Global Initiative To Address Pain in Children

NATIONAL HARBOR –  The ChildKind initiative, set to launch this year, will promote the incorporation of child comfort into the culture of pediatric healthcare facilities by encouraging an institutional commitment to pain relief, according to a scientific poster describing the program at the 31st Annual Meeting of the American Academy of Pain Medicine (AAPM). 

Lead author Neil Schechter, MD, wrote an executive summary describing the initiative. Schechter is executive director of ChildKind, director of the Chronic Pain Clinic at Boston Children’s Hospital and associate professor of anesthesia (pediatrics) at Harvard Medical School in Boston, Mass. 

Since the successful pilot of the accreditation process in four North American children’s hospitals (Boston Children’s Hospital, Connecticut Children’s Medical Center, Seattle Children’s Hospital and the Hospital for Sick Children in Toronto), 20 additional institutions have expressed interest in receiving ChildKind certification. 

Approximately 20% to 30%  of children in high-income countries and 80% to 100% of children in low-income countries experience unnecessary pain while hospitalized, according to Schechter et al.

Although a number of strategies have been attempted to improve pain care such as educational initiatives, guideline development and quality audits, barriers often remain and practice behavior remains unchanged, according to the summary. 

The guiding philosophy of ChildKind is that sustained change is more likely if pain control is a core institutional value and commitment, similar to confidentiality or safety. 

“Interventions such as lectures and audits are more likely to impact on behavior if they fit into an institutional culture in which addressing pain is an expectation,” Schechter said in a press release. “In that way, appropriate pain management does not rely on the memory or good graces of any one practitioner but instead becomes part of the institutional fabric.” 

ChildKind emerged from the Special Interest Group on Pain in Childhood at the 7th International Symposium on Pediatric Pain. An organizing meeting was held in November 2008, in Bellagio, Italy, at the Rockefeller Foundation Study Center with the support of the Mayday Fund, the Institute of International Education and the Rockefeller Foundation. 

At that meeting, 20 experts in pediatric pain representing 14 countries as well as the World Health Organization (WHO), established ChildKind criteria that include the presence of a facility-wide pain policy, ongoing education, evidence of a developmentally-appropriate process for pain assessment, evidence informed pain management protocols and continuous quality improvement.

Modeled after the WHO and UNICEF effort to encourage breastfeeding in hospitals known as the Baby Friendly Hospital Program, ChildKind is meant to represent an alternative to other models, which may be more punitive in nature and are often less successful. 

ChildKind has been endorsed by major international health organizations including IASP, the Canadian Pain Society, the National Association of Pediatric Nurse Practitioners, the World Federation of Societies of Anaesthesiologists, the International Pharmaceutical Federation, the Royal College of Nursing, the Child Life Council and the Canadian Nurses Association. Schechter is hopeful that the core philosophy of ChildKind will spread: 

Those interested are encouraged to visit www.childkindinternational.org for more information. The website serves as a clearing house for information on pediatric pain and will provide technical assistance to institutions attempting to improve the quality of pain management that they provide. 

Reference

1. Schechter N, et al. Poster 199. “The Development of ChildKind: A Global Initiative to Reduce Pain in Children.” Presented at: AAPM 2015. March 19-22, 2015; National Harbor, Maryland.