Fractures are an extremely common injury sustained by children. Experts say broken bones are probably the most common reason for a child to visit an orthopedic surgeon.
Typically, children with a broken bone either need to have the bone set or reduced or else just have a cast put on without setting or reducing it.
Dr. Jan Luhmann, from St. Louis Children's Hospital, said there are two different types of broken bones. Ones that are not angulated or displaced -- they're already lined up fine -- would only require a cast.
Patients who have a fracture that is either displaced or angulated -- meaning that the bone is bent -- need to have those bones set before they're put in a cast.
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Nitrous Oxide
Laughing gas used on kids during treatment for severe trauma.
 
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"Those are much more painful fractures. Pain related to orthopedic trauma -- especially fractures like that -- are the most painful emergencies that we take care of," Luhmann said.
Studies have shown adults are much more likely -- about two to one -- to get pain medications for fracture pain.
Luhmann said she believes children are usually given pain medications for the actual setting or reducing of the bone.
"For the pain control prior to the setting, children, in most circumstances, are probably under-treated for it," Luhmann said.
She said part of this may be the misperception that children don't experience as much pain as adults.
"They don't communicate their pain to us. They cry, and sometimes, unfortunately, that's interpreted as normal baby or child behavior rather than painful behavior," she said.
Even when children are given pain mediations, those medications often come in a needle. Luhmann said the biggest fear, and cause for anxiety, in many children who come to the hospital, is the fear of needles. Because of this fear, Luhmann is interested in other systems for delivering pain medication.
She and colleagues at St. Louis Children's Hospital are studying nitrous oxide otherwise known as laughing gas. She said researchers began experimenting using NO as a pain reliever in children a few years ago, but had little luck with the gas.
She said that could be because the system under study was an adult-oriented system.
"You have to take a very deep breath to trigger the machine to get the medicine in order for it to work. We feared that many people who tried nitrous oxide and thought it just didn't work in children had used the same type of equipment, had a
similar experience, and just gave up on it," Luhman said.
Researchers and biomedical technicians at St. Louis Children's Hospital devised a system that was more child-friendly. The kid-size system doesn't require those deep breaths to work, and they even use scented sprays in the masks before placing them on the children. The results look promising.
"Many children laugh through the whole procedure. It reduces pain in mild to moderate situations when it's used alone, it reduces anxiety, and it reduces memory of the event," Luhmann said.
She also said parents also notice the benefits.
"Parents are extremely pleased to have their child laugh through the procedure rather than cry or scream or show signs of anxiety and distress," she said.
She adds that the gas is very safe in children and that no serious adverse effects have been reported with NO. She points out that the effects of the gas wear off within minutes of removing the mask.
