Paeds Flashcards
What are the 3 limitations of self-report of pain in Paeds?
:
o Developmental level
o Verbal limitations
o Emotional distress etc
What are the 3 approaches to pain assessment in children? Explain them and give one example of each
- Physiological: Monitoring parameters e.g. heart rate (HR), respiratory rate (RR), blood pressure (BP), and oxygen saturation (O2 sats).
- Behavioral: Observing vocal expressions (e.g., crying), facial expressions, rigid body posture, clenched hands/toes, body movements (e.g., withdrawal from pain stimulus, limpness or flaccidity in preterm or ill infants), altered sleep patterns, and inconsolability)
Examples of outcome measures: Neonatal Facial Coding System (NFCS), Neonatal Infant Pain Scale (NIPS) - Self- report: 2-year-olds: presence and location of pain, Age 3/4: pain intensity
Examples: Faces Pain Scale (FPS), Wong-Baker Faces Pain Scale, verbal numerical rating scale, Visual analogue scales (VAS), Coloured Analogue Scale (CAS), Pieces of Hurt Tool, The Oucher-Photographic and Numerical Rating Scale
Give examples of Nonpharmacologic pain management
NOT substitute for analgesia, rather complementary
Distraction
Guided imagery
Hypnosis (trained practitioner)
Infants and younger children: Comfort measures e.g.
Cuddling
Auditory and tactile stimulation
Suckling
Outline the physiotherapy management of paediatric pain:
- Thorough Pain assessment
o nature, intensity, location, and duration
o age-appropriate, considering the child’s ability to communicate their discomfort. - Monitor correct pharmacological management
- Advocate for child
- Communication with parents/caregiver
- Distraction techniques, play therapy, or relaxation exercises to help the child cope with pain.
- Other Physio analgesic modalities
o Ice and Heat Therapy: acute pain
o Transcutaneous Electrical Nerve Stimulation (TENS): chronic pain management
o Soft Tissue Techniques
o Stretches
o Cardiovascular Exercise: endorphins
What are the 2 indications for respiratory physiotherapy in infants?
- Lobar collapsed due to plugging (not inflammation - RSV)
- Increase or retention of secretions that baby can’t clear on their own
At how many weeks is a baby considered to be born premature?
<37 weeks
What are the indications for physiotherapy in the premature infant?
Retention of secretions and lobar collapse due to plugging
Meconium aspiration
Aspiration of feed or vomit
Chronic lung disease
Postoperatively (positioning)
What are the 2 kinds of chronic lung disease?
Chronic lung disease (CLD I): Infants who are still oxygen dependent at one month
Bronchopulmonary dysplasia (CLD II): cystic changes on x-ray.
What are the contraindications to respiratory physiotherapy in infants?
- Unstable infant
- Pulmonary haemorrhage
- Respiratory distress syndrome
What are the signs of respiratory distress in infants and young children?
Tachypnoea
Nasal/alar flaring
Grunting
Recessions or retractions
Head bobbing
Abnormal positioning
Expiratory wheeze/prolonged expiration
Stridor
The musculoskeletal system of children is different to that of adults. These differences account for differences in fracture presentation, healing and management. What are these differences?
Growth plate
o Children have an active growth plate
o Facilitates remodelling
o Injured growth plate leads to deformity
Bone
o Higher collagen to bone ratio
o More porous
o Bone fails in tension and compression
o Bone transitions
Periosteum
o Metabolically active
o Thickness and strength
Cartilage
o Increased ratio of cartilage to bone improves resilience but makes interpretation of xrays more difficult.
Ligaments
o Relatively stronger than bone.
o Avulsion injuries common in children
What are the preventable and non-preventable complications of fractures?
Non-preventable complications
o Avascular necrosis
o Physeal injuries
Preventable complications
o Compartment syndrome
o Malunion
o Physeal bar formation
o Deformity from small physeal bars
o Fixation complications
o Cast complications
What are the issues with early specialisation in sports?
- Can lead to increased stress on specific body areas and overuse injuries.
- Year-round participation in same sport
- Infrequent rest periods
- Lack of diversity of movement and loading
- Focusing on a single sport at a young age may hinder overall physical development.
Why are females at a higher risk of developing ACL and lateral ankle ligament injuries?
Anatomical variances such as increased Q-angle and dropped navicular bone.
Hormonal influences, potentially affecting ligament laxity and stability.
Neuromuscular control differences between genders.
Biomechanical variances, including differences in landing mechanics and muscle strength.
What is the female athlete triad?
Combination of three interrelated health issues often observed in active females:
o Disordered eating /low energy availability.
o Menstrual disturbances/amenorrhea.
o Bone loss/Osteoporosis
What are the 7 risk factors for pediatric sports injuries?
- Training Errors:
* Sudden increase in training volume, speed, or intensity. - Musculo-Tendinous Imbalances:
* Result from Repetitive Demands on Physiological and Biomechanical Systems
o E.g. baseball pitcher, swimmer, long distance runners
* Risk can be reduced by concentrating on a well-designed training programme which corrects the imbalances and focuses on technique above performance measures initially - Anatomical Malalignment:
* Structural deviations affecting joint alignment and movement patterns.
* Altered joint mechanics increase stress on surrounding structures.
* May lead to abnormal movement patterns and contribute to injuries. - Improper Footwear:
* Contributes to increased muscle action and potential injuries. - Faulty Playing Surfaces:
* Playing surfaces can cause increased muscle action by increasing the ground reaction forces, uneven surfaces, cambered road or increase muscle work as with long grass - Associated Pathology:
* Conditions like Perthes disease or juvenile rheumatoid arthritis can affect movement mechanics and increase injury risk.
* Growing bones and cartilage are susceptible to overuse and trauma.
* Pathology or previous injuries may impact injury susceptibility and severity - Growth Factors:
* Growing bones, cartilage, and soft tissues vulnerable to trauma.
* Rapid bone growth can lead to increased risk of fractures and other injuries. - In SA context: nutritional status –current and during development
Why does performance in sport decrease in a growth spurt?
- Effect of growth spurt
o Loss of Body awareness
o Loss of Proprioception
o Loss of Motor control
o Loss of Muscle strength
o Loss of Muscle flexibility
o Loss of Co-ordination
o “Gangly”
What are the 3 most common lesions in prematurity?
- periventricular leukomalacia (PVL)
- Intraventricular haemorrhage (IVH)
- Periventricular haemorrhagic infarction (PHI)
Outline the preterm picture
- The preterm infant has hypotonia, poor physiological flexion and therefore little activity
- Movement is jerky and limbs are abudcted and extended
- There is poor postural stability
- Most sensory input is noxious
- No self-soothing strategies
- Primary reactions are absent or weak
- Primary responses therefore not reliable for survival
- No established sleep wake cycles
- Infant is physiologically unstable
- The preterm infant has no established midline and therefore no reference point from which to move
- Therefore, acts as if he has no middle
- Therefore, the preterm child with CP has severe hypotonic trunk
- Distal spasticity
- Patterns of movement are more extended and asymmetrical
- Therefore, different combinations of abnormal patterns are seen
What are the general outcomes of prematurity?
- Increased risk of disability and CP
- Lower scores on tests of language, cognition and visuo-spatial recognition (precursors of later learning difficulties)
- NB for physio: motor developmental problems
What are the signs and symptoms of meningitis
- Develops over 1 – 4 days
- Triad
o Rigidity
o Sudden high fever
o Altered mental status - Increased irritability
- Neck stiffness and pain
- Neck retraction and back extension
- High Fever (cold hands and feet)
- Lethargic
- Increased sensitivity to light
- Seizures
What are the 4 most common complaints affecting the quality of life of children with HIV
Pain (joint, limb, headaches)
Fatigue
Sleep disturbances (ARV side effect)
Mobility/physical challenges
What are the physiotherapy principles in burn management
- Maintain a clear dry chest
- Monitor burn wounds
- Maintaining mobility of joints
- Maintaining or increasing strength in LL’s and UL’s
- Maintain good circulation and pressure care
- Keep patient at highest functional level possible
- Educate the patient and family on injury, contraindications and precautions
- Administer a bed exercise program
- Respect Pain!!!
- Infection Control
- Mobilisation
What are the principles of integrated palliative care?
Respect for the dignity of patients and families
o Respect and listen to patient and family goals, preferences and choices.
o School age children can articulate treatment preferences.
o Children older than 14 can be involved in decision making.
o Address differences in opinion between family and health care providers.
Access to comprehensive and compassionate palliative care
o Address physical symptoms, comfort, functional capacity, pain etc
o Acknowledge psychological distress
o Respite care?
Use of interdisciplinary resources
o No one clinician can provide all the care and support needed
o Don’t forget psychologists, social workers, pastoral care, friends and family, the child’s peers.
Acknowledging and supporting caregivers
o Parents
o Siblings
o Extended family
Commitment of quality improvement of palliative care through research and education
o Continue to monitor and evaluate services
