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This document discusses pain management in children of different age groups. It outlines the physiological, metabolic, and behavioral effects of acute pain in children. Various methods for assessing pain in infants, toddlers, preschoolers, school-aged children, and adolescents are presented. The document also covers classification of pain, types of pain including procedural and postoperative pain, principles of pharmacology for pain management in children, and use of analgesics like NSAIDs and opioids.
This document discusses pain management in children of different age groups. It outlines the physiological, metabolic, and behavioral effects of acute pain in children. Various methods for assessing pain in infants, toddlers, preschoolers, school-aged children, and adolescents are presented. The document also covers classification of pain, types of pain including procedural and postoperative pain, principles of pharmacology for pain management in children, and use of analgesics like NSAIDs and opioids.
This document discusses pain management in children of different age groups. It outlines the physiological, metabolic, and behavioral effects of acute pain in children. Various methods for assessing pain in infants, toddlers, preschoolers, school-aged children, and adolescents are presented. The document also covers classification of pain, types of pain including procedural and postoperative pain, principles of pharmacology for pain management in children, and use of analgesics like NSAIDs and opioids.
Department of Pediatric Surgery LUMHS Jamshoro. Pain Management in Children Different age Groups Neonates- 0 to 30 days. Infants- Birth to 1 year. Toddlers- 1 to 3 years. Preschoolers- 3 to 5 years. School Age- 6 to 12 years. Adolescent- 13 to 18 years. Pain in Children Infants are neurologically immature and therefore cannot conduct pain impulses. Infants do not remember pain, because of cortical immaturity. Children do report pain while playing or sleeping. Effects of Acute Pain Physiologic
Decrease in oxygen saturation Metabolic Response Increased secretion of catecholamine, glucagon, and corticosteroids. Delayed wound healing Poor intake / anorexia Impaired mobility Sleep disturbances Irritability
Behavioral Response Facial expression of pain. Infant Response to Pain Forcefully closed eyes Lowered brows Deepened furrow between nose and outer corner of lip. Square mouth Cupped tongue
Toddler and Pre-school Limited in their cognitive abilities in localizing and expressing pain intensity, and understanding reasons for pain. Find out word they use to express pain Point to pain Faces is a good tool for them. School-age Increased ability to communicate pain in more abstract terms. They can describe pain: squeezing, stabbing or burning Respond well to direct questioning. Tools: body outline, faces scale, visual analog. Pre-procedural Pain
Key to managing procedural related pain is anticipation Anticipated intensity and duration Child / parent receive appropriate information to minimize distress Child / Parent Preparation Quiet environment Calm nurse Clear confident instructions Pain management according to cause or underlying disease. Localized anesthetics Systemic agents Sedatives Classification of Pain Nocioceptive Somatic Bone, joint, muscle, skin, or connective tissue Well localized Aching & throbbing Visceral Visceral organs such as GI tract Poorly localized Cramping
Neuropathic Central Injury to peripheral or central nervous system causing phantom pain Dysregulation of the autonomic nervous system (e.g. Complex regional pain syndrome) Peripheral Peripheral neuropathy due to nerve injury Pain along nerve fibers Types of Pain Procedural pain Post-operative pain Sickle cell pain Neuropathic pain Cancer pain Pain in palliative care
Operative Pain Morbidity and mortality can be reduced by good pain treatment Plans for postoperative pain should be discussed before surgery Goal is to control the pain as rapidly as possible Post-Operative Pain Oral administration is preferred for mild to moderate pain. IV is indicated for immediate pain relief. Persistent moderate to severe pain continuous around the clock dosing at fixed intervals is recommended. PCA patient-controlled analgesia used only when patient can use pump on their own. Side Effects Nausea, vomiting and puritus are common side effects Constipation with prolonged use of opioids
Pain Assessment Methods of assessment vary according to age and cognitive level of child Patient report Numerical scale 1 to 10 FACES can be used at all ages FLAC used on infants FACES Monitoring A cardiac / respiratory monitor is used for infants less than 7 months Oximetry monitors for other patients during use of IV opioids Unstable respiratory status History of difficult airway management Neurologically impaired Principles of Pharmacology Consider patients age, associated medical problems, type of pain, & previous experience with pain Choose type of analgesia Choose route to control pain as rapidly and effectively as possible Titrate further doses based on initial response Anticipate side effects
NSAIDs Antipyretic Analgesic for mild to moderate pain Anti-inflammatory COX inhibitor Prostaglandin inhibitor Platelet aggregation inhibitor
Side Effects of NSAIDs Gastritis Prolonged use increases risk of GI bleed Still rare in pediatric patients compared to adults NSAID use contraindicated in ulcer disease Nephropathy (ATN) Bleeding from platelet anti-aggregation Increased risk versus benefit post-tonsillectomy NSAID use contraindicated in active bleeding Delayed bone healing?
Opioids Analgesics Moderate to severe pain Various routes of administration Different pharmacokinetics for different age groups Infants younger than 3 months have increased risk of hypoventilation and respiratory depression Low risk of addiction among children Side Effects of Opioids All opioids have side effects that should be anticipated & managed Respiratory depression Nausea, vomiting Constipation Pruritis Urinary retention
Key Points Treat pain Adhere to general principles of pain management Anticipate & prevent pain Adequately assess pain Use multi-modal approach Involve parents & patients Use non-noxious routes Understand the pharmacology of non-opioid and opioid analgesics Approach and treat different types of pain accordingly
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