Learning Objective #1: Identify the assessment and management issues parents face following discharge from the ED with a child with a fracture

Learning Objective #2: Identify the utility of devising future comprehensive intervention that enhance parental pain management practices

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Purpose: The majority of children's pain is assessed and managed by their parents, but there is meager literature regarding these practices. Parents are aware of their child's usual behavior patterns and are thought to base their detection and management of the child's pain on changes in those patterns. Fractured limbs or clavicles due to accidental injury exemplify a common childhood pain experience where much of the pain assessment and management is carried out at home. Primarily this study examined the influence of parental perception of children's acute pain behaviors on acute pain management practices. Secondarily the study examined the influence of parental perception of children's usual behavioral style on parental pain assessment and management practices.

Methods: This study employed a prospective design to explore parents' assessment and management practices (pharmacological and non-pharmacological) at home following treatment in the emergency department for a fractured limb or clavicle. The participants included 50 parents of children aged 5-10 years. Analysis of the data included descriptive statistics, correlations, odds ratios, non-parametric tests, and regressions.

Results: The results demonstrated that: parents provide their children with very few doses of analgesia, although most children experienced significant pain during the first two days; children's usual behavioral style influenced the changes in behaviors exhibited as a result of pain, yet did not influence parental management practices; and parents utilize many non-pharmacological pain alleviation methods which they report as being as helpful or more helpful than analgesia.

Conclusions and Implications: The findings demonstrate that parents, though attuned to their children, may benefit from interventions that enhance pain management practices at home. Future interventions should be designed to assist parents in recognizing cues children exhibit when in pain, and comprehensive instructions of how to manage pain in an age-appropriate manner and how to use individually appropriate methods.