title: Prevention and Treatment of Pain in Children: Toward a Paradigm Shift.
abstract: Rosenfeld et al in their recent article "Office Insertion of Tympanostomy Tubes without Anesthesia in Young Children" describe using a "papoose board for restraint" while performing a procedure resulting in severe pain for a significant number of children: a myringotomy and tube insertion. In 2016, it is inappropriate to perform elective painful procedures in children without treatment to avoid or minimize pain. We strongly disagree with the authors' conclusion "that office insertion of tubes in young children is a feasible alternative to general anesthesia for caregivers and clinicians who are comfortable with this choice."
authors.affiliation: Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota, USA University of Minnesota Medical School, Minneapolis, Minnesota, USA stefan.friedrichsdorf@childrensMN.org.
authors.forename: Stefan J
authors.initials: SJ
authors.lastname: Friedrichsdorf
authors.affiliation: Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota, USA University of Minnesota Medical School, Minneapolis, Minnesota, USA.
authors.forename: James
authors.initials: J
authors.lastname: Sidman
authors.affiliation: Stanford Children's Health, Stanford, California, USA Stanford University School of Medicine, Stanford, California, USA.
authors.forename: Elliot J
authors.initials: EJ
authors.lastname: Krane
mesh_terms: D000768:Anesthesia, General; D002648:Child; D006801:Humans; D007223:Infant; D008876:Middle Ear Ventilation; D010146:Pain; D016896:Treatment Outcome
keywords: analgesia; myringotomy; pain; papoose board; pediatric; restraint; tympanostomy