Research aims to relieve pain children feel in emergency departments

Samina Ali. Photo: William Au.

It takes only an hour in a pediatric emergency department to realize how acutely children feel pain, says Samina Ali, an emergency physician at the Stollery Children’s Hospital. 

“It’s such a unique and horrible cry.” 

Six out of 10 children arrive in pediatric emergency departments (EDs) with painful conditions, says Ali. Then they may undergo numerous distressing or painful procedures, such as getting their blood drawn and having IVs inserted or being prepared for emergency surgery. 

Ali and her research team aim to substantially ease all pain felt by ill or injured children in EDs. As the research director for PEAK (Pediatric Emergency Advancing Knowledge)—a 20-person group that includes doctors, nurses, co-ordinators, facilitators, physician trainees, graduate students and volunteers from the Stollery’s ED and the University of Alberta—she’s steering innovative solutions via clinical trials and pilot programs. 

Since 2010, dozens of PEAK-led studies have been completed. Ali also collaborates with a national body of children’s hospital research groups called PERC (Pediatric Emergency Research Canada) and serves as vice-chair.

One PEAK study underway is the Canada-UK AI Study, an international pilot project that equips robots with artificial intelligence so they can read children’s moods and distract them with singing, dancing and stories, or provide them with age-appropriate information about their treatment. A PEAK clinical trial, the No OUCH Study, is determining which of three pain-killing options are most effective for children suffering fractures or sprains. Another trial is testing whether certain medications could allow children with bronchiolitis to avoid hospital stays. 

PEAK’s newest project is Laughter is Good Medicine, which will evaluate the impact of therapeutic clowns in the waiting rooms of the Stollery’s ED.  

“These are not your garden-variety birthday party clowns,” says Ali. Therapeutic clowns use techniques already proven effective to reduce stress in seniors’ homes and long-term care facilities. The Stollery clowns will be trained for pediatrics and will be able to identify those too unwell to interact. 

The project is unique because it targets parents and caregivers first, so that their stress is not transmitted to the children. It takes place in waiting rooms, which parents have identified as the most distressing place in an ED. The PEAK team hopes to replicate other research showing that clowns improve the moods of healthcare workers, too. The project is scheduled to start in spring 2023.

“The Stollery Children’s Hospital Foundation and its generous donors are critical to our goals,” says Ali. “Until the 1980s, the medical profession thought children didn’t feel or remember pain. Because of PEAK’s projects, children are getting better research and clinical care and less frightening experiences in emergency departments across Canada.”

Being educated on the availability, use and science behind pain medication is the number one concern of a parent in a pediatric ED, says Rebecca Liedtke, the mother of a five year old diagnosed at age two with cancer. She appreciates PEAK projects that provide information on posters, from iPads and robots in the ED to relieve unknowns and use waiting time productively. “And having a clown come would completely change the atmosphere!” 

Samina Ali is supported by the Stollery Children’s Hospital Foundation through the Women and Children Health Research Institute.