Great Book Find! “A Child in Pain”

“By definition, pain is a noxious sensation which always has an emotional impact.”

Kuttner, 3

My practicum supervisor recommended that I read A Child  in Pain by Leora Kuttner and I am so glad she did. This is a really great book that covers what pain is and what we can do to help children who are in pain. By focusing on three areas of intervention, Physical, Pharmacological and Psychological, Kuttner explains how medical professionals all play a part in a child’s journey to relief from pain.

Although Kuttner did go into great detail about pharmacological interventions, and I would recommend that you read that part of the book if only to understand the drugs that doctors might prescribe for children, I found that the physical and psychological sections were more applicable to Child Life. This is not a book review as much as it is my sharing with you some of the practical suggestions that I believe would be most helpful to Child Life Specialists. If you like these ideas, I would highly recommend that you read the book for more ideas. If you are a student, I would definitely recommend that you read the book to better prepare you for practicums, internships and eventually your career as a Child Life Specialist. I am not a certified child life specialist yet, but I have already found these ideas helpful.

The book first covers what pain is and I think that is really important to understand if we want to help children find relief from their pain. Kuttner covers the history of pain, during which she mentioned that historically it was believed the newborns in the NICU did not feel pain and would not remember pain. Research has now found that not only do they feel pain, which I just assumed everyone had always known, but also that their fear of doctors, medical equipment and white lab coats are often seen later in life although they could not verbalize their experience in the NICU. Pain can influence the brain and memories, but it can also work the other way around. The mind can influence and control pain. By introducing non painful ideas and distraction, it is possible to suppress the pain.

“We need to let children know that we hear them when they are in pain and that we know they are suffering – whether or not the child’s behavior accords with what we conceive of as pain.”

Kuttner, 19

Kuttner offers a variety of ideas to apply to your own practice, but there were a few that stuck out to me. I was particularly interested by these ideas because they do not require any extra training. Kuttner discussed the benefit of acupuncture, acupressure and hypnosis, but all of these require specific training and education. Kuttner discusses breathing many times, and I have heard this idea many times, but I thought she gave some great guidelines as well as an explanation of why breathing is so helpful during painful procedures. Kuttner suggested blowing bubbles or blowing a pinwheel. Another idea Kuttner had was to “Blow away the red cloud.” The red cloud is a visualization of the pain and the patient tries to blow it away through breathing exercises. Another idea I picked up at conference was this really cool thing called a Marshmallow Launcher. This is a tool that can be used to help children with breathing. In order to use the launcher, you load small marshmallows and then blow to shoot them out. They can be shot in a general direction or at specific targets. Imagery is another idea that is suggested in A Child in Pain. If you haven’t heard of imagery, it is similar to hypnosis but I think it sounded easier to do. It short, imagery is the use of a “happy place” to no longer be in the hospital room, the procedure or the pain. Kuttner suggests discussing with the patient what their likes and interests are and then record a narrative guiding them in imagery. Recording the guided narration allows the patient can use imagery on their own, either at the hospital or at home.

Kuttner discusses the potential of massaging to relieve pain. Although this could require a license or extended training, this is also something that parents and caregivers can do for their children. Kuttner provides a case example of a young boy who found that his stomach pain was alleviated by his mother drawing animals on his stomach with her finger. Although this wasn’t elaborate massaging, the human touch on his stomach provided quick relief. Human touch is often encouraged in the NICU. Parents are not only encouraged to touch their children but also to provide skin to skin contact. I believe that potentially one of the strongest ideas in the book was art. Art is definitely something that is used often not only in the Expressive therapies, but also by Child Life Specialists. Kuttner proposes using art in order for children to express their pain. She brings up a couple case studies of using art to help children express and process their pain. They drew things such as pain going away or a picture of themselves getting rid of the pain.

I hope this post has given you a little insight into A Child in Pain. I found this to be a very informative book and I would highly recommend it to anyone who is in the field of Child Life and also those who are entering the field or just want to learn more about helping children in pain.

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