Sickle cell pain control

Our commitment to pain management

The health care team at Children's Minnesota believes that infants and children have a right to the best level of pain relief that can be safely provided. Therefore, we take a team approach to pain and anxiety management using drug and non-drug therapies. Our goal is to have staff and families work together to evaluate pain promptly and treat it effectively.

How can I care for my child?

Give extra fluids.

While the pain continues have your child drink about double the normal amount of water or any clear liquid. Examples are juice, ice chips, broth, soda, Jell-O®, Popsicles®.

The amount your child needs is based on weight. Check the chart for the amount to give during each 24 hours while in pain.

Weight in pounds (lb.)	Number of 8-ounce cups per day
10 lb.	2 cups
15 lb.	3 cups
20 lb.	4 cups
25 lb.	5 cups
30 lb.	5 to 6 cups
35 lb.	6 to 7 cups
40 lb.	7 cups
50 lb.	8 cups
60 lb.	9 cups
More than 60 lb.	10 or more cups

Give pain medication (see home medication list for dosing).

It is important to let your hematology provider know at a clinic visit that your child needs more opioids. Opioid medications cannot be called to a pharmacy.

Medication	Indication	Time
Ibuprofen (Motrin® or another brand)	Mild to moderate pain	Every 6 hours
Acetaminophen (Tylenol® or another brand)	Mild to moderate pain	Every 6 hours
Tramadol	Moderate or severe pain	Every 6 hours
Oxycodone	Moderate or severe pain	Every 6 hours

Alternate ibuprofen and acetaminophen so your child is receiving something every 3 hours. If having moderate pain, add tramadol or oxycodone every 6 hours in addition to tylenol and ibuprofen. Do not take both the tramadol and oxycodone, just take one of them. Continue this for 24-48 hours, then gradually give them less often, according to how your child feels. If child is sleeping, wake them to give pain medication to prevent uncontrolled escalation of pain.

Chronic Pain

Chronic pain is different than acute pain. If having chronic pain, make sure to take your daily chronic pain medications and perform your wellness activities. Contact your provider if needed for further instructions or advice.

Give constipation medication.

If your child is having hard stools, pain with bowel movements or a difficult time stooling, increase fluids and give constipation medications as prescribed (see home medication list, some common medications include miralax, colace and senna). Constipation is common with sickle cell disease and also common when taking opioids.

What else can I do for pain?

• Give warm baths.
• Use a warm moist towel or a heating pad. Make sure they are warm, not hot. Check the skin often to make sure it is not getting too warm.
• Gentle massage of the area that hurts can be helpful.
• Relaxation and distraction, such as quiet games, stories, music, or videos may help your child focus on other things.

When should I call the clinic?

Call for advice if:

• vomiting, unable to keep medicines or fluids down
• diarrhea
• pain increases, or lasts longer than 72 hours
• any concerns

Call to be seen right away if:

• fever: temperature of 101.5º F (38.6º C) or higher
• severe headache
• dizziness
• breathing problems
• chest pain
• severe stomach pain
• swelling in abdomen (belly)
• painful erection of the penis
• any type of seizure
• weakness
• unable to move part of the body

If you cannot contact your provider, go to the emergency room.

Questions?

This information is for general use only.  For specific medical advice or questions, consult your health care provider.

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