Surgeons finding even the very young feel pain More premature babies now getting painkillers.

October 28, 1991|By Los Angeles Times

On Feb. 9, 1985, a Maryland housewife gave birth to a baby 3 1/2 months early. Jeffrey Lawson weighed only 1 pound, 11 1/2 ounces, and was 12 3/4 inches long. To survive, the boy needed surgery to tie off an unwanted blood vessel near his heart.

It was an operation often performed on premature babies with underdeveloped cardiovascular-pulmonary systems. Several procedures were done at once.

Jeffrey survived only five weeks after his surgery, which left his parents, Jill and James Lawson, devastated. But the couple was horrified when they learned months later that none of the surgical procedures had been performed under analgesia.

Instead of narcotics -- or even mild pain relievers -- the baby had received only pancuronium, a powerful paralytic drug that stopped all his voluntary muscular movement but did nothing to ease his suffering.

What happened to the Maryland infant was not an anomaly. Until as recently as six years ago, hospitals throughout the United States frequently operated on critically ill premature babies without using painkillers. The tinier and sicker the child, the less likely it received pain medication -- a practice that still occurs in some circumstances, according to pain experts.

"Most adults would be shocked if they saw what was done to children in hospitals without anesthetics," said Dr. Myron Yaster, a leading expert on pediatric pain at Johns Hopkins Medical Institutions in Baltimore. "It's like roping and holding down a steer to brand it."

Newborns are not the only pediatric patients who suffer. According to surveys cited by Ronald Melzack and Patrick Wall in their book "The Challenge of Pain," the vast majority of all ill children -- whether they have cancer, an appendectomy or a broken bone -- have been under-treated for pain, if they are treated at all.

"For a long time, it was assumed that the risks associated with strong analgesics, especially narcotics, were simply too great for youngsters to tolerate," Yaster said. "Moreover, it was thought that babies, especially newborns, do not feel pain. And even if they do, they would not remember it."

Recent research has shown that children do feel pain. While pain medications are not risk-free, there is growing evidence that unrelieved pain poses serious health consequences and long-term psychological dangers.

Recognizing the dangers, a growing number of pediatricians, anesthesiologists, psychologists and nurses are changing the way they treat children in pain.

"I suspect in 10 or 20 years we will look back and see what we were doing to children, and think that this was an uncivilized period in medical history," Yaster said.

A handful of hospitals -- including Harvard's Children's Hospital, Johns Hopkins and the University of California, Los Angeles -- have set up interdisciplinary pain services just for children.

A 1970 study showed that only half the children between the ages of 4 and 8 received painkillers post-operatively, even though some had undergone amputations and open-heart surgery. A study nearly two decades later showed little change. Over half the pediatric surgical patients surveyed in 1987 received no analgesics; the rest got inadequate doses.

Some changes have occurred because parents have spoken out. After her baby's death, Jill Lawson wrote letters to medical societies and lawmakers. At first no one listened; eventually doctors began to take note.

In 1987, two years after Jeffrey Lawson's death, the American Academy of Pediatrics stated that it was no longer ethical to perform surgery on preterm babies without anesthetic.

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