INTRODUCTION Prevention and treatment of pain in pediatric patients compared with adults is often not only inadequate but also less often implemented the younger the children are. Children 0 to 17 years are a vulnerable population. OBJECTIVES To address the prevention and treatment of acute and chronic pain in children, including pain caused by needles, with recommended analgesic starting doses. METHODS This Clinical Update elaborates on the 2019 IASP Global Year Against Pain in the Vulnerable "Factsheet Pain in Children: Management" and reviews best evidence and practice. RESULTS Multimodal analgesia may include pharmacology (eg, basic analgesics, opioids, and adjuvant analgesia), regional anesthesia, rehabilitation, psychological approaches, spirituality, and integrative modalities, which act synergistically for more effective acute pediatric pain control with fewer side effects than any single analgesic or modality. For chronic pain, an interdisciplinary rehabilitative approach, including physical therapy, psychological treatment, integrative mind-body techniques, and normalizing life, has been shown most effective. For elective needle procedures, such as blood draws, intravenous access, injections, or vaccination, overwhelming evidence now mandates that a bundle of 4 modalities to eliminate or decrease pain should be offered to every child every time: (1) topical anesthesia, eg, lidocaine 4% cream, (2) comfort positioning, eg, skin-to-skin contact for infants, not restraining children, (3) sucrose or breastfeeding for infants, and (4) age-appropriate distraction. A deferral process (Plan B) may include nitrous gas analgesia and sedation. CONCLUSION Failure to implement evidence-based pain prevention and treatment for children in medical facilities is now considered inadmissible and poor standard of care.

中文翻译：

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Pädiatrische Schmerztherapie und -prävention bei Hospitalisierten Kindern

简介 与成人相比，儿童患者的疼痛预防和治疗往往不仅不足，而且儿童越小，实施的就越少。0 至 17 岁的儿童是弱势群体。目标 使用推荐的镇痛剂起始剂量预防和治疗儿童急性和慢性疼痛，包括针头引起的疼痛。方法 本临床更新在脆弱的“儿童疼痛实况表：管理”中详细阐述了 2019 IASP 全球抗疼痛年，并回顾了最佳证据和实践。结果 多模式镇痛可能包括药理学（例如，基础镇痛药、阿片类药物和辅助镇痛）、区域麻醉、康复、心理方法、灵性和综合方法，与任何单一镇痛药或方式相比，它们协同作用更有效地控制急性儿科疼痛，副作用更少。对于慢性疼痛，包括物理治疗、心理治疗、综合身心技术和正常化生活在内的跨学科康复方法已被证明是最有效的。对于选择性针头手术，例如抽血、静脉通路、注射或疫苗接种，现在有压倒性的证据要求每次都应向每个孩子提供 4 种方法来消除或减轻疼痛：(1) 局部麻醉，例如， 4% 利多卡因乳膏，(2) 舒适体位，例如，婴儿的皮肤与皮肤接触，不束缚儿童，(3) 蔗糖或婴儿的母乳喂养，以及 (4) 适合年龄的分散注意力。延期过程（计划 B）可能包括亚硝酸气镇痛和镇静。结论 未能在医疗机构中对儿童实施循证疼痛预防和治疗现在被认为是不可接受的和护理标准差。