Heart Conditions
Pain and Discomfort

Perhaps one of the most worrying aspects of heart surgery is the thought of your child suffering from pain.

Try to be reassured that our aim is to promote comfort at all times.

We would like to involve children and parents in the assessment of pain and work in partnership to promote comfort.

Pain assessment tools are a helpful way for children to identify their level of pain. We use various pain assessment tools to help us keep your child as comfortable as possible. They are used in conjunction with observations of the child and with discussion with parents. Research has shown that from a very early age children can have a constructive role in their pain management.

Babies, toddlers and children with special needs may not be able to tell us that they are in pain in the same way older children can. Pain assessment charts are used in conjunction with observation and of course the experience of a children’s trained nurse.

How you as a parent can help
Before operation
Special cream is used when taking blood. This freezes the area where the doctor puts a small tube to take blood from. Your child may be frightened at the thought of having blood taken. Be assured you can stay with your child whilst blood test are being done to comfort and support your child. You could try distractions such as stories, games, telling jokes or whatever you feel would work! The nurse looking after you will explain more. Please ask if you want to know more or let us know if you have any special requests!

The pain assessment charts will be discussed with you and your child before the operation.

Help us to identify special words or ways that may show us that your child may be in discomfort.

Please rest assured that injections are not used following surgery for the relief of pain.

After the operation
Straight after surgery pain relief will be given into a drip by a special machine called a syringe pump. The usual type of painkiller used is morphine. This is given by an infusion, with the dose being worked out according to the weight of your child. Often children return to the ward from intensive care with an infusion of morphine. The nurse looking after you will give you more information. There are also leaflets on the ward designed by the Childrens Pain Service at Leeds, that you may find helpful and informative.

As your child begins to improve medicines will be given and the drip will be removed.

Medicine can be in the form of liquid or tablets. Morphine, Dihydrocodiene, Diclofenac and Paracetamol are examples of the most common painkillers. Encouraging your child to take medicine or tablets for pain is important. Once their pain is under control, children will return to the all-important job of getting better!

As well as medicines there are other ways of taking away discomfort and anxiety. These are probably ways you as a parent know best for your child!

Cuddling your child, reading a story to them, watching television or a favourite video are all ways that might help relieve anxiety and along with appropriate medicines are ways that you can work with us to help make your child’s stay in hospital as comfortable as possible.

Once they are feeling up to it a trip to the playroom or walk to the bathroom often helps children feel better. Often actually getting out of bed may be a little daunting both for children (and their parents!) but be assured the staff on the ward are there to support you all the way through your stay in hospital.

Pain Relief : Distraction Therapy
Distraction is one of the many behavioural therapies used to help a child cope with pain.
People think that distraction is a way of diverting the child’s attention away from the pain. They are altering their understanding of it. The more absorbed the child is in the distraction technique, the more they can reduce the pain. It has recently been scientifically recognised as to why distraction reduces the intensity and unpleasantness of the child’s pain. The child’s concentration or active absorption could play an important part in starting an internal pain-suppressing system to block pain.

Who should provide Distraction?
Through research it appears a child will not cope with their pain effectively alone. Therefore an effective coping strategy, e.g.: distraction therapy, must be interactive with an adult. It is not sufficient to leave a child with a book, toy or just music to listen to. A child’s primary nurse or play specialist can assess the child’s needs and provide preparation and suitable distraction techniques, to use during invasive and painful procedures.

How to use Distraction
Games or exercises which encourage controlled breathing
Blowing bubbles/ Balloons/ Blowpipes/ Party Blowers/ Blowing Feathers/ Blowing imaginary balloon

Books
Sound/ Pop up/ Where’s Wally/ Puzzle/ Books & Tapes

Games and Puzzles
Hand held games/ Small puzzles/ Water games/ Counting/ Magnetic games/ Pop up Games Interactive games: Hangman, Connect4, Downfall

Music
Walkman and tapes/ Singing/ Musical toys/ Musical Instruments

Sensory Experiences
Koosh balls/ Stress balls/ Squeaky toys/ Mobile phone toys/ Cuddly toys / Messy Substances: playdough, gak cornflour, slime, jelly

Mental Aptitude
Logical thinking/ Mental games/ Jokes/ Imaginary stories with reality

Imaginary and Make-believe Play
Puppets/ Favourite soft toy/ Therapeutic dolls/ Imaginary journeys

DISTRACTION PROVIDES FUN CONTROL AND UNDERSTANDING OF
CHILDREN’S EMOTIONS AND FEELINGS.

IT ALLOWS CHILDREN TO UNDERSTAND THEIR TREATMENT WITH A CLEAR EXPLANATION.

Pain relief at home
Usually children do not need any specific drugs for pain on discharge home. A mild painkiller such as Paracetamol is all that is needed. This will be discussed with you before you go home.