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Pharm 129 > Acute pain in pediatrics > Flashcards

Acute pain in pediatrics Flashcards

1
Q

How to assess for pain in nonverbal children (<3 y/o)

A

FLACC scale - face, legs, activity, cry, consolability
score of 1-3 = mild
4-6 = moderate
7-10 = severe

r-FLACC^2 (if cognitively impaired)

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2
Q

How to assess pain in younger children (3-8 y/o)

A
  • 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
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3
Q

Pain assessment in older children (8-11 y/o)

A

vNRS - rate their pain along a horizontal/vertical numeric scale

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4
Q

Pain assessment in adolescents

A

Numeric rating scale without pointing at scale

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5
Q

Tips for Using Self-Report Pain Scales

A
  1. Ensure age-appropriateness
  2. introduce the scale to the child when they are not in pain
  3. 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)
  4. Judge the severity of the pain and the efficacy of the interventions
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6
Q

What are the goals of therapy for managing pain

A
  1. Relieve the pain until the cause is managed
  2. Identify and treat the cause of pain
  3. If possible, prevent the pain
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7
Q

Physical non-pharmacologic strategies for pain

A
  • heat or cold therapy
  • acupunture
  • immobilize fractures
  • massage therapy
  • breastfeed infant
  • sucrose
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8
Q

Behavioural non-pharm strategies

A
  • relaxation
  • exercise
  • art and play therapy
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9
Q

cognitive non-pharm strategies

A

distraction
imagery
hypnosis

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10
Q

Monitoring for pain relief

A
  • desired outcome = reduction in pain
  • change expected within 1-2 hours of taking analgesic
  • patient monitors daily
  • RPh follow up in 2-3 days
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11
Q

What is teething

A

Eruption of deciduous (“milk”) teeth through gingival tissues

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12
Q

When does teething start

A

4-12 months (avg 6 months)

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13
Q

When does the full set of primary teeth occur

A

3 years

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14
Q

when do you start losing primary teeth

A

5-6 years

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15
Q

When does teeth development begin

A
  • in the womb
  • pregnancy nutrition vital (calcium, phosphorus, vitamin C, vitamin D)
  • Avoidance of certain medications while pregnant (ex. tetracycline harmful to developing teeth)
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16
Q

What is the first tooth to erupt

A

central incisor on lower teeth

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17
Q

How many teeth erupt a month

A

1 tooth/month

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18
Q

What is the timeline of primary tooth eruption

A

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

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19
Q

What is the order of teeth that are erupted

A 
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)
20
Q

When does secondary/permanent dentition eruption start

A

6 - 7 years
continues for 6 years
symmetrical eruption

21
Q

How many teeth are in the primary dentition

A

20

22
Q

how many teeth in permanent dentition

A

32

23
Q

Who is likely to have delayed tooth eruption (DTE)

A

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

24
Q

What are associated signs and symptoms of teething

A
  • 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
25
Q

What is NOT associated with teething

A
  • Vomiting
  • Diarrhea
  • Malaise
  • Fever
  • Rashes (on stomach, etc)
26
Q

Do all babies experience symptoms of teething

A

No, only 2/3 of infants

27
Q

What is the teething window

A

8 days

  • 2-5 days before teething breaks skin
  • few days afterwards
  • symptoms usually resolve 3 days after tooth erupts
28
Q

Does teething cause fever

A

not really, (poor quality studies)
some association of fever with day of eruption +/- 1 day
fever on any other day should be assessed for other sources

29
Q

What are eruption cysts

A

Dome-shaped, soft, bluish, swollen area filled with tissue, fluid and blood
localized to gum overlying erupting tooth
not infection
lasts <1 week (disappear if left alone)
see dentist if lasts longer, or causes pain/feeding problems

30
Q

Red flags that require dental consult when possible

A

Pericoronitis (wisdom tooth infection)
Delays of >6 mo in a primary tooth eruption (ex. at 12 months)
Delays of >12 mo in a permanent tooth eruption (ex. at 7 y/o)
Eruption cysts (do not disappear or causing pain/problems with feeding)

31
Q

Red flags that require URGENT dental consult

A

Pericoronal abscess

  • caused by pericoronitis
  • can spread infection to cheeks, face, neck
  • compromised airway
32
Q

Red flags that require medical consult when possible

A

Suspected systemic illness in a young child (diarrhea, fever)

33
Q

Goals of therapy for teething

A
  1. Minimize/relieve gum pain and irritation
    - Reduce child’s irritability
    - Minimize sleep disturbances
  2. Prevent complications
    - Involve medical or dental professionals when indicated
34
Q

Prevention measures for teething

A

Wipe gums of infants BID
Brush primary teeth BID (when beginning solid foods)
Monitor teeth
No bottles in bed with milk, formula or juice - Baby Bottle Tooth Decay
Assessment by dentist within 6 months of first tooth eruption or by 1 y/o and every 6 months after

35
Q

Nonpharm therapy for teething

A

ROKD
R - rub the gums (with clean finger, damp washcloth, cold spoon)
O - offer the rings (teething rings)
K - keep it cool (cold washcloth, COLD not frozen teething ring, cold foods)
D - dry the drool

36
Q

What oral analgesics can be used for teething

A

acetaminophen and ibuprofen

37
Q

Acetaminophen dosing for teething

A

10-15mg/kg/dose by mouth Q4-6H prn

MDD=75mg/kg/day

do not exceed 5 doses/day

38
Q

Ibuprofen dosing for teething

A

5-10mg/kg/dose by mouth Q6-8H prn

MDD=40mg/kg/day

no more than 4 doses/day

39
Q

What topical anesthetics can be used for teething

A

NOT RECOMMENDED (benzocaine = Orajel)

  • max 4 times/day
  • cannot eat/drink 10-30 mins after application
  • risk of disabling gag reflex if swallowed
  • risk of MetHb (methemoglobenemia)
40
Q

What is MetHb

A

blood contains too much methoglobin (form of hemoglobin that does not bind oxygen properly)
- therefore, affected person does not get enough O2

41
Q

symptoms of Methemoglobinemia

A

weakness, confusion, headache, difficulty breathing and/or pale, gray or blue-coloured skin, lips and nail beds.

the greater the concentration, symptoms become more severe
(>10 g/dl MetHb = death)

42
Q

NHP for teething

A

no studies to support efficacy, therefore do not recommend

examples: Orajel homeopathic, camilia teething liquid, hyland’s baby oral pain relief

43
Q

What to avoid for teething treatments

A

Alcohol
Teething biscuits (cariogenic - too much sugar)
Aspirin (Reye’s syndrome)
Rubbing oral pain relievers directly on the gums
Topical anesthetics
Frozen items

44
Q

Monitoring and follow up for teething

A

follow up 3-5 days

refer if non-pharm and pharm treatment both ineffective or if symptoms uncharacteristic of teething

45
Q

What is the 1st therapy for teething

A

non-pharm

2nd line is for relief - oral analgesics

Pharm 129 (14 decks)

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