Social barriers to optimal pain management in infants and children

Objective: To examine the social barriers that lead to less than optimal management of pain in children. Design: Recognizing the vulnerabilities of infants and children and their dependence on caring adults, a model of pain communication is proposed. The model examines (a) the pain experiences of children, including social determinants; (b) developmental variations in the capacity to encode the severity and qualities of pain as expressive behavior; (c) adult skills and deficiencies in decoding pain; and (d) the actions of adults predicated on the meaning and significance attached to children's actions, Limitations in care were examined. Data sources: The current research and professional literature were accessed through searches of the Psyclit and Medline databases for relevant investigations on the basis of our working knowledge of the literature. Conclusion: Numerous deterrents to optimal care are identified in the domains of commonplace beliefs about the nature of pain in infants and children: failure to recognize the impact of socialization in familial and cultural modes of experience and expression; needs for age-specific assessment instruments: the limited capacity to use available evidence concerning pain; the need to employ clinicians, parents, and other adults more effectively in delivering care; and structural problems in the health care system.