Incidence and risk factors for care-related pain in children with physical disabilities

BACKGROUND: The daily life of children with a physical disability is organized around interventions and care, which is coordinated by a multidisciplinary team. Little is known about the incidence of care-related pain in pediatric rehabilitation centers and health facilities for children. AIM: To determine the incidence and intensity of care-related pain in children with physical disabilities, identify risk factors for pain and practices used to prevent care-related pain in pediatric rehabilitation centers and health facilities for children in France. DESIGN: Non-interventional observational study. SETTING: Sixteen pediatric rehabilitation and special education centers in 4 departments of Brittany (France). POPULATION: A number of 280 children with physical disabilities randomly selected (mean age: 12±4 years). Predominant medical diagnosis was nervous system diseases (68%; e.g., cerebral palsy 33%). METHODS: The FLACC-r scale was used to evaluate pain during each care activity or intervention that required physical contact with the child for five consecutive days and one night. RESULTS: The recorded interventions were 7689. Pain was induced by 6% of physical acts, and 48% of children experienced at least one painful act during the study period. Acts that were more frequently associated with pain and had the highest pain intensity were standing frame use, feeding, gentle mobilizations and bladder catheterization. Age, level of dependency and type of act were all risk factors for care-related pain (P<0.01). Pain prevention was used for only 26.5% of acts. CONCLUSIONS: Care-related pain is frequent and under-recognized in pediatric rehabilitation and health facilities for children. All acts that involve direct physical contact can cause pain. Young and severely dependent children are most at risk of pain. CLINICAL REHABILITATION IMPACT: All professionals who are involved in the care of children with a physical disability and significant limitations in activity and participation must be aware of the issue of pain and that pain can be induced by even the most routine physical act. The management of care-related pain requires a benefit-risk analysis, a prevention and pain assessment, and a family-professional partnership. A multidimensional approach is needed for more individualized pain management and to evaluate the impact of pain on children’s participation.