Authors: Bahise Aydın, Meyase Demir, Vahide Sarı
Categories: Research, Mothers, Child, Pain management, Drugs
Source: BMC Pediatrics
Authors: Bahise Aydın, Meyase Demir, Vahide Sarı
Pain is a common health problem and a leading reason for hospital admissions in children. Rational drug use is crucial in pediatric pain management, especially for young children who rely on their parents.
This study aimed to determine the attitudes of mothers of children aged 0–6 years toward rational drug use in pain management.
This descriptive, cross-sectional, and correlational study involved 403 mothers attending pediatric outpatient clinics at a university hospital. Data collection took place between April and June 2024 using a personal information form and the Parental Attitude Scale Towards Rational Drug Use (PASRDU). Data analysis included the Mann-Whitney U test for pairwise comparisons, the Kruskal-Wallis H test for groups larger than two, and Spearman Correlation analysis for variable relationships.
The mean age of the mothers was 31.60 (± 5.328) years; 45.4% had one child, and 50.9% held a university degree or higher. The mean PASRDU score was 174.01 ± 17.225. A statistically significant positive attitude towards rational drug use was linked to younger mothers, those with fewer children, and those with higher education and socioeconomic status (p < .005). PASRDU scores were also higher among mothers who reported greater self-efficacy in relieving their child’s pain and those who did not administer non-prescribed analgesics (p < .005).
Mothers generally exhibited high attitudes toward rational drug use in pain management. Attitudes varied by age, education, number of children, socioeconomic status, self-perceived competence in pain management, and use of non-prescribed medications. Nurse-led assessment and tailored education may support rational drug use in pediatric pain management.
Not applicable.
Children often experience pain, which is one of the most frequent reasons for seeking medical care [1]. Children admitted to hospitals often experience pain due to pathology, surgery, medical treatment, and other procedures [2]. Research in the literature has shown that many children suffer from severe pain at home after discharge from surgery [3, 4]. A large number of these children go back to the hospital for pain that does not get better [5].
After being discharged from the hospital, it is very important to manage children’s pain at home. Parents, the principal caregivers, play an active role in this process. Proper administration of medications, non-pharmacological methods appropriate to the child’s age and condition, consistent assessment of the child’s pain, and consulting a health care professional in case of persistent pain are important components of pain management. Therefore, education delivered by healthcare professionals is vital for optimal pain management [6].
Studies in literature indicate that post-operative pain management in children is often inadequate [3, 4]. A study conducted in the United States with children aged 2–15 years who were discharged after surgery found that 21% of them received insufficient doses of painkillers from their parents throughout the entire week following surgery [3]. In such cases, inadequate pain management can lead to serious consequences for children. Untreated pain can result in physiological problems (e.g., delay in returning to normal functionality, prolonged healing, etc.), psychological issues (e.g., stress, anxiety, etc.), social challenges (e.g., reduced peer interactions, delayed social development, etc.) and financial burdens (e.g., increased healthcare costs, higher expenses for medication and medical supplies, etc.) for both the child and the family [5, 7]. The primary causes of untreated pain in children are often related to parental factors, including failure to recognize the child’s pain, disbelief in the child’s pain perception, fear of drug side effects, a tendency to administer lower-than-prescribed doses of analgesics, or even skipping doses despite the child experiencing pain [8]. Additionally, child-related factors such as fear, anxiety, and difficulty swallowing, when combined with drug- and system-related factors such as incorrect medication forms and dosages, as well as lack of information, create a significant patient safety issue [3, 6]. Medication-related harm is one of the most common patient safety concerns, and one of the key strategies to prevent this issue is providing parents with education on rational drug use delivered by trained healthcare professionals [9].
The World Health Organization defines rational drug use as the ability of individuals to obtain and use appropriate medications according to their clinical findings and personal characteristics, in the correct dose and duration, at the lowest possible cost, and with ease of access [10]. Parental attitudes and behaviors play a critical role in ensuring rational drug use practices in children. Nurses have a central role in providing education and counseling to parents, as medication administration in children differs substantially from that in adults due to their psychological and developmental characteristics [11]. Irrational drug use contributes to increasing morbidity and mortality in childhood infections and various chronic diseases, resulting in adverse health outcomes [12]. By promoting rational drug use, it is possible to minimize the undesirable effects of medications and prevent adverse outcomes that may compromise health [13].
In most societies, mothers assume primary responsibility for childcare and play a vital role in preparing and administering medicines at home. Nevertheless, in the literature, mothers have been cited as having a deficiency regarding rational drug use [14, 15]. For example, a study found that 63.1% of mothers with children under 5 years used over-the-counter medicines, with 13.5% giving non-prescribed analgesics [16]. Although mothers of hospitalized children aged 0–6 generally had positive attitudes toward rational drug use, older mothers and those with four or more children had lower attitude scores [14]. Other inappropriate practices include administering medications not prescribed by physicians, not adhering to prescribed durations for antibiotics, not using the spoon provided with suspensions, mixing medications with food, and keeping leftover medicines. Such practices may lead to medication errors and harm, including the administration of wrong medication, inappropriate dose or formulation, insufficient therapeutic effect, adverse reaction, and intoxication. As children are entirely dependent on a caregiver between the ages of 0–6, rational drug use is essential for children [11].
A review of the literature suggests that evidence is limited regarding mothers’ attitudes toward rational drug use, specifically in the context of home-based pediatric pain management [3, 8, 15–17]. Considering that children aged 0–6 years are highly dependent on their caregivers for health practices and daily care, understanding maternal attitudes in this area is essential for identifying medication safety risks and guiding the content of parent education programs. Therefore, this study aimed to assess the attitudes of mothers with children aged 0–6 years toward rational drug use in pain management.
Research Questions:
What are the mean scores of mothers regarding rational drug use?What are the factors influencing mothers’ rational drug use in their children’s pain management?
This study is cross-sectional and correlational in design.
The study was conducted between April and June 2024 in the pediatric outpatient clinics of Çanakkale Onsekiz Mart University Hospital, Çanakkale, Türkiye, a tertiary, university-affiliated general hospital that serves as a regional tertiary referral center and provides comprehensive pediatric care. The hospital has 565 inpatient beds, 96 intensive care beds, 16 neonatal intensive care beds, and 90 outpatient clinics. Data were collected in pediatric outpatient clinics, including general Pediatrics/Child Health and Diseases and 10 pediatric subspecialty clinics (e.g., Pediatric Surgery, Pediatric Infectious Diseases, Pediatric Endocrinology). These clinics provide outpatient assessment and follow-up for acute and chronic pediatric conditions, serve children from infancy through adolescence, and accept both scheduled and walk-in visits on weekdays.
Hospital records indicated that 6947 children attended the pediatric outpatient clinics between January 2022 and January 2023; this figure was used as the population size (N) for sample size estimation. The sample size was calculated using a sample size formula [18]. Because no prior prevalence estimate was available for the target outcome, the most conservative expected proportions were assumed (p = .5, q = 0.5). This value represents the most conservative estimate and is commonly used to maximize sample size when prevalence is unknown. At a 95% confidence level (t = 1.96) and a margin of error of 0.05, the minimum required sample size was calculated to be 364 mothers. Considering a potential dropout rate of 10%, the final targeted sample size was set at 400. This study was completed with 403 mothers.\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$ :n=\frac{\mathrm{N}{t}^{2}\mathrm{p}\mathrm{q}}{{\mathrm{d}}^{2}\left(\mathrm{N}-1\right)+{\mathrm{t}}^{2}\mathrm{p}\mathrm{q}}
\usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$ \:n=\frac{6947\times\:{\left(1.96\right)}^{2}\times\:0.5\times\:0.5}{{\left(0.05\right)}^{2}\left(6947-1\right)+{\left(1.96\right)}^{2}\times\:0.5\times\:0.5}=364 $$\end{document} N: Population size **(6947) ** n: Required sample size **(364)** p: Estimated prevalence (assumed as **0.5 **due to lack of prior prevalence data) q: 1-p **(0.5)** t: The theoretical value corresponding to the desired confidence level **(1.96 for 95% confidence)** d: The acceptable margin of error **(0.05)** A non-probability consecutiv e (convenience) sampling approach was used. The sampling frame comprised all mothers who attended the pediatric outpatient clinics during the study period and met the eligibility criteria. Eligible mothers were consecutively invited on data-collection days until the target sample size was reached. Inclusion criteria Age ≥ 18 years, having at least one child aged 0–6 years, ability to read and speak Turkish, and willingness to participate. In addition, mothers reporting a diagnosed mental health disorder were excluded; this criterion was assessed via self-report during recruitment. ### Data collection After providing written informed consent, mothers completed paper-based (printed) data-collection instruments in the outpatient clinic. Completion took approximately 15 min. The study data were collected using the Personal Information Form and the Parental Attitude Scale for Rational Drug Use. #### Personal Information Form Developed by the researchers based on the literature, this form comprises 21 10 questions on mothers’ sociodemographic characteristics and 11 on pain management and caregiving practices [19, 20]. In addition to sociodemographic and clinical characteristics, the Personal Information Form included items assessing mothers’ recognition of their child’s pain (e.g., behavioral cues such as restlessness, vocalizations, sleep changes, and facial expressions) and the strategies used at home to relieve pain (e.g., seeking healthcare, comforting behaviors, administering medication, and massage). The Personal Information Form included an item assessing self-reported socioeconomic status operationalized as perceived household income relative to expenses (income less than expenses, income equal to expenses, or income higher than expenses). #### Parental Attitude Scale for Rational Drug Use (PASRDU) Developed by Çelebi (2018), this 40-item scale is rated on a 5-point Likert format and comprises two accurate and conscious use (29 items) and effective and safe use (11 items). Total scores range from 40 to 200, with higher scores indicating more positive parental attitudes toward rational drug use. Cronbach’s alpha coefficient for the original scale was reported as 0.88 [13]. In the present study, Cronbach’s alpha coefficient for the total scale was 0.89. ### Data analysis The data were analyzed using SPSS 26.0 (Statistical Package for the Social Sciences). Descriptive statistics, including frequencies, percentages, means, and standard deviations, were used to examine participants’ characteristics. The Kolmogorov-Smirnov test indicated that the data were not normally distributed. Therefore, the Mann-Whitney U test was used for comparisons between two groups, and the Kruskal-Wallis H test was applied for comparisons involving more than two groups. Relationships between variables were assessed using Spearman’s correlation analysis. The level of statistical significance was set at *p* < .05. ### Ethical consideration #### Ethical approval for the study was obtained from the Ethics Committee of the Graduate Education Institute of a university (No: E-84026528-050.01.04-2300263667, Date: 30.10.2023) and from the hospital directorate. Prior to data collection, the purpose of the study was explained to the mothers, the informed consent form was presented, and written consent was obtained. Permission to use the scale was obtained via email from the original author. ## Results The mean age of the participating mothers was 31.60 ± 5.33 years, and their children were 25.99 ± 24.30 months. Of the children, 50.6% were male, 84.1% had no congenital or chronic disease, and 88.1% did not use any medication regularly. PASRDU total scores varied by maternal age group, number of children, maternal education level, and income status (*p* < .005). Higher PASRDU scores were observed among mothers aged 18–28 years, those with one child, those with a university education or higher, and those with income exceeding expenses (Table 1). Table 1Comparisons of parenteral attitude scale for rational drug use scores according to mothers’ sociodemographic characteristics (*n* = 403)CharacteristicsMean ± SD *n* %PASRDU Score(Mean ± SD)Test*p* valueMaternal age (years)31.60 ± 5.32818–2811829.3177.75 ± 14.6096.289*0.04329–3519748.9172.55 ± 18.23736–518821.8172.25 ± 17.540(1 > 2, 1 > 3) Games-HowellNumber of children1.70 ± 0.718118345.4176.96 ± 15.70312.039*0.002215939.5172.71 ± 18.167≥ 36115.1168.56 ± 17.595(1 > 3) Games-HowellMaternal educationIlliterate92.2 155.22±16.430 33.227* 0.000Literate30.7 160.67±6.429Primary school8120.1 167.09±20.334High school10526.1 174.18±14.849University or higher20550.9 177.68±15.760(1 < 4, 1 < 5, 3 < 5)Games-HowellMaternal employmentEmployed10325.6175.41 ± 16.23414498.500**0.351Unemployed30074.4173.53 ± 17.553Family typeExtended family307.4171.20 ± 25.7111.918*0.383Nuclear family36991.6174.38 ± 16.284Other (single parent)41.0160.75 ± 22.5891.918*0.383Socioeconomic statusIncome < expenses6516.1170.52 ± 16.4449.253*0.010Income =expenses27267.5173.90 ± 16.615Income > expenses6616.4177.91 ± 19.75(1 < 3) Games-HowellChild’s age (month)25.99 ± 24.3041–1218846.7174.62 ± 16.4601.314*0.51813–369523.6174.02 ± 19.89237–7712029.8173.05 ± 16.200Child’s genderFemale19949.4173.48 ± 17.83819652.000**0.580Male20450.6174.53 ± 16.633Presence of congenital/chronic diseaseYes6415.9173.78 ± 14.90710429.500**0.624No33984.1174.05 ± 17.648Regular medication useYes4811.9175.15 ± 15.0108307.500**0.779No35588.1173.86 ± 17.516 **Kruskal-Wallis test* ***Mann-Whitney U test;* Statistically significant *p*<.05 In this study, nearly half of the mothers (48.9%) reported attending the outpatient clinic due to illness; the remaining visits were primarily for routine screening/check-ups (47.1%), with a small proportion for heel prick/blood draw (0.5%) or other reasons (3.5%). Among mothers, 79.4% reported that their children were not experiencing pain at the time of data collection. Among mothers who reported that their children had pain, 50% indicated that the duration of pain was 1–3 days, 35.5% reported that the pain was in the abdomen, and 43.5% described the pain intensity as moderate. While 66% of mothers perceived themselves as competent in recognizing their child’s pain, 55.3% believed that the individual practices they implemented were partially effective in relieving pain, and 63% reported that they sometimes felt inadequate in alleviating their child’s pain. Additionally, 17.4% of the mothers reported administering non-prescribed medication to their children when they experienced pain (Table 2). Table 2Comparison of parenteral attitude scale for rational drug use scores according to mothers’ pain management characteristics (*n* = 403)CharacteristicsMean ± SD *n* %PASRDU Score(Mean ± SD)Test*p* valueReason for clinic visitHeel prick/blood draw20.5174.50 ± 27.5770.272*0.965Illness19748.9173.28 ± 18.456Routine screening/check-up19047.1172.51 ± 15.736Other143.5173.93 ± 19.089The child currently has pain.Yes6215.4171.47 ± 16.4452.389*0.303No32079.4174.64 ± 17.329Do not know215.2171.95 ± 17.840Duration of child’s pain (days) (*n* = 62) 27.16 ± 87.01–33150.0167.06 ± 17.5913.870*0.1444–71625.8172.44 ± 15.214≥ 81524.2177.27 ± 12.555Pain location (*n* = 62)Abdomen2335.5172.55 ± 14.3880.7080.702Throat2133.9169.52 ± 14.902Other1830.6170.06 ± 20.4090.7080.702Pain intensity (*n* = 62)Mild2540.3172.12 ± 16.0661.204*0.548Moderate2743.5168.30 ± 17.360Severe1016.1175.00 ± 13.524Perceived competence in recognizing a child’s painCompetent26666.0174.09 ± 17.4224.466*0.215Partly competent12230.3174.93 ± 16.616Inadequate153.7165.07 ± 17.165Perceived effectiveness of practices to relieve painEffective17443.2174.40 ± 17.6960.362*0.835Partly Effective22355.3173.59 ± 17.038Ineffective61.5178.33 ± 9.750Self-evaluation of the ability to relieve the child’s painCompetent11729.0175.42 ± 19.13811.742*0.003Sometimes inadequate25463.0174.62 ± 15.746Inadequate327.9164.00 ± 18.425(1 > 3, 2 > 3) Games-HowellGiving non-prescribed analgesics when the child has painYes7017.4166.17 ± 13.99715990.500**0.000No33382.6175.66 ± 17.403*Kruskal-Wallis test**Mann-Whitney U testStatistically significant *p*<.05 Group comparisons showed differences in PASRDU total scores based on mothers’ self-evaluation of their ability to relieve their child’s pain and on non-prescribed medication use when the child was in pain (*p* < .005; Table 2). Mothers who reported being competent in relieving their child’s pain had higher PASRDU total scores than those who reported being inadequate or sometimes feeling inadequate (*p* < .005; Table 2). Mothers who reported not administering non-prescribed medications when their child experienced pain had higher PASRDU total scores than those who reported administering such medications (*p* < .005; Table 2). The mean score of mothers on the parental attitudes scale toward rational drug use was 174.01 ± 17.225 (Table 3). Table 3Distribution of scores on the parenteral attitude scale for rational drug use (*n* = 403)Scale and SubscalesMean ± SDMin-MaxScale Score RangeCorrect and Conscious Use (subscale)131.85 ± 12.83441–14529–145Effective and Safe Use (subscale)42.16 ± 8.82811–5511–55Total Score174.01 ± 17.22565–20040–200 Pain recognition cues included restlessness (64.8%), vocalizations (58.3%), sleep changes (difficulty sleeping or excessive sleeping; 37.7%), and facial expressions (36.7%). Reported pain-relief strategies included seeking care at a healthcare facility (78.2%), holding or comforting the child (51.6%), administering medication (48.9%), and massage (47.4%). Correlation analyses identified very weak negative correlations between PASRDU total scores and mothers’ age (*r* = − .112, *p* < .05), number of children (*r* = − .171, *p* < .01), and self-evaluation of ability to relieve the child’s pain (*r* = − .130, *p* < .01). The PASRDU total score showed positive correlations with maternal education level (*r* = .268, *p* < .01) and socioeconomic status (*r* = .150, *p* < .01). It also correlated with non-prescribed medication use when the child was in pain (*r* = .244, *p* < .01). Non-prescribed medication use was negatively correlated with maternal age (*r* = − .112, *p* < .05), number of children (*r* = − .129, *p* < .01), and self-evaluation of ability to relieve the child’s pain (*r* = − .128, *p* < .05; Table 4). Table 4Correlations between selected variables and parenteral attitude scale for rational drug use scoreVariable12345671. PASRDU Total Score12. Maternal age-0.112*13. Maternal education0.268**0.09314. Number of children-0.171**0.287**-0.384**15. Socioeconomic status0.150**0.0060.197**-0.08716. Self-evaluation of ability to relieve the child’s pain0.130**0.043-0.0340.073-0.104*17. Giving a non-prescribed analgesic when the child has pain0.244**-0.112*0.016-0.129**0.025-0.128*1* *p* < .05 ** *p* < .01 ## Discussion Mothers are primary caregivers of their children and manage their daily illnesses at home; therefore, their medication-related decisions may directly influence child health and medication safety. In this context, this study examined mothers’ attitudes toward rational drug use in pediatric pain management and the factors associated with these attitudes. Accordingly, mothers in the present study had high attitude scores toward rational drug use, reflecting an overall positive orientation to appropriate medication practices and medication safety. Prior studies reported varying levels of parental attitudes, with some identifying high levels of rational drug-use attitudes [21, 22] and others reporting moderate levels [15, 23, 24]. This variability may reflect differences in sample characteristics and contextual factors, including sociodemographic profiles, access to healthcare, study settings, and children’s health status. Based on the literature, several factors are associated with the rational drug use attitude of mothers. Research has shown that younger mothers [25], those with higher educational attainment [16, 25, 26], those with higher income [16, 26], and mothers with fewer children [24, 25] tend to have more positive attitudes. Consistent with this evidence, the present study showed that mothers aged 18–28 years, mothers with one child, mothers with a university degree or higher, and mothers whose income exceeded their expenses had higher attitude scores. These patterns can be explained, in part, by enhanced health literacy and greater access to reliable health information among younger and more educated mothers, which may support more informed decision-making in childcare and illness management. Additionally, higher socioeconomic status may facilitate access to healthcare services and evidence-based resources, thereby supporting safer and more rational medication use. In this study, mothers with higher self-efficacy in relieving their child’s pain reported more positive attitudes toward rational drug use. Likewise, a study of Korean parents reported that those with higher self-efficacy in managing postoperative pain showed more positive attitudes toward analgesic use [27]. These findings underscore the importance of maternal knowledge and self-efficacy in promoting rational medication practices within home-based pediatric pain management. In particular, gaps in mothers’ knowledge regarding pain assessment and analgesics have been shown to limit rational medication use at home and to complicate children’s pain control [19]. Therefore, interventions that combine pain-assessment education with skills-based coaching may help strengthen parental self-efficacy and support safer home pain management. In the current study, mothers who stated that they did not give a non-prescribed drug when their child experienced pain had higher attitudes toward rational drug use than those who did. A similar pattern has been reported previously [25]. In the present sample, 17.4% of mothers reported administering non-prescribed analgesics when their child experienced pain [25]. In a sample of mothers of children with epilepsy, over-the-counter medication use was reported at substantially higher rates (97.5%), most commonly antipyretics (89%) and, to a lesser extent, analgesics (7.5%) [25]. In line with the literature, Avan and Avan (2024) reported that 53.1% of parents used over-the-counter antipyretics for their children [28], and rational drug use levels were generally positive. According to Yılmaz Kurt et al. (2022), 43.5% of mothers used non-prescribed medicines for their children in the past six months. The most used medication was antipyretics/analgesics that were obtained from previous prescriptions, the pharmacist, or friends/relatives [29], while overall rational use attitudes remained high. Clinically, these results indicate that positive attitudes toward rational drug use may coexist with non-prescribed practices at home. This highlights the importance of nurse-led counseling that provides clear guidance on indications, dosing, duration, and red flags that require professional evaluation for over-the-counter analgesics. In young, non-verbal children, home-based pain management relies not just on parents’ recognition of pain but also on their decisions regarding whether to apply each strategy, when to apply it, and how. In the present study, the mothers reported that their child’s pain is identified through behavioral cues, including restlessness (64.8%), vocalizations (58.3%), sleep changes (37.7%), and facial expressions (36.7%). To relieve pain, mothers most frequently sought care at a healthcare facility (78.2%). In addition, they used comforting behaviors such as holding/caressing (51.6%), giving medication (48.9%), and massage (47.4%). Qualitative evidence indicates that parents may experience uncertainty when interpreting children’s pain—particularly in the early stages—and may develop more adaptive responses over time [30]. Furthermore, parental affect (especially anxiety/stress), child behavior and temperament (e.g., sleep or feeding difficulties), and parental expectations and beliefs may also shape symptom perception and reporting [31]. Studies focused on how parents interpret ambiguous symptoms also suggest variation in how these symptoms are appraised, with possible implications for care-seeking [32]. In clinical practice, the uncertainty of pain signals for nonverbal young children may directly influence parents’ analgesic-related decision-making and rational drug use behaviors. Consequently, discharge or outpatient counseling led by nurses and clinicians that emphasize identifying pain signals, choosing appropriate non-pharmacological strategies, and key principles for the safe use of analgesics (indications, doses, and dose intervals) may strengthen rational drug use and support safer home pain management. ### Recommendations for practice Based on the present findings, nurse-led education and counseling should (i) early recognition of pain cues in non-verbal young children; (ii) stepwise use of evidence-based non-pharmacological strategies; and (iii) safe and rational use of analgesics, including indication, weight-based dosing, dosing intervals, maximum daily dose, and red flags requiring professional evaluation. Structured discharge/outpatient counseling using teach-back and a brief written home pain plan may help translate favorable attitudes into safer home practices, particularly among families with lower socioeconomic resources, lower education levels, or higher caregiving burden (e.g., multiple children). ### Implications for nursing practice These findings underline the need for nurse-led education and counselling to translate favorable attitudes into consistently safe home practices. When families are encountered in outpatient visits or during discharge planning, nurses should provide a brief, structured, and tailored approach to families at higher risk (e.g., lower education or socioeconomic resources, multiple children) focusing on recognizing pain cues in verbal and nonverbal young children, selecting appropriate non-pharmacological strategies for pain relief and safe use of analgesics (i.e., indication, weight-based dosing, dosing intervals, max dose/day and red flags that require evaluation by a professional). Using teach-back and giving an easy written home pain plan may increase parental self-efficacy and decrease non-prescribed medication use. ### Limitations This research has some limitations. The cross-sectional and correlational design does not allow causal inferences. As a second limitation, data were collected from a single center and were based on mothers’ self-reports, which can be biased by recall and social desirability and may not reflect actual practices. Third, the outcome measure was an attitude toward rational drug use rather than objectively observed behavior; therefore, favorable attitudes may not have translated into the safe administration of medications. Finally, because the sample consisted of only mothers of children aged 0–6 years at outpatient services, the findings may not be generalizable to other caregivers, settings, or older pediatric populations. ## Conclusions In conclusion, mothers with children aged 0–6 years have generally high attitudes toward rational drug use for children. More favorable attitudes were associated with younger maternal age, fewer children, higher education and socioeconomic status, greater perceived competence to relieve the child’s pain, and avoidance of non-prescribed medications. Specifically targeting families that would be at a greater caregiving burden or with fewer resources and skills, nurse-led counseling may enhance parental self-efficacy and support safer, more rational home-based pain management.