Pediatric Palliative Care

Question 1

What are 6 tools to use for pre-verbal/non verbal children to assess for pain?

Answer 1

1) FLACC (face, legs, activity, cry, consolability) tool (good 1-3)
2) PPP (Pediatric Pain Profile)
3) NCCOC (Non-Communicating Children’s Pain Checklist)
4) CHEOP
5) CRIES- best for INFANTS
6) NIPS

Question 2

Rule of 7s for capacity in children?

Answer 2

Rule of 7s
- < 7, do not have capacity
- 7-14, emerging capacity
- 14+, should be included in decisions

Question 3

For kids 3+ what pain score tools can be used?

Answer 3

• Faces
• Bieri Modified
• Visual Analogue Scales

Question 4

When is assent in a minor not required?

Answer 4

Still SOUGHT but not required if BENEFIT to child is clear and could be significant

Question 5

What predicts parental complicated grief? (10)

Answer 5

1) Watching child in pain/have difficult moment prior to death (not relieved by drugs)
2) Parents&raquo_space;> adults at risk of complicated grief
3) Female gender
4) Pessimistic outlook
5) Pre-existing mood disorder
6) Decreased social support
7) Insecure attachment
8) Increased stress
9) Positive caregiving
10) Dependency on deceased

Question 6

Pain assessment in kids

Answer 6

• Neonates
  ○ CRIES scale (looks at crying, O2 requirement, VS, facial expression, sleeplessness)
  ○ COMFORT scale
  ○ PIPP scale
  ○ CHIPPS
  ○ N-PASS
  
  • QUESTT model
    ○ Question child if verbal, and parent of verbal/non verbal children
    ○ Use pain rating scales
    ○ Evaluate behavior and physiological change
    ○ Secure parental involvement
    ○ Take cause of pain into account
    ○ Take action and evaluate results
  • Wong Baker FACES: ages >4
  • Visual Analogue Scale: ages> 7
    Numeric Rating Scale: ages 8+

Question 7

4 Tools for Pain for NEONATES?

Answer 7

CRIES scale, COMFORT, PIPP, and N-PASS