TABLE 1.

Characteristics of included studies

First author (reference), year	Age	Surgery	Sample size	Control	Intervention
Chambers et al (24), 1997	2–12 years; mean ± SD 4.3±2.4 years	Tonsillectomy and adenoidectomy, circumcision, hernia repair, strabismus ± repair, orchidopexy, dental extraction and restorations	n=82; control, n=27; pain education, n=27; pain assessment, n=28	Written information: General surgery preparation pamphlet in addition to ‘standard care’ Administered preoperatively by mail	Pain education and assessment: Additional written information: sources of pain, measuring pain, and pharmacological, psychological (eg, distraction) and physical (eg, massage) treatments for pain. Pain assessment only: Additional written information on measuring pain. Both booklets provided preoperatively by mail
Sutters et al (28), 2004	6–15 years	Tonsillectomy ± adenoidectomy ± myringotomy	n=80; control/PRN, n=28; ATC n=26; ATC + nurse coaching, n=26	Written information: Dose administration, instructions on activity restrictions, school attendance, postoperative bleeding, diet, ear and throat pain, analgesic administration, possible changes in sleep patterns, expected appearance of the back of the throat, fever and the follow-up appointment with the surgeon. Timing of provision unclear	ATC: Additional written information: Instructions in use of digital timer to remind of dose. Timing of provision unclear. ATC + coaching: Written information from ATC group. Additional verbal information and coaching: evaluation of the child’s current condition, review of the pain intensity scores, verification that the child was taking the pain medication, re-education regarding the rationale for ATC dosing, review of strategies to facilitate medication administration, and re-education about potential side effects associated with analgesic administration. Provided during follow-up telephone calls
Franck et al (25), 2007	6–12 years	Planned day surgery	n=25: control, n=10; intervention, n=15	Verbal information: Pain assessment and use of paper pain scale. Provided preoperatively	Pain assessment only: Additional verbal information on use of temporary tattoo of Wong-Baker Faces Pain Scale. Tattoo placed postoperatively
Helgadottir (26), 2007	3–7 years; mean ± SD 5.27±1.12 years	Tonsillectomy with/ without minor procedures	n=27: control n=13; intervention, n=14	Verbal and written information: ATC medication dosing instructions (including waking at night for dose), education about types of acetaminophen, pain assessment, consequences of inadequate pain management, education about addiction. Timing unclear	Nonpharmacological strategies: Additional verbal and written information: use of distraction. Timing unclear
Unsworth et al (30), 2007	4–12 years	Tonsillectomy ± adenoidectomy ± grommet insertion	n=72: control, n=39; intervention, n=33	Verbal information: Analgesic administration instructions: administer paracetamol for mild pain, or ibuprofen for moderate to severe pain. Administer codeine if pain not improved within 1 h. No instructions on how to determine mild, moderate or severe pain. Provided postoperatively	Pain assessment only: Modified verbal information: instructions in use of Wong-Baker Faces Pain Scale. Analgesic administration instructions based on Wong-Baker score (paracetamol for scores 1, 2 and 3, ibuprofen for scores 4 and 5. If child reported a score of 5 1 h after ibuprofen, administer codeine). Provided postoperatively
Kankkunen et al (27), 2009	1–2 years; mean 22 months	Day surgery	n=50: control, n=19; intervention, n=29	Verbal information: Timing and dosing the analgesics, contact information for the surgical ward. Timing unclear	Pain assessment only: Instructions on use of Parent’s Post-Operative Pain Measure. Timing unclear
Sutters et al (29), 2010	6–15 years	Tonsillectomy ± concurrent minor procedures	n=113: PRN, n=39; ATC, n=34; ATC + nurse coaching, n=40	Same as Sutters et al (28), 2004	ATC, ATC + coaching: Same as Sutters et al (28), 2004
Vincent et al (31), 2012	7–17 years; mean ± SD 13.7±2.5 years	Any child hospitalized for at least 23 h and sent home with an analgesic prescription	n=108: control, n=55; intervention, n=53	Standard care: No protocol, health care provider-dependent	Pain education and assessment: Verbal and written information: consequences of unrelieved pain, pain assessments, pharmacological and nonpharmacological treatment and concerns about analgesics. Assess parent understanding of analgesics’ adverse effects and of addiction. Timing unclear

ATC Around the Clock; PRN Pro re nata, as needed