Chapter 39: Pain Management for Children

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Welcome back to The Deep Dive.

Today we are opening a file that I know creates a lot of anxiety for nursing students and, quite frankly, even for seasoned professionals.

We are focusing on a critical aspect of pediatric care that often doesn't get the attention it deserves until you're standing at the bedside with a crying child.

It is the heavy stuff.

It really is.

We are taking a comprehensive look at chapter 39 from Maternal Child Nursing, sixth edition.

The topic is pain management for children.

And before we even craft the book open, I want to set the stage here immediately because the sources are screaming one thing loud and clear.

This is not just about making a child comfortable.

It's not just about being nice.

No, absolutely not.

It is a vital sign.

Exactly.

It's about safety.

It's about advocacy.

And honestly, it's about physiology.

The text makes a compelling argument that pain is effectively the fifth vital sign, yet historically it has been the most ignored one in pediatric care.

We measure temperature, pulse, respiration, blood pressure, and then we sort of guess about pain.

And that's the critical tension in this chapter.

We have the history of what the text calls oligoanalgesia.

Which is a fancy word we are going to unpack, but it basically means we chronically undertreat pain in kids.

So if you are a nursing student listening to this or getting ready for the NCLEX or prepping for your first rotation in a PICU, the mission today is simple.

We need to completely rewire how you think about pain.

We aren't just memorizing drug dosages today.

We are going to deconstruct the gate control theory so you actually understand why rubbing a bump shin helps.

We're going to look at the wall of shame, those dangerous myths about addiction and respiratory depression that stop nurses from giving meds.

And we are going to build a toolkit for assessing pain in a patient who cannot speak.

It is the ultimate detective work.

So let's start with the basics.

Section one starts with what they call the golden rule from the International Association for the Study of Pain, or IASP.

It seems simple on the surface, but when you really think about it, it's actually quite radical for a definition.

It is radical because it shifts the power dynamic entirely.

The definition is pain is whatever the person experiencing the pain says it is, existing whenever the person says it does.

Existing whenever the person says it does.

That that removes the clinician's judgment from the equation entirely.

It does.

And that is the hardest part for the scientific brain to accept.

We want evidence.

We want to see a wound, a break, a burn, or a lab value that says pain.

But this definition tells us that pain is subjective, multi -dimensional, and deeply personal.

If a child says, my tummy hurts, but their abdomen is soft and non -tender and their labs are clean, they are still in pain.

Right.

And the text mentions psychosomatic pain here.

I think there is a tendency in the medical field to dismiss that as fake or maybe attention seeking.

Oh, that's a huge mistake.

Psychosomatic doesn't mean fake.

It means the origin might be psychological or emotional, maybe stress, maybe fear, but the sensation is physical.

The pain signals are firing.

For the nurse, the takeaway is absolute trust.

You cannot verify pain with a blood test.

You have to verify by listening.

If you start doubting the patient, you start failing the patient.

Okay.

So let's get into the wiring then.

How does that signal actually move?

The source material spends a lot of time on the gate control theory by Melzack and Wall.

This is from 1965, but it's still a foundational model for everything we do.

It's the model that explains the why behind our interventions.

Imagine the spinal cord, specifically the dorsal horn.

This is the relay station.

It's where the peripheral nerves meet the central nervous system.

Okay.

So we have the spinal cord acting as a gatekeeper.

Literally.

There is a gating mechanism in the substantia gelatinosa of the dorsal horn.

Now to understand this, you have to know your players.

You have small nerve fibers, A delta and C fibers.

These are your pain couriers.

When I touch a hot stove.

Those small fibers, the A delta and C fibers are screaming.

They stimulate the transmission cells and open the gate.

The signal shoots up the spinal cord to the brain and you say, ouch.

But the theory says we can close the gate.

How do we do that?

This is the aha moment for nursing interventions.

You also have large nerve fibers, a beta fibers.

These don't carry pain.

They carry benign non -painful sensations like touch pressure or vibration.

Here is the magic.

If you stimulate the large fibers, they crowd out the signal from the small fibers.

They inhibit the transmission.

They effectively jam the gate shut.

So when I stub my toe and I instinctively grab it and rub it hard, you are flooding the dorsal horn with large fiber input.

You are physically closing the gate on the pain signal.

This is why we use massage.

This is why heat and cold work.

It's why holding a child's hand isn't just emotionally supportive.

It is physiologically blocking pain transmission at the spinal level.

That's fascinating because it validates all the soft skills, so to speak.

It's not just about being nice.

It's about neurology.

Precisely.

And it also explains why cognitive factors matter.

The gate isn't just controlled from the bottom up.

It's controlled from the top down.

Descending nerve impulses from the brain stem can also close the gate.

So anxiety.

Anxiety opens the gate.

Focus and distraction close it.

If you have a child focusing intently on a kaleidoscope or a video game, their brain is sending signals down to the spine that say, we are busy.

Close the gate.

You are attacking the pain from two directions.

Before we move on to the barriers, we need to distinguish between the types of pain because the treatment plan changes drastically based on the category.

We have acute, chronic, and neuropathic.

Right.

Think of these as three different buckets.

First, acute pain.

Sudden onset, limited duration.

This is your broken arm, your appendicitis, or the big one in pediatrics.

Procedural time.

Which is a huge part of a nurse's day.

The needle sticks, the catheter insertions, the dressing changes, all of it.

Exactly.

Then you have chronic pain.

This is pain that persists beyond the expected healing time, usually defined as lasting more than three months.

This is tricky because the physiological signs like elevated heart rate or blood pressure often disappear as the body adapts.

The body can't stay and fight or flight forever, so the child looks normal, but the suffering remains.

It impacts sleep, school, social life.

And the third bucket?

Neuropathic pain.

This is nerve pain.

It's often described as burning, shooting, electric, or tingling.

Standard painkillers like Tylenol or even morphine often don't touch this effectively.

You need different meds like anticonvulsants or antidepressants to calm those firing nerves.

This leads us to a term in the text that stops you in your tracks.

Oligoanalgesia.

It's a damning term.

Oligo means few or scant.

Analgesia is pain relief.

It refers to the systemic practice of giving children less pain medication than they need.

It implies that we as a medical community have decided that children's pain matters less or is less real.

Why are we doing this?

If we know the physiology and we have the drugs, why is there a wall of shame, as the text implies in table 39 .1?

It comes down to myths.

Deeply ingrained, incorrect beliefs held by both medical staff and parents.

These are the barriers you will face on the floor.

Okay, let's bust them.

Myth number one.

Neonates in infants don't feel pain.

This is the most dangerous one because it persisted for so long.

For decades there was a belief that because a baby's nervous system wasn't fully myelinated, meaning the nerves didn't have that protective fatty sheath yet, they couldn't transmit pain signals or people thought their cortex wasn't developed enough to interpret pain.

Basically thinking of them as biological dolls.

Right.

The science proves this is categorically false.

The nervous system is functional very early in gestation.

A 26 -week preemie feels pain.

In fact, here is the kicker.

Because their inhibitory pathways, the systems that dampen pain signals, are the last thing to develop, they might actually feel pain more intensely and more diffusely than an adult.

Wow.

So not only do they feel it, they feel it worse.

And the text mentions that this early pain has long -term consequences.

It's not just cry and forget.

No, that's myth number two.

Children forget pain easily.

Give them a lollipop, you won't remember.

The conscious memory might fade, but the somatic memory sticks.

We have evidence that untreated pain in infancy changes the architecture of the nervous system.

It creates wind -up phenomena.

What does that mean, wind -up?

It means the nervous system becomes sensitized.

It can lead to altered feeding habits, sleep disturbances, and a permanent hypersensitivity to pain.

You are setting that child up for needle phobia and care anxiety for the rest of their life.

You are wiring their brain to fear the hospital.

That raises the stakes significantly.

But then we run into the parents' biggest fear, and honestly a lot of nurses' biggest fear, addiction.

The opioid myth.

This is huge.

Right.

A parent sees you coming with morphine for a broken leg and thinks, am I turning my child into an addict?

And the answer from the literature is a resounding no.

We have to separate physical dependence from addiction.

Physical dependence is a normal physiological response.

If you are on opioids for a long time, your body gets used to it.

Addiction is a psychological drive to take a drug for its psychic effects despite harm.

When opioids are used for a legitimate medical condition in a controlled environment for a limited time, the risk of addiction in children is vanishingly small.

So how do we explain that to a terrified parent at the bedside?

You educate them on the difference.

You say your child is in metabolic stress because of this pain.

Treating the pain helps them heal.

We are monitoring them.

We are not creating an addict.

We are treating a patient.

Related to that is the fear of respiratory depression.

If I give this dose, the kid stops breathing.

This is the fear that causes nurses to underdose.

They give a wimpy dose just to be safe.

But the text says clearly.

Children are not at a higher risk for respiratory depression than adults if you are dosing by weight correctly.

Yes.

Yes, you monitor them.

But you don't withhold the standard of care out of fear.

You titrate.

You give small amounts until pain is relieved.

And you watch the respiratory rate.

So the takeaway from Section 2 is pretty blunt.

Check your bias.

Correct.

If you walk into a room assuming the baby won't remember, or the teenager is just drug seeking, or that pain builds character, you are already failing the patient.

Let's pivot to the how -to.

Section 3 is assessment.

And this is where the rubber meets the road.

Because children are not just small adults.

They are entirely different species at different ages.

The assessment has to be developmentally appropriate.

The gold standard is self -report.

If they can talk and understand, you ask them.

But for the pre -verbal or non -verbal, you have to be a detective.

Let's start with the neonates and infants.

They can't tell us it hurts here.

So we look at behavior.

The text emphasizes facial expression as the most consistent indicator.

We aren't just looking for crying.

We are looking for the pain face.

Describe that for the listeners.

What are we seeing?

Okay, look for bulging brows.

Brows drawn together and lowered.

Eyes squeezed shut tight.

A deepening of the nasolabial furrow.

That's the line from the nose to the corner of the mouth.

An open square mouth.

It's a distinct grimace.

And the cry itself.

Is it different from a feed me cry?

Very different.

A hunger cry is rhythmic.

Wah wah wah.

A pain cry is high -pitched, harsh, tensor.

It sounds urgent.

It cuts through the noise of the unit.

What about the body?

The text references figure 39 .1, discussing a total body response.

For a young infant, it's generalized thrashing.

They become rigid or they flail everywhere.

They don't know where the pain is coming from.

They just know their whole world hurts.

But here's a fascinating developmental shift.

As they get older into the late infant stage, you start to see purposeful withdrawal.

So if you prick a heel, a newborn thrashes the whole body.

An older baby pulls that specific leg away.

They're beginning to localize the sensation.

And can we rely on vital signs?

Heart rate BP.

Be very careful there.

Yes, acute pain usually causes the sympathetic nervous system to fire tachycardia.

So a high heart rate, tachypnea, rapid breathing, and decreased oxygen saturation.

But so does hunger.

So does a wet diaper.

So does separation anxiety.

So vital signs are a clue, but not the verdict.

Exactly.

You have to look at the whole picture.

Moving up to toddlers.

The no phase.

This must be tough.

Toddlers are tricky.

They have some words, ouch, boo boo, hurt.

But they don't have the vocabulary to describe intensity.

They can't tell you it's a 4 out of 10.

Their reaction is often physical.

They might be aggressive, biting, kicking, kidding the nurse.

Or they might be regressive.

Regression is a big flag.

Huge.

A body trained toddler might start wetting the bed.

A toddler who sleeps alone might demand to be rocked.

They might curl up in a fetal position.

And guardian?

Yes.

That's a key physical sign.

If a toddler has an ear infection, like in figure 39 .2, they're constantly touching or pulling that ear.

If their tummy hurts, they're protecting it with their arms.

They guard the site.

Then we get to the preschoolers, ages 3 to 5.

This is the age of magical thinking.

How does that complicate pain assessment?

It complicates it massively because they lack logic.

They are egocentric.

They often view pain as a punishment.

I was bad.

I hit my brother.

So now my stomach hurts.

They think they caused it with their thoughts or actions.

That is heartbreaking.

It is.

And because of magical thinking, they might believe that if they just wish it away, it will go.

Or, conversely, they might deny pain entirely.

Why would they lie?

Why deny it?

Because they have made an association.

Pain equals nurse.

Nurse equals needle.

They are smart enough to know that admitting pain might lead to a procedure.

So they sit there, in agony, telling you they are fine because they are terrified of the shot.

So with a preschooler, you have to look for stalling behaviors?

Exactly.

Wait, I need a drink of water.

Wait, I need to go to the bathroom.

Wait, let me tell you a story.

They are trying to delay the inevitable,

that stalling is a sign of anxiety and anticipated pain.

Next up, school -aged children, ages 6 to 12.

Now we are getting logical.

Yes.

They can describe location, intensity, and quality.

It's a sharp pain in my left side.

But their fears shift.

They aren't scared of the pain being a punishment anymore.

They are scared of bodily harm.

They are scared of death.

Is my body broken forever?

And their behavior changes, too.

They try to be brave.

This is the stiff body posture the text describes in figure 39 .3.

You might walk in and see an 8 -year -old lying perfectly still, staring at the ceiling, fists clenched, tears rolling down the side of their face, but silent, quietly sobbing.

Because they are trying to control themselves.

Exactly.

Don't mistake that silence for comfort.

That child is holding it together by a thread.

That is high -level distress.

Finally, the adolescents.

They can think abstractly, they understand cause and effect, so it should be easier, right?

You think so.

But they are battling a massive social pressure.

They do not want to look weak.

They do not want to lose control in front of their peers or parents.

So they mask it.

They act cool.

And the text mentions a specific cognitive trap they fall into.

The mind reader assumption.

Yes.

A teenager assumes, you are the nurse.

You know I just had surgery.

You checked my incision.

You know I heard.

Why do I have to ask for the medicine?

They think you're withholding it on purpose.

Or they just think suffering is part of the deal.

If you don't offer it, they suffer in silence.

So with teens, you have to be proactive.

You don't wait for them to beg.

You ask and you validate.

That brings us to section 4.

The tools.

We've assessed the behavior.

Now we need a number.

We need data.

And the rule here is consistency.

You cannot swap tools halfway through a shift.

If you start with FLACC, stick with FLACC.

Otherwise, you can't track the trend.

Let's run through the big ones in table 39 .2.

Start with FLACC.

FLACC is the gold standard for infants, toddlers, and nonverbal kids.

It stands for face, legs, activity, cry, consolability.

Is this score a card?

Yes.

Zero to two points for each category.

For face, a smile or no expression is zero.

A quivering chin or clenched jaw is a two.

For legs, relax is zero.

Kicking or drawn up is a two.

For cry, no cry is zero.

Steady crying or screaming is a two.

You sum it up to get a score out of ten.

It turns subjective observation into objective data.

Then there's the faces scale.

The Wong Baker.

Everyone knows the cartoon faces.

Right.

Used for ages three and up.

But there is a huge caveat here that students often miss.

You have to give the right instructions.

What do you mean by that?

You have to explain to the child that these faces show how they feel inside, not what their face looks like.

A child might pick the smiling face because they are trying to be a good boy and smile for the nurse even if they are in pain.

Or they might see the crying face and say, I'm not crying.

So they pick the happy face.

You have to clarify.

Point to the face that shows how much hurt you have deep inside.

That's a critical distinction.

Then there is the outter scale, shown in figure 39 .4.

I love the outter.

It's for ages three to 12.

Instead of cartoons, it uses real photographs of children's faces and increasing levels of distress.

And it is culturally sensitive.

There are versions for Asian, African -American, Hispanic, and Caucasian children.

So the child can identify with the image, that kid looks like me.

Exactly.

It improves accuracy because it feels more real to them than a cartoon.

And the numeric rating scale, the classic zero to ten.

Only for ages nine and up.

Maybe a very smart eight -year -old.

They have to understand the concept of seriation.

That five is more than four, but less than six.

If you ask a five -year -old, rate your pain zero to ten, they will just say a random number.

Usually the biggest number they know, or their favorite number, or they say 100.

Exactly.

You need cognitive maturity for the number scale.

There is one more mentioned.

The APPT adolescent and pediatric pain tool.

It looks pretty detailed.

It is.

This is for eight to 17 years, as seen in figure 39 .6.

It's more detailed.

It has a body outline they can color in to show location, which is great for complex pain.

And it provides a list of descriptive words like throbbing, stabbing, burning.

It helps them articulate the quality of the pain, not just the intensity.

Okay.

We have identified the pain.

We have scored the pain.

Now we have to treat the pain.

Section five covers non -pharmacologic interventions.

And the text uses the word multimodal.

Multimodal is the key to modern pain management.

It means we don't just throw a pill at the problem.

We use meds plus distraction plus an environment plus psychology.

We attack the pain from every angle.

We talked about distraction closing the gate earlier.

Give us some practical examples for the toolkit.

Bubbles are my absolute favorite for the younger ones.

Bubbles.

Why bubbles?

Think about the mechanics.

To blow bubbles, the child has to take a deep breath and exhale slowly.

That regulates their breathing.

It stops the hyperventilation.

Then they have to visually track the bubble.

That occupies the visual cortex.

It is physiologically difficult to be in a panic state while effectively blowing bubbles.

That is brilliant.

It forces relaxation.

Kaleidoscopes work the same way.

Visual fixation.

Video games are powerful for older kids and for the nurse, just conversation.

Talking about their life.

Yes.

Who is your favorite superhero?

Do you play baseball?

What level are you on in Minecraft?

Do this during the procedure.

The brain has limited bandwidth.

If they're retrieving memory about Minecraft, they aren't processing the needle stick as intensely.

For infants, the text highlights sucrose, sugar water.

It's practically magic.

Concentrate in sucrose, 24 percent.

You dip the pacifier in it or give a few drops orally, but two minutes before procedure like a heel stick or venipuncture.

How does sugar stop pain?

It releases endogenous opioids,

natural painkillers in the brain.

It only lasts a few minutes, but for a quick stick, it is highly effective.

Combine that with non -nutritive sucking, so the pacifier, and kangaroo care, which is skin -to -skin holding, and you have a powerful analgesic package without touching a narcotic.

And what about the parents?

They often feel so helpless.

Don't let them just stand there looking terrified, fears contagious.

Give them a job, hold this hand, talk into this ear, sing their favorite song.

It reduces the parent's helplessness and calms the child, which in turn calms the parent.

It creates a positive feedback loop.

Now, let's open the medicine cabinet, section six, pharmacologic interventions.

This is where we need to be precise.

Yeah.

Let's start with the route.

How are we getting the drug in?

The text is very, very firm on this.

Avoid IM.

Avoid intramuscular injections at all costs.

Think about it from the child's perspective.

They are in pain.

You come in to help them, and your help involves stabbing a needle deep into their muscle.

It is terrifying, it is painful, and frankly, the absorption is inconsistent because blood flow to the muscle might be poor if they are cold or stressed.

Do not add pain to treat pain.

That's the rule.

Oral is preferred for convenience.

Four is preferred for speed and control.

Let's look at the non -opioids first.

Tylenol, socetaminophen, and Motrin, the NSAIDs.

Tylenol is great for mild to moderate pain.

It acts on the central nervous system.

It raises the pain threshold.

It is safe even for neonates.

But watch the liver.

And NSAIDs like ibuprofen.

Excellent anti -inflammatories.

They work on the peripheral nerves.

But there is a hard constraint.

Do not give ibuprofen to infants under six months.

Their kidneys aren't mature enough to handle it.

And always, always check hydration.

NSAIDs rely on renal blood flow.

If a kid is dehydrated, you can hurt their kidneys.

And there is a massive warning in red letters about aspirin.

Never give aspirin to a child for pain or fever.

It is linked to Ray syndrome, a catastrophic condition that causes liver failure and brain swelling.

Unless a cardiologist specifically ordered it for a specific heart condition, keep the aspirin away.

Just use Tylenol or ibuprofen.

Now, the heavy hitters.

The opioids.

First, note the language.

We say opioid, not narcotic.

Narcotic is a legal or police term.

Opioid is the medical term.

Morphine.

The gold standard.

It's the benchmark.

Peak effect in about 10 to 20 minutes.

Saffy.

It's effective.

It's predictable.

It is the drug of choice for severe pain.

The powerhouse.

It is synthetic and 70 to 100 times more potent than morphine.

But it acts fast and leaves fast.

It's perfect for a short, painful procedure like inserting a chest tube or setting a bone.

It hits in minutes, wears off quickly.

And a bonus.

It causes less histamine release, so less itching than morphine.

And then there's codeine.

The tax basically puts a skull and crossbones next to this one.

Codeine is dangerous in pediatrics.

We are moving away from it entirely.

It has a black box warning.

Why?

I remember getting codeine as a kid.

We all do.

But we learn better.

The problem is genetic variability.

Codeine is a pro -drug.

It doesn't do anything until your liver converts it into morphine using the cell IPDD6 enzyme.

The problem is, some children are ultra -rapid metabolizers.

They have a genetic variant that makes them convert it all to morphine instantly.

So you give a standard dose, and suddenly the child has a massive overdose of morphine in their system.

They stop breathing.

It's too unpredictable.

So sticking to morphine or fentanyl is safer because we know what they do.

And if we do use opioids, we need the safety net.

Naloxone.

Narcan.

This is the reversal agent.

If you overshoot and the respiratory rate drops, this pulls the opioid off the receptors.

But the text warns.

Administer slowly.

Very slowly.

If you slam Narcan, you rip all the pain relief away instantly.

The child wakes up in screaming agony.

The sympathetic nervous system goes haywire.

And you can actually cause cardiac arrest from the shock.

You want to titrate it.

Give just enough to get them breathing, not enough to wake them fully up and return the pain.

Let's talk about PCA patient -controlled analgesia.

The button.

This is a great tool for older kids.

Usually five or six and up.

It gives them control.

They push the button when they hurt.

It reduces anxiety because they know relief is right there.

Is it safe?

Incredibly safe.

The pump has a lockout interval.

They can push the button 100 times, but it will only give a dose once every 10 minutes or whatever And there is a natural safety feedback loop.

Sedation comes before respiratory depression.

If the kid is too sleepy to push the button, they don't get the drug.

They sleep it off.

Unless someone else pushes it.

That is PCA by proxy.

That's the biggest danger.

Mom sees the kid sleeping and thinks, I don't want him to wake up in pain.

So she pushes the button.

Now you have bypassed the safety check.

The kid overdoses.

Nurses must educate parents strictly.

Do not touch the button.

One last category of drugs that I think is underutilized.

Topicals.

Numbing the skin before the stick.

EMLA cream or LMX4.

These are local anesthetics.

You put a glob on the vein, cover it with a clear dressing and wait.

But the waiting is the problem, isn't it?

It is.

EMLA takes 60 minutes to penetrate in cact skin.

LMX4 takes about 30.

You have to plan ahead.

If you need an IV now, EMLA is useless.

What if we don't have an hour?

Vapiculin spray.

It's a can of freezing spray.

You spray the skin for 15 seconds.

It numbs the receptors instantly and you poke.

Or the J -tipid uses pressurized gas to shoot lidocaine into the skin without a needle.

It sounds like a soda can popping.

It works in minutes.

These should be standard care.

There is no excuse for a non -emergency needle stick without some kind of numbing.

Finally, section 7 touches on the deep end.

Procedural sedation and epidurals.

Procedural sedation, sometimes called conscious sedation, is a delicate balance.

We want the child out of it enough so they don't care about the pain, but awake enough to maintain their own airway and reflexes.

We use meds like midazolam and ketamine.

Yes, midazolam or versed causes amnesia.

They won't remember the procedure, which is a blessing for preventing trauma.

Ketamine is also fantastic because it provides analgesia and sedation, but keeps the respiratory drive intact.

But the nurse's role here is intense.

You are the lifeline.

The doctor is focused on the procedure, setting the bone, sewing the cut.

You are focused on the patient.

You watch the oxygen saturation, the heart rate, and crucially the CO2 with capnography.

You are the one who says, stop, he's not breathing.

And for epidurals, usually post -op?

Yes, for big thoracic or orthopedic surgeries.

The catheter goes into the epidural space.

The nurse needs to check dermatones using ice to see where the numbness stops and starts to make sure the block is working, but not climbing too high, which could figure breathing and check the site.

Don't let that catheter get pulled out.

We have covered a massive amount of ground today from the dorsal horn to the PCA pump.

It's a lot, but it's necessary.

Let's recap the big takeaways for the learner.

If they walk away with four things, what are they?

One,

believe the child.

Pain is what they say it is.

Discard your bias about who looks like they are in pain or who's too young to feel it.

Fit the assessment to the age.

Don't ask a toddler to rate pain 0 to 10.

Look at the face.

Look at the legs.

Listen to the cry.

Understand the developmental language of pain.

Multimodal is the way.

Don't just rely on morphine.

Use the bubbles, the sucrose, the parents, the distraction, and the meds.

Attack the pain from the brain down and the nerves up.

Safety through knowledge.

Know why coding is bad.

Know why we don't use aspirin.

Know how to use Narcan correctly.

Knowledge is safety.

I want to leave the listener with a final thought from the text.

We talked about how untreated pain rewires the nervous system.

That means when you, the nurse,

effectively manage a child's pain today, you aren't just getting them through a shift.

You are potentially preventing chronic pain,

anxiety, and healthcare phobias in the adult they will become 20 years from now.

You are protecting their future.

It's profound work.

It is.

Thank you for helping us break this down.

My pleasure.

To our listeners, good luck with your studies.

Go be that advocate.

And a warm thank you from the last minute lecture team.

We will see you on the next deep dive.