Combining these two methods is one effective strategy in mitigating pain in children (Cohen). Additional strategies that involve both the patient and family are evident, particularly when dealing with chronic pain. Children sometimes internalize pain, believing that they must restrict their activity, particularly when parents worry and hesitate to allow them to be active. Parents see play as worsening of the situation or a relapse, contributing to an overprotectivness. This, in turn, reflects on the self-image of the child. In any case, experts recommend that parents not react in a negative way -- either by thinking the child is faking pain or becoming so overprotective that the child is a virtual prisoner. Instead, the psychological strategy should be to set realistic and evolving strategies so that there is not a continue pessimism regarding future health outcomes. This, for adolescents, is critical since there is also a self-esteem issue that goes along with the time period. An additional Strategy for this type of Chronic Pain Reduction is Cognitive Behavior Therapy, which targets both self and family perceptions and finds win-win situations for all sides (over time) (Christie & Wilson, 2005).

One basic strategy that is effective for older pediatric patients as well as some adults is the Wong-Baker Faces Pain Rating Scale. Children need to be cognitively aware enough to understand that the faces are in order, that they mean something, and have a logistical and chrological value. While there are other tools and strategies, the clear message is that the parents and the nursing staff need to participate as a team effort in managing the child's pain. The more comfortable the child can be, the more likely that the healing process will be accellerated (Pediatric Pain Management).

Process Map

Conclusions

In the contemporary medical field, there is no need for any patient to experience unnecessary pain once under treatment. Certainly, there is the need for more research on the manner in which certain drugs interact with younger people, and certainly treatment of children with pain will improve as pain management education evolves. Pain has been defined in the literature as whatever the person says it is, since it is so difficult to establish an actual definition of pain, rather than a scale mode. This, of course, places preverbal children at the greatest risk for inconsistent and often arbitrary measures pain.

There are, of course, a number of interventions that can take place when dealing with pain in children -- from intermittent, to chronic pain, and all levels in between. One of the key elements, however, is observation of behavior and the ability for the advocate nurse to help in the decision-making process that will allow the more effective treatment. Because opiates and other analgesics can be dangerous and, at times, unpredictable for children, it is incumbent upon the neonatal nurse to try other measures to comfort and alleviate pain in children. Often, pain is perceived in children because they do not understand it. and, despite more and more research evidence that shows psychological interventions to be effective, there are indeed challenges for neonatal and child medical professionals. How many children, for instance, can be reached through these interventions in a busy hospital ward? How can the family be taught to help intervene...

In any case, knowing that there are assessment tools and interventions available, no child should experience unnecessary pain within a medical paradigm (Handbook of Pediatric Chronic Pain, 2011).
Appendix a -- Facial Coding Systems in Pediatric Pain (Schiavento)

APPENDIX B -- NEUROBIOLOGY of PAIN in CHILDREN (McClain)

REFERENCES

The Handbook of Chronic Pain. (2007). New York: Nova Science Publishers.

Handbook of Pediatric Chronic Pain. (2011). New York: Springer.

Carter, B., & Threlkeld, M. (2012). Psychosocial perspectives in the treatment of pediatric chronic pain. Pediatric Rheumatology, 10(15), 1-11. Retrieved January 2013, from Pediatric Rheumatology: http://www.ped-rheum.com/content/pdf/1546-0096-10-15.pdf

Christie, D., & Wilson, C. (2005). CBT in Pediatric and Adolescent Health. Developmental Neurorehabilitation, 8(4), 241-47.

Cohen, L., et al. (2007). Evidence-based Assessment of Pediatric Pain. Journal of Pediatric Psychology, 33(9), 939-55.

Committee on Psychosocial Aspects of Child and Family Health. (2001). The Assessment and Management of Acute Pain in Infants, Children and Adolescents. Pediatrics, 108(793), 793-98.

Gould, H. (2007). Understanding Pain. Saint Paul, MN: AAN Enterprises Inc.

Loeser, J. (2013, January). About Pain. Retrieved from International Association for the Study of Pain: http://www.iasp-pain.org/AM/Template.cfm?Section= Pain_Defi...i splay.cfm&ContentID=1728

Manworren, R., & Hynan, L. (2003). Clincal Validation of FLACC: Preverbal Patient Pain Scale. Pediatric Nursing, 29(2), 140-46.

(n.d.). Pediatric Pain Management. Fort Sill, OK: Reynolds Army Community Hospital.

Schiavenato, M. (2008). Facial Expression and Pain Assessment in the Pediatric Patient: The Primal Face of Pain. Journal for Specialists in Pediatric Nursing, 13(2), 89-97.

Walco, G., et al. (1994). Pain, hurt and harm: the ethics of pain control in infants and children. New England Journal of Medicine, 331(2), 541-544.

Woolf, C. (2010). What is this thing called pain? Journal of Clinical Investigation, 120(11), 3742-44. Retrieved January 2013, from http://www.ncbi.nlm.nih.gov / pmc/articles/PMC2965006/

Young, K. (2005). Pediatric Procedural Pain. Annals of Emergency Medicine, 45(1), 160-71.

Expand knowledge about pediatric pain management through seminars, training, and continuing education

Provide a calm environment for procedures; music, calm room, pictures, comfortable chairs.

Use appropriate pain assessment tools and techniques for the age of the patient

Provide a calm environment for procedures; music, calm room, pictures, comfortable chairs.

Anticipate predictable painful experiences, intervene, and monitor accordingly to the situation.

Use a multimodal approach to behavior management (psychology, behavioral, physical, etc.

Involve families and make the interventions individualized for the family and the patient.