assessment

• location

• quality

• duration

• intesnity

• aggravating/relieving

• what analgesia

• consider

  • medicien

  • preparation

  • dose

  • effect

• self reporting

  • from \~18mo acquired words to express pain

  • 3-4 provide infromation

• if pain presnet for a while

  • usual behavioral indicators

    • grimacing

    • crying

    • replaced by:

      • abnormal postureing/movement

      • lack of facial expression/interest

      • quietness

      • low mood

      • changes in:

        • sleep

        • appeitite

        • sociability

• assessment tools

  • wong baker faces

  • poker chip tool

Management

non-pharmacological

• distraction

• comfort

• information

  • why it hurts

  • when it will resolve

• RICE

• stabilise injury

pharmacological

• mild

  • Paracetamol

    • used with caution in children who are dehydrated

    • hepatic impariment and chronic malnutrition increase risk of toxicity

    • 15mg/kg q4hrs

    • not >1g/dose or 4 doses/24hours

  • Ibuprofen

    • prefered NSAID

    • 5-10mg/kg every 6-8hours

    • 5mg/kg in children 1-3mo

    • don’t exceed 30mg/kg

  • Aspirin CI \<16yo

    • Reye’s syndrome

  • lack of evidence combining or alternating dose

    • using together theoretically increase risk of renal and hepatic toxicity

  • if pain with paracetamol or ibuprofen

    • confirm reciving adequate dose at correct dosing interval

  • codeine and tramadol not recommended

    • pro-drug CYP2D6 -> morphine

    • unpredictable in children

• severe:

  • morphine

    • iv (over at least 5mins

      • 1-6mo

        • 100mcg/kg every 6hrs

      • 6mo - 12yo

        • 100mcg/kg (max 2.5mg) q4hrs

    • oral

      • 1-3mo

        • 5-100 mcg/kg every 4hrs

      • 3-6mo

        • 100-150mcg/kg q4h

      • 6-12mo

        • 200mck/kg q4h

      • 1-2yrs

        • 200-300mck/kg q4h

      • 2-12yrs

        • 200-300mcg/kg (max 10mg) q4h