demonstrates a positive perspective on pain management among children and their parents, shaped by factors such as prior inpatient admissions, parental education, and family environment. This compelling data highlights the critical need to elevate awareness, implement structured pain management programs, and empower parents to take active roles in managing pediatric pain. To achieve optimal pain control outcomes in pediatric settings, it is essential to strengthen communication among healthcare providers, children, and parents.