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 Childrens

Introduction

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

WHY?

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 Childrens

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."

Effect of acute pain

Increased heart rate Increased respiratory

rate Increased blood

pressure Decrease in oxygen

saturation

Physiologic

Effect of acute pain

Increased heart rate Increased respiratory

rate Increased blood

pressure Decrease in oxygen

saturation

Physiologic

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 arousal

Interpretation: minimum score: 0 maximum score: 7

FFACE

LEGS

ACTIVITY

L

A

CRY

No particular expression or smile 0

Occasional grimace or frown, withdrawn, disinterested 1

Frequent to constant quivering chin, clenched jaw 2

Normal position or relaxed 0

Uneasy, restless, tense 1

Kicking or legs drawn up 2

Lying quietly, normal position, moves easily 0

Squirming, shifting back and forth, tense 1

Arched, rigid or jerking 2

No cry, (awake or asleep) 0

Moans or whimpers; occasional complaint 1

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

C

Content, relaxed 0

Reassured by occasional touching, hugging or being talked to.

1

Difficult to console or comfort 2

CONSOLE

C

Wong Baker Pain Scale (3 yrs and older)

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.

Wongs Essentials of Pediatric Nursing, 6/e, St. Louis, 2001, P.

1301.

Crit Care Nurse 2009;29:59-66

Crit Care Nurse 2009;29:59-66

Nonpharmacologic Sensorimotor strategies for infants

Cognitive/behavioral strategies for older children

Child participation strategies

Physical strategies

Management

Distraction

Blowing bubbles

Playing with pop-up toys

Looking through a kaleidoscope

Imagining a superhero

Suggestion

Breathing techniques

Guided imagery

Combine pharmacologic and nonpharmacologic

options when possible and appropriate

Procedure related pain

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