Parental administration of analgesia to children attending the emergency department with acutely painful conditions.

Background: Acute paediatric pain management is often suboptimal in the emergency setting. There is a paucity of published literature on parental administration of analgesia to children, prior to their arrival at the emergency department (ED). The objective of this study was to describe the prevalence of pre-hospital analgesic administration by parents/guardians of children ≤16 years presenting to ED, with acutely painful conditions. Methods This was a prospective cross-sectional study conducted across two EDs in the South of Ireland with a collective annual attendance of approximately 100,000 patients. A consecutive sample of 400 parents/guardians of children aged between 6 months and 16 years, who were self-referred to ED with acutely painful conditions, were included. Data collected included patient demographics, pain score and analgesia administration. Data was analysed with SPSS software using descriptive and inferential statistics. Results 189/400(47%) children received analgesia from their parents/guardians pre-ED arrival. Factors independently associated with increased parental administration of analgesia were: pain score ≥5/10 53.4%(95%CI 48%-59%) vs ≤4/10 29%(95%CI 21%-38%), children with siblings 49.7%(95%CI 45%-56%) vs without siblings 35.3%(95%CI 24%-47%) and presenting <48 hours from onset of pain 50.1%(95%CI 45%-55%) vs presenting ≥48 hours 30.5%(95%CI 19%-42%). Of the 400 participants, 211(53%) received no analgesia before attending ED. Reasons for parents not administering analgesia included: 62/211(29.4%) did not think the child needed it, 39/211(18.5%) accident did not happen at home, 34/211(16.1%) did not want to mask the presence of the pain, 20/211(9.5%) believed the hospital should give medications, and 18/211(8.5%) afraid it would be wrong/harmful. Conclusions Over half the children presenting to ED, with acutely painful conditions, did not receive adequate or timely pain relief pre-ED arrival, causing avoidable suffering. Parental misconceptions about acute pain management are major barrier to analgesic administration. Educational strategies are required to dispel misconceptions, which may ultimately improve the care for this population.