Is This Child in Pain?

When the child is nonverbal.

Nurses regularly assess patients’ pain. It’s a much more difficult task when the patient is unable to articulate what they’re feeling or even where they hurt. How much more difficult is it when the patient is a nonverbal child with a complex medical history?

In this month’s AJN, Brenna Quinn and colleagues share their research on pain in these children. They define “children with medical complexity” as “those having a cognitive-chronological age mismatch, profound developmental delays, limited or no verbal abilities, and multisystem diagnoses, and who are completely dependent on others for care.” These kids tend to experience pain more frequently (often, daily or weekly), and are more likely to be hospitalized than are neurotypical children.

A ‘wide range of pain-associated behaviors.’

While it is often harder to assess pain in children than in adults, most children have a narrow range of “pain behaviors” that are easily identifiable. This isn’t true of children with medical complexity; some may even seem, from their expressions, to be laughing when they are in pain.

“More than 40 pain assessment tools have been developed for use in infants and children who cannot provide self-report. Despite the availability of these tools, the evaluation of pain in children with medical complexity remains […]

2018-08-13T08:09:58-04:00August 13th, 2018|family caregiving, Nursing, Patients, pediatrics|0 Comments
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Codeine Overused in Children: Alternatives Exist for Hard-to-Manage Pain

By Jacob Molyneux, senior editor

According to a story at MedlinePlus, a study in Pediatrics has found that codeine is still prescribed too often to children during ER visits, though it’s known that a small but significant subset of children metabolize the painkiller far more rapidly than do other children, leading to potentially dangerous results. As AJN‘s February CE article on treating the often severe and stubborn posttonsillectomy pain in children noted, there are other effective and safer options for children in pain, such as hydrocodone in combination with acetaminophen, as well as some non-opioid analgesics. Here’s a brief overview of the article:

Tonsillectomy, used to treat a variety of pediatric disorders, including obstructive sleep apnea, peritonsillar cellulitis or abscesses, and very frequent throat infection, is known to produce nausea, vomiting, and prolonged, moderate-to-severe pain. The authors review the causes of posttonsillectomy pain, current findings on the efficacy of various pharmacologic and nonpharmacologic interventions in pain management, recommendations for patient and family teaching regarding pain management, and best practices for improving medication adherence.

There’s often no perfect answer in pain management, but it helps to know the full range of available strategies, their safety, and how well they work. As with all CE articles, this one is free.

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2016-11-21T13:04:56-05:00April 23rd, 2014|Ethics, nursing perspective, pain management|1 Comment
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Posttonsillectomy Pain in Children: Safer, More Effective Treatment Strategies

By Shawn Kennedy, editor-in-chief

Capture

One of the CE articles in the February issue is “Posttonsillectomy Pain in Children.” It might seem like a no-brainer—ice-collar, cold fluids, and acetaminophen with codeine, right? WRONG. As the article indicates, there’s a lot more to managing this stubborn, sometimes severe pain.

For one thing, there’s been a big reversal in choice of pain medication. Acetaminophen with codeine, long a mainstay in managing children’s pain, is no longer recommended—in fact, the FDA issued a black box warning last year saying that codeine should not be used because its metabolism rate in one subset of children can cause excessive sedation. Reports of three deaths and a case of nonfatal respiratory depression in children who received appropriate doses prompted the warning. […]

2016-11-21T13:05:19-05:00February 26th, 2014|nursing perspective, pain management|0 Comments
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Essential Reading for Nurses Responding to Disasters

Many nurses are volunteering their services to assist the residents of Haiti following the earthquake. The magnitude of the damages and injuries will require a sustained disaster relief effort. AJN has compiled a list of our articles with useful information for nurses participating in any disaster relief effort. Given the current urgency of this issue, we have made all articles free. We hope you’ll take a look and pass along anything you find informative or helpful.

For example, our Disaster Care article back in December dealt with the often-overlooked physiologic and psychosocial needs of children in public health emergencies. These can be very different from those of adults.

(And if, by some chance, you’ve actually had any experiences working in Florida or in Haiti with the victims of this earthquake, please let us know what skills and knowledge you’ve found most crucial.) 

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2016-11-21T13:19:51-05:00January 26th, 2010|career, nursing perspective|0 Comments
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Views expressed on the blog are solely those of the authors or persons quoted. They do not necessarily reflect AJN’s views or those of Wolters Kluwer Health/Lippincott Williams and Wilkins.
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