o Think room is not safe spot/scary ppl in scrubs Pain Assessing pain in children can be very difficult o Don’t have cognitive ability to understand what pain is, may not tell due to fear of shot, medicine, stay longer Each child is different in terms of how they can explain/report their pain Several different pain scales for pediatrics Parental input is often necessary Generally want pain level 3/10 or less Document pain number and scale used Pain Scale: Numeric Generally for ages 8 and up ( school aged children) 2 nd or 3 rd grade r and up
Pain Scale: Faces For children ages 3-4 years and up Must explain to child what the faces mean Pain Scale: Oucher Similar to the Faces Scale, but with photos instead of cartoons Use for preschoolers Use the photo/ethnicity that looks most like the patient
Pain Scale: FLACC Face, Legs, Activity, Cry, Consolability Good for infants through school age children about 7 years old KNOW FLACC!!
Pain Scale: CRIES Used in neonates (generally 2 months old and younger) Pain Scale: OPS
Observational Pain Scale Infants to preschoolers Post-OP use until they are awake Chronic Pain Kids with cancer, Sickle Cell, other chronic conditions May require a higher does of pain medication due to CNS sensitization Their pain symptoms may be less severe or not present at all (no elevation in HR or BP, for example) Treat whatever pain they say they have Pain Myths Infants cannot feel pain – NOT TRUE Infants feel pain but they can’t remember it – NOT TRUE Children tolerate pain better than adults – NOT TRUE Opioids are unsafe for children – NOT TRUE – oral/IV forms Analgesic Options for Kids Non-pharamlogical interventions o Comfort holds, distractions, sucrose pacifier Oral OTCs o Motrin, tylenol IV/IM prescription analgesics (Toradol- IV NSAID) Oral controlled substances (oxycodone)
IV/IM controlled substances (Morphine, Fentanyl) PCAs for ages 5 and up o have to make sure CHILD is pushing button, NOT PARENTS o have to be able to assess that child understands if have pain, push button Epidurals/blocks o Extensive surgery Trust If you don’t know, say you don’t know (“Does it taste yucky?”) o Say what other kids think, ask their opinion, let me know… etc If it is going to hurt, tell them it’s going to hurt o Warm cloth, do something afterward, only for a short time Give choices if possible Always be honest Caring for Children is a Privilege “62% of the people in adult hospitals are there because of the lifestyle choices they exercise. Kids are here, not because of choices they’ve exercised, but because of fate and they’re a vulnerable population and they deserve all of the affection, attention and quality we can give them.” –David Westbrook
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- Spring '17