• Rachel Yaffa Zisk, Margaret Grey, Barbara Medoff-Cooper, Jill E MacLaren, and Zeev N Kain.
• Departments of Anesthesiology, Yale University School of Nursing, New Haven, CT, USA. yaffazisk@gmail.com
• Pediatr Emerg Care. 2008 Feb 1; 24 (2): 89-96.

ObjectivesThe purpose of this study was to examine parental pharmacological and nonpharmacological pain management practices after extremity fractures.MethodsParents of children aged 5 to 10 years who were diagnosed with a fractured limb and treated in an emergency department were recruited and completed pain records at home for 2 days.ResultsThe findings demonstrated that on the day after the fracture, 20% of children received no analgesia and 44% received 1 dose. On day 2, 30% received no analgesia and 37% received 1 dose. The correlation between analgesia and child report of pain increased from day 1 (r = 0.4, P < 0.05) to day 2 (r = 0.52, P < 0.05) as did parental impression that increased from day 1 (r = 0.43, P < 0.05) to day 2 (r = 0.6, P < 0.05). Correlations between pain scores, however, decreased from day 1 (r = 0.6, P < 0.05) to day 2 (r = 0.41, P < 0.05). Although most children received analgesia based on exhibiting active, loud behaviors such as crying (r = 0.63, P < 0.001), children exhibited quiet behaviors more frequently than crying (59.4 % vs. 31.2%, P < 0.001).ConclusionsBased on these findings, it was concluded that children received few doses of analgesia at home after a fracture. Although quiet, withdrawn behaviors were exhibited more frequently, parents provided more analgesia if children exhibited active, loud behaviors. Future intervention should be developed to assist parents in recognizing the unique pain cues children exhibit and instructions for safe and effective pain management.

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