title: The squeaky wheel gets the grease: parental pain management of children treated for bone fractures.
abstract: OBJECTIVE
  The purpose of this study was to examine parental pharmacological and nonpharmacological pain management practices after extremity fractures.
  
  
  METHODS
  Parents of children aged 5 to 10 years who were diagnosed with a fractured limb and treated in an emergency department were recruited and completed pain records at home for 2 days.
  
  
  RESULTS
  The findings demonstrated that on the day after the fracture, 20% of children received no analgesia and 44% received 1 dose. On day 2, 30% received no analgesia and 37% received 1 dose. The correlation between analgesia and child report of pain increased from day 1 (r = 0.4, P < 0.05) to day 2 (r = 0.52, P < 0.05) as did parental impression that increased from day 1 (r = 0.43, P < 0.05) to day 2 (r = 0.6, P < 0.05). Correlations between pain scores, however, decreased from day 1 (r = 0.6, P < 0.05) to day 2 (r = 0.41, P < 0.05). Although most children received analgesia based on exhibiting active, loud behaviors such as crying (r = 0.63, P < 0.001), children exhibited quiet behaviors more frequently than crying (59.4 % vs. 31.2%, P < 0.001).
  
  
  CONCLUSIONS
  Based on these findings, it was concluded that children received few doses of analgesia at home after a fracture. Although quiet, withdrawn behaviors were exhibited more frequently, parents provided more analgesia if children exhibited active, loud behaviors. Future intervention should be developed to assist parents in recognizing the unique pain cues children exhibit and instructions for safe and effective pain management.
authors.affiliation: Departments of Anesthesiology, Yale University School of Nursing, New Haven, CT, USA. yaffazisk@gmail.com
authors.forename: Rachel Yaffa
authors.initials: RY
authors.lastname: Zisk
authors.forename: Margaret
authors.initials: M
authors.lastname: Grey
authors.forename: Barbara
authors.initials: B
authors.lastname: Medoff-Cooper
authors.forename: Jill E
authors.initials: JE
authors.lastname: MacLaren
authors.forename: Zeev N
authors.initials: ZN
authors.lastname: Kain
mesh_terms: D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage*; D002648:Child; D002652:Child Behavior; D002675:Child, Preschool; D003448:Crying; D003463:Cues; D004636:Emergency Service, Hospital; D005260:Female; D050723:Fractures, Bone / Q000150:complications*; D006801:Humans; D008297:Male; D010146:Pain / Q000209:etiology; D059408:Pain Management; D010147:Pain Measurement; D010290:Parents
chemical_list: D018712:Analgesics, Non-Narcotic