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Pain Management
Children and Youth - Procedural Pain Management

Some health care procedures can lead to pain, anxiety, stress, and fear. Pain management occurs before, during, and after the procedure. Parents or care-givers, children and health care providers can all help with pain management. 

Poorly managed pain can have immediate and long-term effects. Pain is stressful and affects the body's ability to heal. Pain causes fear, anxiety, aggression, and distrust. Children may refuse further tests or care if past experiences have been painful. Even though young children may not consciously remember pain, repeated or intensely painful events early in life can change how the nervous system develops and how pain is processed later in life.

Every child is different. The approach to care might be different each time.
Find more information below, or on this parent handout.

What Matters?

Pain during a procedure is influenced by:

  • type of procedure
  • patient's and parent's emotional state and level of anxiety
  • previous pain experiences
  • understanding of the procedure
  • medical condition
  • environmental factors (setting)

The health care team will determine whether or not medications or sedation are needed during a procedure. Medications (including sucrose) may be taken by mouth, applied to the skin (ointments), inhaled or injected. The following non-drug (non-pharmacological) pain management methods may also be helpful:

Before the Procedure

  • Tell - Show - Do: give the child accurate information on what will take place and what he/she is likely to feel (Tell), demonstrate the procedure on a parent, doll, with a book or video (Show), then proceed with the task (Do)
  • Ask the child what he/she expects to feel during the procedure
  • Coach the child on distraction or coping techniques and practice before the procedure
  • If more than one procedure will take place, plan the order of the procedures from least to most painful

During the Procedure

Infants​Toddler and Preschool​School-age and Adolescents​
  • pacifier
  • positions of comfort
  • skin-to-skin contact (kangaroo care)
  • breastfeeding
  • rocking
  • singing
  • toys​
  • blow bubbles or pinwheel
  • positions of comfort
  • singing or music
  • toys
  • guided imagery
  • tell stories or jokes
  • TV or video games​
  • guided or independent imagery
  • progressive muscle relaxation
  • deep breathing and exhaling
  • listen to music
  • conversation
  • tell stories or jokes
  • TV or video games​

 *not a complete list of all pain management methods

After the Procedure

  • Focus on the good parts of the procedure - why it was done, what worked to help the child cope
  • Praise the child for pain coping attempts
  • Thermal - cold packs or warm blankets


Some pain management methods take time and preparation to set up, while others can be started with no preparation. This diagram shows some of the methods and the time required to get them started (not a complete list).


Where to Get Extra Help

Families and patients admitted to the in-patient acute care Pediatrics ward can ask their health care team for a referral for Recreation Therapy Services. Recreation therapists will:

  • teach or reinforce coping strategies to help reduce anxiety, enhance pain management, and improve cooperation with treatment
  • provide support and distraction during procedures
  • offer play, recreation and expressive opportunities which encourage normal development in spite of challenging circumstances

For more information, read Prevention and Management of Procedural Pain in the Neonate: An Update from the Committee on Fetus and Newborn and Section on Anesthesiology and Pain Medicine article published February 2016, Reducing Pain During Vaccine Injections: Clinical Practice Guideline article published August 2015, or review the resources listed on the Resources for Parents and Resources for Healthcare Providers pages of the Children and Youth webpage. ​

Last Modified: Friday, November 24, 2017 |
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