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o Oral Hygieneo Sores, infectionso Say “ahhh” = depresses tongue Physical Exam Variations, Based on Age Talking to KidsMedication Administrationo Physiological differences Immature liver and kidneys Higher risk for med errorsdue to different dosages for each patient (weight based) Different concentration of medicationsMedication Administrationo Oral syringes Caps – choking hazardo Medication cupso Pills vs Liquid Depends on childo Crushed pills in pudding, applesauceo Mix in baby bottles? NO – would have to take entire thingo Coercion and using Child Lifeo Offer to let parent give (in your presence)IVso Can place in the head on an infanto Feet are acceptable until the child is walkingo May need to use protective equipment to guard IV (but must be removable to assess site) IVsPediatric IM Injectionso Site based on child’s sizeo Limit on volume injected in one siteo May or may not be able to give the child a choice of injection locationComfort Holds and Restrainingo Often necessary to use restraints to protect medical equipment and/or keep child from injuring himselfo Comfort holds are used for painful procedures and allow the child to be held by parent/nurse while the procedure is completedPaino Assessing pain in children can be very difficulto Each child is different in terms of how they can explain/report their paino Several different pain scales for pediatricso Parental input is often necessaryo Generally want pain level 3/10 or lesso Document pain number and scale usedPain Scale: Numerico Generally for ages 8 and up (school aged children)oPain Scale: Faces For children ages 3-4 years and up Must explain to child what the faces meanoPain Scale: Oucher Similar to the Faces Scale, but with photos instead of cartoons Use for preschoolers Use the photo that most like the patientoPain Scale: FLACC Face, Legs, Activity, Cry, Consolability Good for infants through school age children about 7 years oldoPain Scale: CRIES Used in neonates (generally 2 months old and younger)oPain Scale: OPS Observational Pain Scale Infants to preschoolersChronic Paino Kids with cancer, Sickle Cell, other chronic conditionso May require a higher does of pain medication due to CNS sensitizationo Their pain symptoms may be less severe or not present at all (no elevation in HR or BP, for example)o Treat whatever pain they say they havePain Mythso Infants cannot feel paino Infants feel pain but they can’t remember ito Children tolerate pain better than adultso Opioids are unsafe for childrenAnalgesic Options for Kidso Non-pharamlogical interventions Warm pack, cold pack, light up toys, baths
o Oral OTCs Tylenol, motrino IV/IM prescription analgesics (Toradol)o Oral controlled substances (oxycodone)o IV/IM controlled substances (Morphine, Fentanyl)o PCAs for ages 5 and upo Epidurals/blocks Trust o If you don’t know, say you don’t know (“Does it taste yucky?”)