How Child Temperament Affects Analgesic Dosing at Home

Surgical Rounds®, August 2014,

As more pediatric surgical procedures being conducted as same-day procedures, parents are assuming responsibility for their children's immediate post-operative pain management.

As more pediatric surgical procedures being conducted as same-day procedures, parents are assuming responsibility for their children’s immediate post-operative pain management. Even minor procedures can cause considerable post-operative pain; however, due to misconceptions parents have about pediatric pain relievers or a misunderstanding about how to medicate effectively, parents may aggravate the child’s pain.

Parents also may give inadequate doses or wait until the child’s pain is spiraling out of control. Another factor — child temperament — may also influence parental behavior.

Researchers in Orange County, CA, addressed how children’s temperament (activity, emotionality, shyness, and sociability) can affect parent dosing in a study appearing in the August issue of the Journal of Pediatric Surgery. The authors enrolled 286 Spanish- and English-speaking parents of children who had outpatient elective surgery.

Parents administered a total of 544 doses of acetaminophen over post-operatively. Approximately 70% of the acetaminophen doses parents administered were sub-therapeutic. About 40% of codeine doses were below the therapeutic range.

For ibuprofen, 90% of doses were appropriate, and almost all doses of hydrocodone were correct. The authors suggest that prescription drugs are labeled with exact doses, which may account for the difference.

Children rated by their parents as emotional in temperament received more acetaminophen, ibuprofen, and hydrocodone (but not codeine). These children appeared to be more vocal about their needs. Surprisingly, children rated as having shy behavior were the most likely to receive analgesics; the researchers indicate that shyness can be interpreted as negative emotionality, which suggests parents read shy behavior as needy behavior.

“Dimensions of children’s temperament, specifically emotionality, predict analgesic administration by parents following surgery even after controlling for confounding variables,” the authors concluded.

They urge clinicians to tailor analgesia and consider proximal factors (e.g., type of surgery, pain severity) and distal factors (e.g., child temperament) factors.