31 May 2022, Singapore – KK Women’s and Children’s Hospital (KKH), Singapore, is the first hospital outside of the United States and Canada, to be certified by ChildKind International. Childkind assesses and recognises healthcare facilities that have developed institution-wide excellence in the assessment, prevention, management of children’s pain as well as the promotion of pain education.

Professor Alex Sia, Chief Executive Officer, KKH, said, “Compassion drives how we, at KKH, provide care for our patients, famiies and the community. This extends to the way we manage pain. We understand how pain can affect a child, their caregiver and family, which is why we place pain management as a priority. Our care teams, especially our paediatric pain specialists, continually assess and help our young patients manage his or her pain at each and every touchpoint, to make it as comfortable, pain-free and stress-free as possible. The Childkind certification is a testimony to the commitment and hard work of the team, to continually improve our patients’ and their families’ hospital experience.”

ChildKind commended KKH for being “extremely well-organised and immersed in alleviating pain in children”. Some of the highlights include:

  • Senior Management shows strong institution support for the prevention and relief of pain in children, which is recognised as a strategic priority with defined milestones.
  • Ongoing pain-related quality improvement (QI) initiatives and the use of QI data to improve practice.
  • A well-established multidisciplinary Pain Committee – first in Singapore and the region. The Committee comprises doctors, nurses, allied health professionals and administrators from over 20 specialties, and is integral for good pain governance and improvement in clinical management (refer to Annex A).
  • A multidisciplinary Children’s Pain Management Clinic - also first in Singapore and the region - that manages challenging and complex chronic pain in an outpatient setting (refer to Annex A).

Dr Serene Lim, Senior Consultant, Department of Paediatric Anaesthesia, KKH, who was also KKH’s Chief Liaison Officer for the ChildKind certification, said, “Pain affects everyone including newborns. If unaddressed, pain can cause long-term emotional and psychological after-effects.1 The resultant increase in anxiety and fear has a negative impact on both the perception of pain and how one copes with pain.2 To mitigate this, KKH prioritises pain prevention and promotes a multi-modal approach to optimally manage pain in children. We place great emphasis on reducing pain through modalities other than medications, utilising non-pharmacological options such as art, music or hospital play therapy, pain education, and building resilience.”

Patients who have encountered accurate and frequent pain assessments, good pain education and management during their hospitalisations are better empowered to cope with and manage their pain more effectively3. This leads to earlier mobilisation and improves cooperation with physiotherapy, and hence quicker recovery with possibility of earlier discharge. Good pre-planned analgesic prescription and well-controlled pain upon discharge also lead to fewer pain-related hospital re-admissions and an overall improved hospital experience for both the child and family.4,5

To achieve certification, KKH had to demonstrate the following five principles of ChildKind:

  • A hospital-wide commitment to pain prevention, assessment, and treatment.
  • Ongoing education programmes and awareness initiatives on pain for staff, trainees, patients and caregivers.
  • Use of evidence-informed, developmentally-appropriate processes for assessment of acute and chronic pain.
  • Specific evidence-based protocols for pain prevention and treatment including pharmacological, psychological, and physical methods.
  • Regular institutional self-monitoring within the framework for continuous quality improvement.

KKH joins the ranks of 11 other renowned paediatric healthcare institutions in North America such as Boston Children’s Hospital, Hospital for Sick Children (SickKids), and Rainbow Babies and Children’s Hospital, to be recognised for their excellence in pain prevention and management in children.

The ChildKind initiative was conceived in 2008 by the Special Interest Group on Pain in Childhood of the International Association for the Study of Pain to reduce pain in children. The international certification is endorsed by 12 pain-related organisations including the World Federation of Societies of Anesthesia and the American Society for Pain Management Nursing (please refer to Annex B for more information on ChildKind International).

This is the first time that the certification process was conducted virtually due to the COVID-19 pandemic. The ChildKind International certification elevates KKH’s status as the regional leader in paediatric pain management. In the near future, the hospital plans to explore collaborations with Singapore and regional partners to further research and education in paediatric pain management.

1 Taddio A, Katz J, Ilersich AL, Koren G. Effect of neonatal circumcision on pain response during subsequent routine vaccination. Lancet 1997; 349:599–603.
2 Victoria NC, Murphy AZ. Exposure to early life pain: long term consequences and contributing mechanisms. Curr Opin Behav Sci 2016;7:61–8.
3 Wells N, Pasero C, McCaffery, M. Patient safety and quality: an evidence-based handbook for nurses - Chapter 17: Improving the quality of care through pain assessment and management. April 2008.
4 D Janet Pavlin et al. Pain as a factor complicating recovery and discharge after ambulatory surgery. Anesth Analg. 2002 Sep.
5 Tina Hernandez-Boussard, et al. The Fifth Vital Sign Postoperative Pain Predicts 30-day Readmissions and Subsequent Emergency Department Visits. Ann Surg. 2017 September ; 266(3): 516–524.