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Pediatric Emergency and Critical Care Working Group Indonesian Pediatric Society
Pediatric Emergency and Critical Care Working Group Indonesian Pediatric Society
Pediatric Emergency and Critical Care Working Group Indonesian Pediatric Society

Pediatric Emergency and Critical Care Working Group

Indonesian Pediatric Society

Introduction

  • Children admitted to the hospital have pain caused either by the underlying disease or by the diagnostic or therapeutic procedures.

  • More often than not, patients receive insufficient analgesic treatment, even for painful procedures.

  • Effective management of pain in children is a major priority for patients, parents, and health-care providers,

  • highlighted as a priority in the Children’s

Introduction

WHY?
WHY?
  • The long-term negative effects of pain are becoming more apparent

  • Inadequately treated pain, particularly in the neonatal period

INCREASES MORBIDITY AND MORTALITY

Pediatrics in Review Vol.24 No.10 October 2003

Introduction

  • Children admitted to the hospital have pain caused either by the underlying disease or by the diagnostic or therapeutic procedures.

  • More often than not, patients receive insufficient analgesic treatment, even for painful procedures.

  • Effective management of pain in children is a major priority for patients, parents, and health-care providers,

  • highlighted as a priority in the Children’s

Definition

As defined by the International Association for the Study of Pain (IASP):

PAIN is "an unpleasant sensory and emotional experience associated with actual or potential

damage, or described in terms of such

damage."

Definition As defined by the International Association for the Study of Pain (IASP): PAIN is "
Definition As defined by the International Association for the Study of Pain (IASP): PAIN is "

Effect of acute pain

Physiologic

•Increased heart rate •Increased respiratory rate •Increased blood pressure •Decrease in oxygen saturation
•Increased heart rate
•Increased respiratory
rate
•Increased blood
pressure
•Decrease in oxygen
saturation

Effect of acute pain

Physiologic

•Increased heart rate •Increased respiratory rate •Increased blood pressure •Decrease in oxygen saturation
•Increased heart rate
•Increased respiratory
rate
•Increased blood
pressure
•Decrease in oxygen
saturation

Effect of acute pain

•Facial expression of pain
•Facial expression of
pain

Behavioural

Effect of acute pain •Facial expression of pain Behavioural

Factors that Modify Pain Perceptions

  • Age

  • Cognition

  • Gender

  • Previous pain experience

  • Temperament

  • Cultural and family factors

  • Situational factors

  • Pain scale on Pediatrics??

    • COMFORT scale anxiety or pain?

    • VAS visual Autonomic system?

    • FLAGS Autonomic system?

    • WBPS patient must consciousness

    • NIPS Neonatal Infant Pain Scale

NIPS (1) facial expression (2) cry (3) breathing patterns (4) arms (5) legs (6) state of
NIPS
(1) facial expression
(2) cry
(3) breathing patterns
(4) arms
(5) legs
(6) state of arousal
Interpretation:
• minimum score: 0
• maximum score: 7
NIPS (1) facial expression (2) cry (3) breathing patterns (4) arms (5) legs (6) state of
FACE No particular expression or smile 0 Occasional grimace or frown, withdrawn, disinterested 1 F Frequent
FACE No particular expression or smile 0

FACE

No particular expression or smile

0

 

Occasional grimace or frown, withdrawn, disinterested

1

F

Frequent to constant quivering chin, clenched jaw

2

     
 

Normal position or relaxed

0

Uneasy, restless, tense

1

L

LEGS

Kicking or legs drawn up

2

   
Lying quietly, normal position, moves easily 0
Lying quietly, normal position, moves easily 0

Lying quietly, normal position, moves easily

0

Squirming, shifting back and forth, tense

1

A

Arched, rigid or jerking

2

 

CRY

No cry, (awake or asleep)

0

C

 

Moans or whimpers; occasional complaint

1

Crying steadily, screams or sobs. Difficult to console. 2

Crying steadily, screams or sobs. Difficult to console.

2

 
   

Content, relaxed

0

C

Reassured by occasional touching, hugging or being

1

talked to.

Difficult to console or comfort 2

Difficult to console or comfort

2

 

ACTIVITY

FACE No particular expression or smile 0 Occasional grimace or frown, withdrawn, disinterested 1 F Frequent

CONSOLE

Wong Baker Pain Scale (3 yrs and older)

Brief word instructions: Point to each face using the words to describe the pain intensity. Ask
Brief word instructions: Point to each face using the words to describe the
pain intensity. Ask the child
to choose face that best describes own pain and record the appropriate number.

Wong’s Essentials of Pediatric Nursing, 6/e, St. Louis, 2001, P.

1301.

Wong Baker Pain Scale (3 yrs and older) Brief word instructions: Point to each face using
Crit Care Nurse 2009;29:59-66
Crit Care Nurse 2009;29:59-66
Crit Care Nurse 2009;29:59-66
Crit Care Nurse 2009;29:59-66

Crit Care Nurse 2009;29:59-66

Management

  • Nonpharmacologic

    • Sensorimotor strategies for infants

    • Cognitive/behavioral strategies for older children

    • Child participation strategies

    • Physical strategies

Management  Nonpharmacologic  Sensorimotor strategies for infants  Cognitive/behavioral strategies for older children  Child
Management  Nonpharmacologic  Sensorimotor strategies for infants  Cognitive/behavioral strategies for older children  Child

Distraction

  • Blowing bubbles

  • Playing with pop-up toys

  • Looking through a kaleidoscope

  • Imagining a superhero

Suggestion

Breathing techniques Guided imagery

Distraction  Blowing bubbles  Playing with pop-up toys  Looking through a kaleidoscope  Imagining

Procedure related pain

  • Combine pharmacologic and nonpharmacologic options when possible and appropriate

Procedure related pain  Combine pharmacologic and nonpharmacologic options when possible and appropriate
Procedure related pain  Combine pharmacologic and nonpharmacologic options when possible and appropriate

WHO step ladder

WHO step ladder
WHO step ladder
WHO step ladder

WHO step ladder

WHO step ladder

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