[Evaluation of analgesics in children. Round table no. 5. XV].

Despite recent progress, childhood pain in France is still underevaluated and undertreated and its treatment very heterogeneous among clinicians and health care providers. Pain assessment is often a difficult task in this population. The ontogeny of nociceptive pathways, their maturation, and their functionality during development are not completely understood. Painful sensations primarily involve the child's own experience but can be modified, influenced by his/her parents and the psychosocial environment with their own experience of pain and anxiety. The use of analgesics cannot be precisely quantified using retail sales data. However, the 'Pediadol' survey has demonstrated that their use in children experiencing painful situations is definitely insufficient. Also, another survey conducted among pharmacists showed that at least one-third of analgesics approved for adults are not licensed for paediatric use, sometimes due to inadequate drug formulation. The situation is even more critical for young infants and neonates for whom there are even fewer available approved analgesics. A number of issues need to be addressed in order to improve pain management in children. First of all, evaluation of pain should be generalized. Auto-evaluation should be used in children over 6 years of age. Under 6 years, the initial step would be to further evaluate and validate hetero-evaluation scores. Second, analgesics should be evaluated in order to be licensed for paediatric use. When possible, data obtained in adults or older children should be used and studies in younger infants performed only when necessary. Finally it is of paramount importance to continue to increase paediatricians' and health care providers' awareness of the existence of pain in children and to train them to evaluate pain and treat it appropriately.