Social barriers to optimal pain management in infants and children

Clin J Pain. 1996 Sep;12(3):232-42. doi: 10.1097/00002508-199609000-00011.


Objective: To examine the social barriers that lead to less than optimal management of pain in children.

Design: Recognizing the vulnerabilities of infants and children and their dependence on caring adults, a model of pain communication is proposed. The model examines (a) the pain experiences of children, including social determinants; (b) developmental variations in the capacity to encode the severity and qualities of pain as expressive behavior; (c) adult skills and deficiencies in decoding pain; and (d) the actions of adults predicated on the meaning and significance attached to children's actions. Limitations in care were examined.

Data sources: The current research and professional literature were accessed through searches of the Psyclit and Medline databases for relevant investigations on the basis of our working knowledge of the literature.

Conclusion: Numerous deterrents to optimal care are identified in the domains of commonplace beliefs about the nature of pain in infants and children: failure to recognize the impact of socialization in familial and cultural modes of experience and expression; needs for age-specific assessment instruments; the limited capacity to use available evidence concerning pain; the need to employ clinicians, parents, and other adults more effectively in delivering care; and structural problems in the health care system.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Child
  • Family
  • Humans
  • Infant
  • Pain Management*
  • Pain Measurement
  • Social Support*