Acute pain in pediatrics Flashcards
(45 cards)
How to assess for pain in nonverbal children (<3 y/o)
FLACC scale - face, legs, activity, cry, consolability
score of 1-3 = mild
4-6 = moderate
7-10 = severe
r-FLACC^2 (if cognitively impaired)
How to assess pain in younger children (3-8 y/o)
- Faces Pain Scale (FPS) - 7 faces, 0-6 score
- FPS revised (4+ y/o) - 6 faces, 0-10 score
- Wong Baker Faces Pain Rating Scale (WBFPRS) 3-6y/o+ - created with children, 6 faces, 0-10 score
- Oucher pain scale - uses photos, shows diff ethnicities
- Colour analog scale (CAS) - 4-5+ y/o, darker colour = more intense
- Verbal Numeric rating scale (vNRS): 6+ y/o (usually 8+), rate from 0-10
Pain assessment in older children (8-11 y/o)
vNRS - rate their pain along a horizontal/vertical numeric scale
Pain assessment in adolescents
Numeric rating scale without pointing at scale
Tips for Using Self-Report Pain Scales
- Ensure age-appropriateness
- introduce the scale to the child when they are not in pain
- obtain successive pain ratings over time to track events known to cause pain as well as the efficacy of interventions (how does _ compare to last time)
- Judge the severity of the pain and the efficacy of the interventions
What are the goals of therapy for managing pain
- Relieve the pain until the cause is managed
- Identify and treat the cause of pain
- If possible, prevent the pain
Physical non-pharmacologic strategies for pain
- heat or cold therapy
- acupunture
- immobilize fractures
- massage therapy
- breastfeed infant
- sucrose
Behavioural non-pharm strategies
- relaxation
- exercise
- art and play therapy
cognitive non-pharm strategies
distraction
imagery
hypnosis
Monitoring for pain relief
- desired outcome = reduction in pain
- change expected within 1-2 hours of taking analgesic
- patient monitors daily
- RPh follow up in 2-3 days
What is teething
Eruption of deciduous (“milk”) teeth through gingival tissues
When does teething start
4-12 months (avg 6 months)
When does the full set of primary teeth occur
3 years
when do you start losing primary teeth
5-6 years
When does teeth development begin
- in the womb
- pregnancy nutrition vital (calcium, phosphorus, vitamin C, vitamin D)
- Avoidance of certain medications while pregnant (ex. tetracycline harmful to developing teeth)
What is the first tooth to erupt
central incisor on lower teeth
How many teeth erupt a month
1 tooth/month
What is the timeline of primary tooth eruption
7+4 mnemonic
•at 7 months: first teeth
•at 11 months (4 months later): 4 teeth
•at 15 months (4 months later): 8 teeth
•at 19 months (4 months later): 12 teeth
•at 23 months (4 months later): 16 teeth
•at 27 months (4 months later): 20 teeth
What is the order of teeth that are erupted
central incisor - lateral incisor - first molar - canines - second molar symmetrical eruption (upper teeth erupt after 1-2 month after the same tooth on lower teeth)
When does secondary/permanent dentition eruption start
6 - 7 years
continues for 6 years
symmetrical eruption
How many teeth are in the primary dentition
20
how many teeth in permanent dentition
32
Who is likely to have delayed tooth eruption (DTE)
Premature and low birth weight babies
Racial, ethnic, sexual and individual factors can influence eruption
If eruption does not occur by 12 months, should be referred
What are associated signs and symptoms of teething
- Gum redness, swelling +/- tenderness
- Gum rubbing, biting or chewing on hard objects
- Drooling (causes facial irritation)
- Irritability, restlessness, crying, insomnia
- Decrease in appetite (for solids), increased thirst
