Introduction

Problem statement

Medical procedures and interventions in the hospital for the purpose of diagnosis, treatment and care are often the cause of significant pain and discomfort in children. Pain, discomfort, anxiety and fears are exacerbated by the unfamiliar surroundings, with “strange-looking” people and equipment, and the fact that the child’s significant others (parents, siblings, friends) are not always present.
Even in developed countries, pain management and control in children remains inadequate. Recent research has shown that children, even neonates in intensive care, undergo many painful procedures without effective pain management.(1) Also, infants and children may experience pain more intensely than adults, and untreated and/or repeated pain early in childhood can affect the neurological pain response and result in psychological manifestations, comparable to post-traumatic stress disorders.(2) Behavioral measures of pain (assessments based on observations) often underestimate the pain experienced by the child, as measured through neurological responses. Paradoxically, new life-prolonging treatments and cures for severe and life-threatening diseases, such as cancer, result in children undergoing more painful medical procedures, often over long time-spans.
Evidence has shown that pain can be controlled not only with medications, but also with non-pharmacological interventions (cognitive – behavioral methods).(3) These non-drug interventions are used even less by health care workers than pharmaceutical pain relief, despite the fact that they are not difficult to teach; they lack some of the side effects of pharmacological methods; and they may also help young patients restore their sense of self control and foster active participation in their care.

Project background

The project “Hospital – a friend to children and families” proposes to introduce the child- and family-centered care approach of Central European and North American hospitals to pediatric hospitals in Serbia. It is expected that this approach will contribute to a humanization of the hospital environment; contribute to faster recovery of the pediatric patients; and increase the satisfaction of the involved hospital workers and families with the care provided. In the longer term, it is expected children will suffer less from trauma caused by their presence in the hospitals during their childhood.

The project entails some changes in hospital policies, the education of doctors, nurses, psychologists and other supporting non-medical staff about child rights, development, pain management, hospital play, preparation/coping and communication and also entails some low-cost improvements in the hospital setting.

Hospital personnel will acquire:

  • An understanding how a child’s developmental level affects his/her response to illness and hospitalization, and how the latter can affect a child’s development
  • Tools and approaches that help children cope more effectively with hospitalization, clinic visits, diagnostic and therapeutic procedures
  • An understanding of the key features of a hospital that provides child- and family-centered care
  • Techniques that can assist health workers to improve their communication skills and share relevant information with children, families and other healthcare workers
  • Techniques that support hospitalized children in managing pain, taking into account the level of pain, the child’s developmental level and family support

The hospital environment will be adjusted to:

  • Allow for play and learning in the hospital setting and during daily routines
  • Increase the participation of the child and family in the child’s care, while at the same time assuring full safety and quality of care

The project builds on the foundation of the UN Convention of the Rights of the Child and the European Child-friendly Hospital initiative.


Hospital personnel will acquire
-(1)International Association for the Study of Pain (2005). Pain Clinical Updates. Why children’s pain matters. XIII (4).
-(2)Kortesluoma, R., Nikkonen, M., & Serlo, W. (2008). “You just have to make the pain go away” Children’s experience of pain management. Pain Manag Nurs., 9(4), 143-149.
-(3)International Association for the Study of Pain (2006). Pain Clinical Updates. Psychological interventions for acute and chronic pain in children. XIV(4).