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Paediatric Pain Management

Paediatric Pain Management. Understanding the child’s perspective on pain. Katrina Shapland Occupational Therapy Student. Try and imagine a time when you were in hospital/in pain as a child:. How did you feel? What did you do to cope? What did people around you do?. Ward-group.

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Paediatric Pain Management

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  1. Paediatric Pain Management Understanding the child’s perspective on pain. Katrina Shapland Occupational Therapy Student.

  2. Try and imagine a time when you were in hospital/in pain as a child: • How did you feel? • What did you do to cope? • What did people around you do?

  3. Ward-group Goals of ward group • Provide opportunity for children to enact hospital procedures through play • Facilitate social interaction • Provide normalcy - play is the primary occupation of childhood. • Allow projection of feelings and experiences onto the teddy to further sense of mastery and control.

  4. Ward group - 2FW

  5. Number of children per caseload identified to benefit from OT services verses number of referrals.

  6. Medical Play • http://www.youtube.com/watch?v=Go8N5i3lCWI

  7. Play! -

  8. What is pain? Pain is whatever the experiencing person says it is, existing wherever they say it does.

  9. Evidence shows that pain is an inherently subjective, multifactorial experience. • For this reason it is impossible to treat pain on a physical level and expect it to disappear.

  10. PEO(Person, Environment, Occupation) Person Occupation Environment Occupational performance

  11. Piaget’s developmental stages Table 1 ref: Piaget, 1932

  12. What does the literature say - 2-4years? • Getting better: (a) ‘hide away,’ (b) ‘fight it’, (c) ‘make it good’. • More frequent the pain, the more frequently these strategies were used.

  13. Strategies: 2-4 years • Explaining the procedure just before it happens • Introduction of medical equipment prior to procedure through play (e.g. X-ray machine = space ship!). • Distraction: blowing bubbles, puppets, toys. • Reflecting on hospital experiences through play with other children.

  14. What does the literature say - 7-11 years? • Taking medicine and other curative actions • Resting and cognitive control strategies e.g. distraction • Decrease in parental support - view themselves as active agents in pain relief. • Non-observable components of pain.

  15. What does the literature say - specific conditions? • Specific conditions develop their own pain patterns - specific strategies to target these. • For example: Tonsillectomy • Visual Analogue Scale O = no pain 10= extreme pain

  16. Assessing pain • Situations that caused pain to all children in hospital were procedures connected with treatment. • Children described pain as physiological, and psychological feelings of pain. • Research indicates school-aged children’s ability to describe their own pain.

  17. Looking to the future: • Assessments- to gauge pain perception before and after medical play • Extending play for older children.

  18. Future research • Influence of individual’s personal experience on the concept of pain. • Influence of socio-cultural factors • Specialised pain intervention strategies

  19. Thank you for your time. • Any questions?

  20. References • Tonsillectomy picture: 200214425-001_XS.jpg retrieved from http://www.livestrong.com/tonsillectomies/ • Baum, C. M, & Christiansen, C. H. (2005). Person-environment-occupation-performance: An occupation-based framework for practice. In C. H. Christiansen, C. M. Baum, and J. Bass-Haugen (Eds.), Occupational therapy: Performance, participation, and well-being (3rd ed.). Thorofare, NJ: SLACK Incorporated. • (Paediatric Pain Management: A Multi-Disciplinary Approach - By Alison Twycross, Anthony Moriarty, Tracy Betts 1998 ) • Piaget, J. (1932). The moral judgment of the child. London: Routledge & Kegan Paul. • reference: 1995 Young children's behavioural responses to acute pain: strategies for getting better.http://www.ncbi.nlm.nih.gov/pubmed/7593943 • reference: 1997 ["It feels like a hedgehog quill sticking in my foot...". School-aged children's experience of pain in the hospital].http://www.ncbi.nlm.nih.gov/pubmed/9429343 ) • reference: 1996  "Getting better from my hurts": toward a model of the young child's pain experience. http://www.ncbi.nlm.nih.gov/pubmed/8772041) • Idvall, E., Holm, C., Runeson, I. (2005). Pain experiences and non-pharmacological strategies for pain management after tonsillectomy: a qualitative interview study of children and parents. Journal of Child Health Care, 9(3), 196-207. 20

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